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CORNELL
UNIVERSITY
LIBRARY

 

BOUGHT WITH THE INCOME
OF THE SAGE ENDOWMENT
FUND GIVEN IN 1891 By
HENRY WILLIAMS SAGE

 

 

 

 

 
 

 

 
      

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FROM A NEGATIVE BY LOMBARDI,

  
   

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VITAL STATISTICS;

MEMORIAL VOLUME OF SELECTIONS FROM
THE REPORTS AND WRITINGS

OF

WILLIAM FARR, M.D, D.GL, OB, ERS,

LATE SUPERINTENDENT OF THE STATISTICAL DEPARTMENT GCF THE
REGISTRAR GENERAL'S OFFICE, ENGLAND,

 

EDITED FOR
THE SANITARY INSTITUTE OF GREAT BRITAIN
BY

NOEL A. HUMPHREYS,

OF THE REGISTRAR GENERAL’S OFFICE, MEMBER OF THE COUNCIL OF THE
STATISTICAL SOCIETY OF LONDON.

 

LONDON:

OFFICES OF THE SANITARY INSTITUTE, 744, MARGARET
STREET, W.
EDWARD STANFORD, 55, CHARING CROSS, S.W,

1885,
®
bese i
A427 5%

Jr
Biographical Sketch of William Farr, M.D., D.C.L., C.B., F.B.S.

GENERAL CONTENTS.

PART I.—Poputation.

Detailed Contents
Introduction =

re
FOV ON Dok WN YH

. Scope of Inquiry at First Six Censuses
. Union or Registration Counties

. Houses

. Numbers

. Density and Proximity

Sexes
Ages

. Civil or Conjugal Condition

. Occupations

. Infirmities

. Economie Value of Population

PART II.—Marriaces.

Detailed Contents
Introduction rs

1.
2. Marriages in Successive Generations
3. Marriage Seasons
t
5
6

Marriage and Prosperity

Ages at Marriage -

. Marriages and Religious Worship

Certified Places of Worship -

PART IIT.—Birrus.

Detailed Contents
Introduction

]
. Fecundity of Marriage

. Illegitimate Births

. Sex Proportion at Death

. Defects of Birth Register; Statistics of First Born
. Still Births

ao Fw Pb

Birth Registration and Birth-rates

Page

vii-xxiii

3
5-6
6-8
8-9
9-12

12-34
34-36
36-37
37-44
44-47
48-50
50-59
59-64

65
67-68
68-75
75-76

76
76-80
81-82
82-83

85
87-88
89-93
93-100

100-104
104
105-107
107-108
a2
iv

PART IV.—Deatus.

Page

Detailed Contents - - 109-110

Introduction 110-116
1. Death-rates, their Constitution, and their Significance as Tests of

Health and Health Progress - 116-146

2. Urban and Rural Mortality 146-178

oor at Different Ages - 179-188

[ = Infant and Child Mortality 188-209
. Causes of Death (General) ; their- Nomenclature, Classification, and

Mortality - 209-317

6. Causes of Death: Epidemic, Tafiedes, and Zymotic Diseases - 317-392

T Class and Occupational Mortality - 392-411

8. Meteorology and Mortality 411-417

9. Mortality in Public Institutions - : 417-438

10. Marriage and Mortality - - 438-441

PART V.—Lire Tasvzs.
Detailed Contents - 443

Introduction 445-447
Extracts bearing meee the Construction, Significance, and Utility of Life

Tables ~ 3 a = fe a - 447-494

PART VI.—MiscELLANrous.
Detailed Contents 495

Introduction : - 497-498

1. Sickness, and Health Insurance 498-517

2. Elementary Education 517-522

3. Civil Registration of Marriages, Births, and Deaths 522-531

4, Cost, and the Present and Future Economic Value of Man - - 501-537
5. Risk of Fatal Accidents, and Insurance against Death or Injury

through Railway Accidents - - - 587-544

6. Family Nomenclature in England and Wales - - 545-550

APPENDIX.—Farr TEstTimoniaL Funp - 551-556

INDEX .-

 

- 557-563
PREFACE.

Tue suggestions which led to the inception of this work had their
origin at the Meeting of the Sanitary Institute of Great Britain in
Glasgow, in July 1883.

Professor W. T. Gairdner, in his Address as President of the section
on “ Sanitary .Science and Preventive Medicine,” dwelt forcibly upon
the work of William Farr in the field of Sanitary Science. He
suggested that the Institute should take steps to publish a selection
from his statistical works, which might serve as an enduring monument
of his fame. “The best of all possible monuments before the lessons
“ of his life and character have ceased to be vividly present to us.”

Immediately after the Address, as Chairman of the Council, I
promised that the subject should have the careful consideration of the
Council, and, that if possible, the proposition should be carried into
cflect. In the following December the suggestion was considered by the
Council; and a Committee, consisting of myself, as Chairman of the
Council, Professor Corfield, Dr. Collingridge, and Professor Robinson,
was appointed to consider and report upon the possibility of carrying
out Dr. Gairdner’s proposition. At a later meeting of the Council,
the Committee was empowered to carry out the proposal, and the
appointment of Mr. Noel A. Humphreys as Editor was sanctioned.

The publication of a deceased Author’s works not being absolutely
provided for by the regulations under which the Sanitary Institute of
Great Britain was established, it was thought best to publish the work
by subscription. The Committee, with the sanction of the Council,
issued a circular, in June 1884, to those interested in sanitary science
and health progress, which contained the following paragraphs —

“Tt has long been the source of much regret amongst students of
“ Vital Statistics, as well as among those practically interested in this
“ branch of Sanitary Science, that the valuable statistical work of the
“late Dr. William Farr, C.B., F.R.S., is, from the form and manner
‘ of its publication, not generally available.

“The Sanitary Institute of Great Britain, having had the desire for
‘ the publication of these statistics pressed upon its notice by those
‘ capable of forming an opinion of the advantages to be derived there-

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‘ from, and being fully impressed with the value of Dr. Farr’s work,
‘ proposes to publish a selection from the official reports, papers, and
‘ addresses, which were contributed by that eminent statistician.

“Mr. Noel A. Humphreys, of the Registrar-General’s Office, has
* consented to undertake the selection and editing of this memorial of
‘ Dr. Farr’s statistical labours, which exercised so marked and so
‘ beneficial an effect on the sanitary progress of England during the
‘ forty years of his official career.”

The result of this circular was a list of upwards of 500 subscribers,
hus assuring the successful realisation of Dr. Gairdner’s suggestion,
vhich can scarcely fail to confer a benefit upon all interested in the
science of Vital Statistics and Public Health.

As an earnest disciple of Dr. Farr, it gave me the greatest pleasure
0 assist in pressing the claims which his works have upon our grateful
‘emembrance before the Council of the British Medical Association,
vhen I was its President, and also before the Sanitary Institute of
xreat Britain.

ALFRED CARPENTER, M.D.,

Cuoairman of the Councin
of the
Sanrvary lystiruter.

 
BIOGRAPHICAL SKETCH

or

WILLIAM FARR, M.D., D.C.L., C.B., F.R.S8.,
&e., &e.

This memorial volume of selections from Dr. William Farr’s literary
work in connexion with vital statistics would be incomplete without a
biographical sketch of the author. The story of his uneventful life,
however, mainly consists of a chronological list of the productions
of his pen.

William Farr was born at Kenley, a small, ancient, and remote village
of Shropshire, on 30th November 1807. His grandfather was a small
farmer in that parish, while his parents, who were in humble circum-
stances, migrated early in their married life to Dorrington, a small town-
ship six or seven miles frem Shrewsbury. Here, while he was still an
infant, he was adopted by Mr. Joseph Pryce, almost the only well-to-do
resident of the neighbourhood. Dr. Farr, in a sketch of his early
recollections, to be called ‘‘The Life of a Medical Student,” which he
began in 18338, but unfortunately never completed, thus alludes to his
parents and his earliest years :—‘ My mother was young, and I was her
“ first child. At the age of two years I left my parents; I do not
“ remember living with them. My mother was ‘ extreme in all’; she
was a woman of violent attachment and temper, retiring and solitary
in her habits, of a strong mind, able and inclined to subsist on itself.
“¢ She was religious from duty and for consistency, rather than from
‘* impulse or feeling, and had a good deal of superstition in her turn of
* mind. The character of my father was very different; he was good-
“ natured, sensible, straightforward, a Christian in faith, feeling, and
simplicity of heart.” Although he did not live with his parents after
he was two years old, he must have seen them frequently, as they lived
at Dorrington after their migration from Kenley, at any rate until the
death of his mother in 1845. His father spent the last years of his life
with his son, and died in 1864 at Dr. Farr’s house at Bickley, Kent.

Of his benefactor and of his childhood, Dr. Farr thus speaks in his
recollections :—“To him I owe my education, the most constant and
“ tender care, and an example of benevolence and integrity. Would
“ that I could add a moment’s duration to his memory! When I first
‘ recollect Mr. Pryce he must have been between 70 and 80 years of
“age; his health was delicate, his senses, with the exception of hearing,

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‘ were acute, his mind was vigorous and active. Dorrington isa village
‘ situated 64 miles from Shrewsbury. It lies on the Hereford Road; 2
‘ brook flows through its meadows; the Lawley and Caradoc rise in

the distance. No parson, no doctor, no great Janded proprietor, lived
in it. Joseph Pryce was the squire, as he was not only the richest,
but the most influential man in the place. His house was constantly

‘ open to the poor; he gave them coals and food in winter, paid the

apothecary when they were sick, established a day school, supported

‘ a Sunday school, and was the principal founder and stay of a place of

religious worship. His acute intellect, his affection, his love of young
children, his benevolence, remained unclouded to the last. At home
Iwas a spoiled child. I always took refuge between Mr. Pryce’s
knees when the wind blew high. I do not recollect the time when
T could not read, and after the dame’s school went to Longuor school,
then the best in the neighbourhood, about a mile and a half from our
residence. * * * The schoolmaster was idle and empty-headed. I

‘ learned writing and accounts, but did not at all distinguish myself.
‘ The rookery and mill-ponds I remember distinctly, but the rest is

confusion. Mr. Pryce enabled B. Jones to open a day school; I
finished my school education here. I read English history, and was

‘ taught English grammar, geography, and Latin, by Mr. Beynon, the

local dissenting minister. Mr. Beynon takes some eredit to himself
for my early instruction; but, though very much indebted to
Mr. Beynon in several respects, I am sorry to say that I learned very
little grammar or Latin from him.”

From these facts it is evident that Dr. Farr’s educational oppor-

unities in childhood were few, and of a most elementary character.
His real education, and his classical and mathematical acquirements
vere mainly due to reading and private study. Even his opportunities
‘or reading in his early years were very restricted, as may be judged by
hhe following extract from his recollections :—“ Our own library was

”

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limited ; its most conspicuous ornaments were ‘ Brook’s Gazetteer,’
‘The Whole Duty of Man,’ ‘ Sturm’s Reflections,’ Timothy Priestley’s
folio Bible, and various old theological works. ‘The pictures in the
old Bible were a favourite study. With what ghastly fear, aud yet
curiosity, did I look on the grim, grinning, bat-winged devils tor-
menting poor Job, and his wife mvitering through them, ‘ Curse God
‘and die.” After leaving school I read as many works as came in my
way. To Mr. J. Palmer J am much indebted; he lent me ‘Smith’s
‘Natural History,’ and ‘ Rollin’s Ancient History.’ To Latin a good
deal of attention was paid, and about 1823 (at 16 years of age) I
commenced learning Hebrew, which, with the help of ‘ Parkhurst’s
‘Dictionary,’ Iwas at last able to read decently. About this time
the books I read were almost exclusively theological, and some
religious friends thought I might make a preacher of the Word.”

He was so constant a devourer of books that his benefactor would
y» “Go, look in the glass; when thou wast a little lad thy face was
66

ix

red and round, now, what a thin yellow cheek thou hast in its place ;

“all is brought on by this reading, morning, noon, and night!” He
expresses his obligations to his friendly intercourse with the Williams
family of Ryton; “their society refined and enlarged my views, and

iT

drew me into the portal of infinite thought.” He thus retrospectively

summarises the advantages and disadvantages of his bringing up :—

“ce

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oe

66

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“

The advantages I enjoyed, the privations and the errors under which
I laboured, are obvious. In point of birth I was favoured ; my parents
were healthy, vigorous, and moral. My intellectual and inquisitive
faculties were not developed in a public school, nor by the example
and excitement of cultivated minds around me. Left to myself my
progress was wayward.”

Ix his nineteenth year, inclination, or chance, or a combination of both,

appear to have turned his attention towards medical study. He
writes :—“Some apothecaries in the neighbourhood several times

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expressed a wish to have me for a pupil, the objection to which was
that Mr. Pryce could not spare me, as he depended upon me for the
management of his business affairs. Besides, the old gentleman had
such a fond attachment to me, that he could scarcely rest when I was
out of his sight for an entire day. In May 1826, Dr. Webster called
accidentally one evening. The ‘ Encyclopedia Metropolitana, and
the ‘ Quarterly Review’ containing an article on ‘Contagion’ by
Dr. Gooch, were on the table. This and other matters were discussed.
The Doctor’s was a striking and original mind, and left an impression
not to pass away. I called on him when I next went to Shrewsbury.
Physic seemed a field opened all at once before me. ‘The plan
suggested was feasible, plausible, and excellent. I was to study with
G. Webster, under the doctor, become a dresser of Mr. Sutton’s at
the Infirmary, and be nominally apprenticed to Mr. Wyke. On
Whit-Monday, in May 1826, I walked io Shrewsbury and called on
Dr. Webster. Through this summer I every day walked to Shrews-
bury, dressed patients at the Infirmary, read with Dr. Webster, and
returned home at evening, nearly 14 miles there and back. As
winter came on a good bay mare was purchased, and I rode to Shrews-
bury every day for two years, Sundays excepted. I thus became
tolerably acquainted with the manual and practical art of chirurgurie.
Sutton was very kind and gentlemanly in his manners, and always
took me to his private operations. With Dr. Webster I studied
anatomy in Fife. We read Celsus and Gregory’s Conspectus.
The judicious and enlightened direction, and the elevated tone,
Dr. Webster gave to my studies, laid the foundation of all I shall
ever do that is useful or good. Many pass the first years of their
scientific career under well-informed industrious men, few, indeed,
under the eye of a man of genius. My medical reading was miscel-
laneous, and was gradually prolonged in the evenings till midnight.
With a Carbonarist from Turin, a Roman patriot, Dr. Webster and
I read Italian—Boccaccio, Dante, Ariosto, Tasso, Alfieri. My health
x

* continued good till the autumn of 1828, when I had acute bronchitis.
‘ During my illness Mr. Pryce was indefatigable in his care for my
* recovery.”

Dr. Farr’s benefactor, Mr. Pryce, who was a bachelor, and 90 years
ff age, was seized with pneumonia in November of the same year
1828), and died after a few days’ illness, leaving a legacy of 500/. to
rromote the education and advancement of William Farr, then 21 years
f age. He remained at Dorrington till the following April, and in
Muy 1829 left Shrewsbury for London ; after staying there for a few
veeks he proceeded to the Paris University to prosecute his medical
tudies.

Dr. W. P. Bain, who enjoyed an intimate and unbroken friendship
vith Dr. Farr of more than fifty years duration, writes :—“TI first met
‘ Dr. Farr in Paris in the beginning of 1830, when I went to study
' there after having passed my surgical examination in Edinburgh, and
‘ took lodgings in the Hotel des Grés, where he had been residing
‘some time. We became intimate and attended lectures together.

There was then a good deal of bad feeling amongst the lecturers. I
‘remember at one of Lisfranc’s lectures at La Pitié, in speaking of
Dupuytreu of the Hotel Dieu, on the banks of the Seine, he called
‘ him ‘Ce brigand au bord de Peau.’ The revolution of July gave us
‘a good opportunity of seeing gunshot wounds and their treatment.
The Hotel Dieu, La Charité, and La Pitié, were full of such cases.”
During his two years’ residence in Paris, Dr. Farr attended the
ectures of Orfila, Louis, Dupuytreu, and Lisfranc on various branches
ff medical science ; of Andral on hygiene; of Gay Lussac and Thenard
m chemistry; of Pouillet on natural philosophy; of Geoffery St.
Hilaire, Dumeril, and Blainville, on comparative anatomy and
yhysiology ; of Cuvier on the history of natural sciences; and of Guizot
nd Villemain on history and literature. It was during the course of
lis studies in Paris that the subject of hygiene, and of medical statistics
wearing thereon, began to attract his special attention, and to engross
iis interest.

On leaving Paris, Dr. Farr and Dr. Bain travelled in Switzerland,
md the latter writes :-—“‘I had many opportunities of studying and
‘ admiring my friend’s character. In a diary which I kept of our tour,
‘I find recorded that ‘Mr. Farr, while of a simple disposition, is
‘endowed with a vastness of ideas and a philosophic mind.’ He gave
evidence then of observation and research. I well remember the
scene at our inn at Martigny, when, after a walk to see the celebrated
waterfall about four miles away, I returned weary and hungry to
dinner. To my surprise, I found the entrance blocked up by at least
a hundred of those miserable beings, the Crétins, who inhabited the
Valais in great numbers. On inquiry of the landlord he told me that
the gentleman inside had commissioned him to get together as many
Crétins as he could, so that he might examine them, After some
* difficulty, I wedged my way into a room, where Mr. Farr was standing

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“ with a table and numerous large sheets of paper before him, on which
“ he was marking the shapes of the different heads of which he had
‘ previously taken the contours vertically and horizontally by means of
“ a leaden tape. That day we dined late.”

On his return to England, after spending a short time in London,
during which he appears to have commenced a course of study at
University College, William Farr went back to Shrewsbury, and,
probably through the influence of his friend Dr. Webster, was appointed
locum tenens for the House Surgeon of the City Infirmary, who had
been granted six months leave for the purpose of obtaining a second
qualification. At the close of this six months the House Surgeon
returned, but without his additional qualification, and the Governors
of the Infirmary, obliged to appoint a surgeon with the double quali-
fication, selected Mr. Yardley, whose brother is still (1885) Vicar of
St. Chads, Shrewsbury. That William Farr fulfilled his hospital
duties to the entire satisfaction of the pupils, may be inferred from
the fact that they presented him, on his leaving, with a silver snuff-
box. At this time Dr. Farr was without any medical qualification, or
itis more than probable that he would have been appointed to the
vacant post. It is impossible to regret what was to him, we believe, the
cause of temporary disappointment, for had Dr. Farr been appointed
House Surgeon of the Shrewsbury Infirmary in 1831, the chances of his
subsequent devotion to medical and vital statistics would have been
exceedingly small.

His Shrewsbury experience would appear to have led Dr. Farr to
lose no more time in qualifying himself for practice. During the
following two years he attached himself to University College, where
he continued his course of medical studies, attending the lectures of
Grant, Carswill, Jenner, Elliotson, and others. In March, 1832, he
passed his examination for the L.S.A. at Apothecaries’ Hall, which
was the only medical qualification he obtained except the honorary
degrees afterwards conferred upon him on the ground of “high
scientific acquirements.”

In 1838, Dr. Farr married a Miss Langford, of Pool Quay on the
Severn, between Welshpool and Shrewsbury, and afterwards resided in
Grafton Street, Fitzroy Square, where he commenced the practice and
teaching of medicine. To supplement a probably precarious income
he about this time wrote for various medical journals, mainly on
subjects connected with vital statistics. He attempted to establish a
course of lectures on what he called Hygiology, but in this respect he
was ahead of his time, for no public licensing body in the United
Kingdom at this time recognised even the desirability of public health
lectures. The subject matter of these proposed lectures formed about
the first* of a long series of papers contributed to the “Lancet,”
Dr. Wakley, the founder, proprietor, and editor of that journal, being

ns

 

* See Lancet, vol. II., 1835~6.
xil

one cf the first 10 recognise the original talent of this young student of
vital statistics.

Tn 1837, in conjunction with his friend Dr. R. Dundas Thomson, he
edited the “ British Annals of Medicine.” He also in the same year
wrote his valuable article on “ Vital Statistics ” in MeCulloch’s Account
of the British Empire. This article, from which many extracts will be
found in this volume, established his claim to a foremost place among
authorities upon this hitherto neglected subject. Although it is now
nearly half a century since this article was written, there is no other
treatise on this subject (thoroughly and soundly treated in all its branches)
that could be more profitably studied by students of vital statistics. This
article may be said to be the foundation of a new science, to the develop-
ment of which, with special reference to the improvement of public
health, Dr. Farr devoted the greater part of the forty-five most active
years of his industrious life. He also contributed in this year to the
British Annals of Medicine “ A method of determining the danger of '
“ the duration of diseases at every period of their progress.” During
this year he lost his good friend Dr. Webster, of Shrewsbury, who left
him a legacy of 5002. together with his library.

Among other work undertaken at this period, Dr. Farr is said to
have been engaged by Sir James Clarke to assist him in revising and
preparing for press his work on “Consumption,” about the same time
that Dr. Farr’s young wife fell a victim to this disease.

In 1837 the civil registration of births, deaths, and marriages came
into operation, and Mr. T. H. Lister was appointed tie first Registrar-
General. The necessity for skilled and scientific assistance in the
compilation of statistical tables from the marriage, birth, and death
registers soon became apparent, aud William Farr was fortunately
selected forthe post of Compiler of Abstracts in the newly created

_ General Register Office. He undoubtedly owed the appointment to
the reputation he had earned in the field of medical and vital statistics
“———by his article in MeCulloch’s work, and by his contributions to the
“ Lancet,” and other medical publications. Sir James Clarke is believed
to have strongly urged the claims of William Farr not oniy on the
ground of his writings but from personal knowledge of his abilities and
qualifications for literary work. The result of Dr. Farr’s appointment
upon English vital statistics, and indirectly upon health progress in
England, most fully justified the selection, and it is now interesting to
read in the Registrar-General’s First Annual Report the announcement
of the appointment, and the reference to “ Mr. Farr, a gentleman of the
“ medical profession, whose scientific knowledge and intimate acquain-
“ tance with statistical inquiries are ample pledges of his peculiar
“ fitness for the post.”

Dr. Farr was appointed to the General Register Office on 10th July
1839, at the modest salary of 350/. per annum, and thus ended his
career aS a medical practitioner, which he had scarcely seriously
commenced. The next 40 years of his life were almost exclusively
xiii

devoted to the, to him, congenial task of creating and developing a
national system of vital statistics, which has not only popularised
sanitary questions in England in such a manner as to render rapid
health progress an accomplished fact, but which has, practically, been
adopted in all the civilized countries of the world.

In 1838, the year preceding his appointment to the General Register
Office, he contributed a notable paper to the ‘‘ Lancet” on “ Benevolent
« Funds, and Life Assurance in Health and Disease”; a “ History of the
** Medical Profession, and its influence on the Public Health” to
the “British Medical Almanac”; and a paper on “'The Law of
“ Recovery and Mortality in Cholera Spasmodica” to the “ Lancet.”

The First Annual Report of the Registrar-General contains the first’
of that long series of letters, addressed to the Registrar-General, on the

Causes of Death in England. With reference to this remarkable series
of letters an eminently competent and thoroughly appreciative pen
wrote of them as “from first to last marked by the same lucid
“ marshalling of the facts, the same masterly command of all the
resources of method and numerical investigation, the same unaffected
and vigorous English, breaking out every now and again, when
stimulated by 2 clear view of some wide generalisation, into passages
of great eloquence and pure philosophy.”

In the first Report were sketched out various fields of investigation
which it was hoped that the resources of the death register might be
used for enlightening ; fields of investigation which afterwards, under
Dr. Farr’s system of cultivation, yielded an abundant harvest of
scientific knowledge. One of the first requirements which Dr. Farr set
himself to fulfil was a system of statistical nosology. In this first
report, Lased upon the deaths in the first half-year of civil registration,
it was pointed out that “ach disease has, in many instances, been
“ denoted by three or four terms, and each term has been applied to
as many different diseases; vague inconvenient names have been
employed, or complications have been registered instead of primary
diseases. ‘The nomenclature is of as much importance in this depart-
ment of inquiry as weights and measures in the physical sciences,
and should be settled without delay.”

The subjects both of nomenclature and classification of diseases
received constant study and consideration in these annual reports, and
out of chaos order and system were evolved.

In connexion with his official contributions to the Registrar-General’s
Reports, special reference should be made to the Supplementary Reports,
dealing with English mortality statistics during the two decennia
1851-60, and 1861-70. These two Reports, in the form of letters
addressed to the Registrar-General, especially the last, published in
1874, take a very high place among what have been aptly styled the
“ statistical classics of William Farr.”

The Supplementary Report, dealing with the 10 years 1861-70, may
be described as the crowning effort of Dr. Farr’s labour at the General

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Register Office, as there is scarcely a subject in the wide field of
vital statistics which is not more or less exhaustively discussed in that
Report both from a theoretical and a practical standpoint.

It is needless, however, here to dilate upon the contents of these
Reports, a large proportion of which forms the bulk of the present
volume, classified and arranged under subject-headings for convenience
of reference, and accompanied by an alphabetical index.

The health aspect of mortality statistics was from the first the main
lesson which Dr. Farr sought, and was eminently successful in his
endeavours, to treat with the help of his well-devised and soundly-
constructed system of vital statistics. He struck the keynote of his
40 years’ work in the General Register Office in the following words
to be found in his first letter in the First Annual Report :-——“ Diseases
“ are more easily prevented than cured, and the first step to their
“ prevention is the discovery of their exciting causes.” Few will be
inclined to dispute the beneficient influence of Dr. Farr’s work upon
health progress, especially in towns, but the authority to which we
have above referred asserted that its “indirect influence (an influence
“ the source of which may not have been generally recognised) upon
“ practical medicine must have been very great. The constant endeavour
“ after exactness of diagnosis and precision of nomenclature is itself a
“ wholesome discipline which re-acts inevitably upon treatment.”

In or about 1841 William Farr migrated trom Grafton Street to
Stoke Newington, and early in the following year married his second
wife, Miss M. KH. Whittall, daughter of Joseph Whittall, of Deal, but
previously of Shropshire. The issue of this second marriage (his first
wife died childless) were eight children, of whom one son and four
daughters survived him.

The pages of the “‘ Lancet” contained many contributions from his
pen during the first few years of his service in the General Register
Office, and it may be noted that in 1839 he delivered an oration on
medical reform at the anniversary meeting of the British Medical
Association.

Dr. Farr’s name is especially identified with the history of the
Statistical Society, the foundation of which was in some measure due
to the institution of the Statistical Section of the British Association
(of which Dr. Farr was also an active member), and to an attempt on
the part of some of its members to limit its specific objects of inquiry.
Tho Statistical Society was founded on 15th March 1834, and Dr. Farr
was elected a Fellow in 1839. His first contribution to the Journal of
the Society was a paper on “ The Mortality of Lunatics” in 1841, many
extracts from which will be found in this volume. In 1846 he read a
paper on “ Influence of Scarcities and of the Prices of Wheat on the
“Mortality of the People of England.” In 1849 he read a paper on
the “ Civil Service of England, with observations on the constitution
“ of Funds for Fatherless Children and Widows.” In 1852 a paper
on “Influence of Elevation on the Fatality of Cholera.’ In 1853 a
xv

paper on “Income and Property Tax,” from which some valuable
extracts find place in the following selections. In 1857 a paper * On
“the Pay of Ministers of the Crown.” In 1865 a paper on “ Infant
“ Mortality, and on alleged inaccuracies of the Census.” In 1866 a
paper on “Mortality of Children in the principal States of Europe.”
Having filled the office of Treasurer of the Society from 1855 to 1868,
he was elected President in 1871, and delivered inaugural addresses at the
opening of the two sessions of the Society in 1871-2 and 1872-3, during
both of which he was President. His last contributions to the Journal
of the Society were two papers on the “ Valuation of Railways, Tele-
“ oraphs, Water Companies, Canals, and other Commercial Concerns,
“ with Prospective, Deferred, Increasing, Decreasing, or Terminating
“ Profits.’ These papers were read in 1873 and 1876. The selec-
tions in this volume have of necessity been almost exclusively confined
to purely vital statistics, and therefore include no extracts from many
of these papers, which, although deservedly held in high repute, deal
with subjects which could not he so classed.

Dr. Farr had no official connexion with the Census of 1841, although
his earnest representations on the subject probably conduced to the inquiry
of that year including a complete enumeration of the ages of the people
which had been omitted at the previous Census. At each of the three
following Censuses he was appointed an Assistant Commissioner, and
not only had the statistical control of the published tables, but wrote,
with but inconsiderable exceptions, the whole of the Census Reports
for 185], 1861, and 1871. These three elaborate reports contain some
of Dr. Farr’s best work, and have contributed liberally to the selections
in this volume.

In the Registrar General’s Fifth Annual Report (dated August 1843), .
was published Dr. Farr’s English Life Table, No. 1, based on the deaths
in England and Wales in 1841, and on the Cengns enumeration in the
same year. The objections to such use of the mortality returns for a
single year, even when the population basis is as large as that of England
and Wales, are obvious; but the rates of mortality in that year were fairly
average rates, and the results of the Life Table, No. 1, were in remark-
able agreement with those yielded by his subsequent tables, which hada
far more extended basis. The Life Table, No. 2, was published in the |
Twefth Annual Report, dated 10th January 1853, and was based upon
the deaths in +e seven years Tese~ 44, and the enumerated population
ijatidl as a separate volume, on the authority of the Regi Resta General,
by Messrs. Longman and Co., in 1864. This Life Table was based upon
the 6,470,720 deaths registered in England and Wales during the 17
years 1888-54, and the two Census enumerations in 1841 and 1851.
The title of the work was “ Tables of Lifetimes, Annuities, and Pre-
* miums, with an introduction by William Farr.” In the Life Table
Part of this volume will be found extracts from this introduc-
tion, dealing with the general construction of the tables. Those
xvi

interested in the more technical aspect of the subject, and expecially in
the infinite variety of formule dealing with different branches of life
insurance, must, however, be referred to the work itself, the introduction
to which has been, not inappropriately, described as “a very elegant
treatise.” Only those officially connected with Dr. Farr in the General
Register Office, and who worked on this laborious volume (of more
than 700 pages) under his superintendence, had the means of fully
realising the unremitting attention he gave to every detail of the
work, or the intense and unvarying interest I:e maintained in every
successive process. It is not easy to forget the expression of his
countenance, beaming with pleasure and triumph, almost childlike in its
unaffected simplicity, when (during the progress of the Life Table, No. 3,)
he reached the office one morning with a small page or two of MS.,
containing one of those formula which had taken him all the night to
work out.

Before quitting the subject of Dr. Farr’s Life Tables, reference should
be made to his Healthy District Life Table, which was contributed in
1859 to the Royal Society, in a paper “On the Construction of Life
“ Tables, illustrated by a new Life Table of the Healthy Districts of
“ England.” ‘This is not the place to speak of the value of this Life
Table as a standard of actually attained healthiness in England.
Extracts from this paper find place in the Life Table Part of this
volume, where will also be found reference to other life-table work of
Dr. Farr’s, published from time to time in the Registrar General’s
Reports.

In or about the year 1846, Dr. Farr moved from Stoke Newington to
Melina Place, St. John’s Wood, where a large circle of friends enjoyed
his society and hospitality. Here he resided until 1860, when he went
to live at Bickley, in Kent. During these years his official salary rose
slowly, until in 1855, on the urgent representations of Major Graham,
who had been appointed Registrar General in 1842, in succession to
Mr. Lister, the Treasury granted him, in consideration of his eminent
services in connexion with mortality and census statistics, a special
allowance of 200/. per annum, which raised his salary as Superintendent
of-the Statistical Department of the General Register Office to 800/.
We may here state, that at subsequent periods his salary was finally
raised, in 1874 ,to 1,1001, of which 3007. was in the form of special
allowance for exceptional services. It may be remarked that his salary
would probably, at this last-mentioned change, have been further
increased except for the fact that the salary of the Registrar General, as
Chief of the Office, did not exceed 1,200/.

In 1852 was published his celebrated Report upon “ The Mortality of
“ Cholera in England, 1848-49.” This undoubtedly added much, not
only to our knowledge of the causation and methods for prevention of
cholera, but also to the reputation of the author. Considerable extracts
from this Report are given in the following pages, as also from his special
Reports upon the subsequent cholera epidemics in 1853-4 and 1865-6, in
Xvii

which his theories as to the causation of this disease and to its dissemination
by means of a polluted water supply, were to every impartial mind most
conclusively corroborated. His history of the outbreak of cholera in
East London, and of his investigations as to its causation, and his con-
clusions drawn from the results of those investigations, form a lasting
monument of his acumen, his power of induction, and his patient deter-
mination to elucidate the truth in face of every difficulty, to say nothing
of the fearlessness which led him to expose himself not only to the risk
of infection in the midst of this remarkable outbreak, but to the unfor-
giving animosity of those intimately connected with the vested interests
of the London Water Companies. Dr. Farr’s disinterested services 10
London, and to science in connexion with the cholera epidemics, and the
lasting benefits resulting therefrom, through improvements in the quality
of the metropolitan water supply, have never been sufficiently appreciated,
much less duly acknowledged.

Dr. Farr gave evidence before the Select Committee on Assurance
Associations which sat during 1852--53, and in 1853 he published a
paper on “A System of Life Assurance which may be carried out, and
“ would (1) be equitable in its operations ; (2) afford the best security ;
“* (3) be well adapted to the wants of the people, as it would afford all
the advantages of an insurance office and some of those of a bank ;
“ and (4) operate at less risk, less expense, and lower premium than
“ small offices ; and (5) also make a considerable source of national
“ revenue.” It was, however, more than 10 years before a scheme of
Government insurance was seriously entertained by the Government;
but in 1865 Dr. Farr was commissioned to draw up a “ Memorandum
“ for the use and guidance of the Chancellor of the Exchequer (W.
“ ¥. Gladstone), in the development of the Government system of
“* insurance.” The system of Post Office insurance, which came into
operation in 1864, was undoubtedly due in a great measure to the initia-
tion of Dr. Farr, whose English Life Table, No. 8, was adopted as the
basis for the tables of premiums, and who acted as consulting actuary
during the early years of its operation, with scant recognition in the way
of remuneration. While it must freely be admitted that Government
insurance has not hitherto attained the success which was anticipated,
its comparative failure must be attributed to want of judgment in its
management, and in the regulations by which it is controlled, rather
than to any unsoundness in the conception of the scheme, or in the
tables upon which the premiums are based.

Dr. Farr took an active part and interest in the International Statistical
Congresses held successively in Brussels, Paris, Vienna, London, Berlin,
Florence, The Hague, St. Petersburg, and Buda-Pesth, between 1853
and 1876. At most of these Congresses he attended as the official
delegate of the English Government, and by his personal influence as
the founder of the English national system of vital statistics contributed
materially to the remarkable development of the closely allied sciences of
vital statistics and of practical hygiene which has taken place throughout

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the civilized world during the past thirty years, and especially in
England and on the continent of Europe. The full bearing of Dr. Farr’s
work on health progress in England and abroad has indeed been more
fully appreciated on the continent and in America than has been the case
in England.

Dr. Farr contributed many papers to the British and Social Science
Associations. From a paper read before the Social Science Association
in 1858, on the “ Influence of Marriage on the Mortality of the French
People,” extracts find a place in this volume. He contributed a paper
to the British Association in 1861 on “Recent Improvements in the
Health of the British Army.” In 1864 he delivered an address as
President of Section F. (Economic Science and Statistics) of the
British Association ; and in 1866 an address as President of the Public
Health Section of the Social Science Association. It was mainly
owing to the influence of Dr. Farr that this section of the Association
was not disestablished in 1877, when he wrote a paper setting forth his
considerations in favour of its maintenance. He was an active member
of a Committee appointed by the British Association for the Promotion
of Uniformity of Weights and Measures, which sat between 1866 and
1874; and contributed a paper to Section F. of the British Association
in 1869 on International Coinage. He was also a member of the
Anthropometric Committee of the British Association between 1876
and 1881; and in 1876, 1877, and 1878, contributed his last three
papers to Section F. of this Association, “On the practicability of
‘“ adopting a common measure of value in the assessment of Direct
“ Taxation,” on “ Some doctrines of Population,’ and on “ Babbage’s
“ Analytical Machine.” In 1878 he also contributed a paper to the
Social Science Association on ‘‘ Density or Proximity of Population ; its
“ advantages and disadvantages.”

It is impossible within the limits of this sketch to do more than
enumerate some of the more important subjects in connexion with
which the advice and assistance of Dr. Farr was from time to time
sought and obtained by the Government. He was a member of the
Committee appointed in 1858 to report on the preparation of Army
Medical Statistics, and of the Royal Commission for Inquiry into
the Sanitary Condition of the Army in India appointed in 1859. He
gave evidence before the Royal Commission on the Condition of Miners
in Great Britain in 1864, and contributed some valuable statistical
information on the subject, which was fully adopted and endorsed in
the report of the Commissioners. Selections from the contributions of
Dr. Farr, printed at length in the Appendix to that Report, are repro-
duced in the section of this volume dealing with Class Mortality. He,
moreover, gave important and valuable evidence, full of statistical
information, before the Royal Commission on Water Supply, and before
the Royal Sanitary Commission, both of which sat in the years 1868
and 1869. Among other subjects on which he was actuarially con-
sulted by the Government may be mentioned the Superannuation of
xix

the Metropolitan Police, on which he prepared an exhaustive report,
with a complete set of tables in 1860.

Dr. Farr, notwithstanding a slight constitutional tendency to
bronchitis, enjoyed exceptionally good health up to the year 1876, when
he was in his 69th year. While attending the Statistical Congress, at
Buda-Pesth, in the autumn of that year, however, he suffered from an
attack of dysentery, which left him much weakened ; and in December
of the same year he lost his second wife. Although he afterwards
enjoyed fairly good health, those who were in the way of seeing him
continually could not fail to observe that he never fully recovered
from the two severe shocks he suffered in the autumn of 1876.

When the retirement of Major Graham, after an eminently successful
administration of civil registration as Registrar-General for nearly
40 years, became imminent, Dr. Farr not unreasonably entertained
hopes that he might be appointed to the vacant post, and in 1879, with
a view to sparing himself the fatigue of railway travelling, which had
begun to be irksome to him, left Bickley, and again took up his
residence in London, in Portsdown Road, Maida Vale. This step was
taken in the prospect of prolonged official service.

The marked success which attended the administration of civil
registration in England during the 40 years 1840-80, may be mainly
attributed to the combined influence of Major Graham and Dr. Farr.
Major Graham possessed in an exceptional degree the power of
organization, with strong business capacity, and gave close and laborious
attention to detail; these combined qualifications made him eminently
fitted to be the administrative chief of nearly 3,000 registration officers,
and of a central office with a staff of nearly 100 clerks of different
grades. He felt the deepest interest in the success of civil registration -
over which he so ably presided, and scarcely less interest in the welfare
of those who served under him. The services of Major Graham, in
the eyes of the public, who are singularly ignorant about the inner
working of Government departments, were to some extent over-
shadowed by the well-deserved esteem in which Dr. Farr’s talents and
services, in utilising the results of civil registration, were held by the
public and the press. Not only abroad, but by a large section of the
Jinglish press, was Dr. Farr regarded and spoken of again and again
as the Registrar-General. This tendency to ignore the more silent
and hidden work of Major Graham, which was, however, none the less
indispensable to the success of civil registration, on the part of an ill-
informed public and press, cannot be admitted as any palliation of the
unaccountable omission of the Government to confer on him at. his
retirement some mark of their appreciation of so long, so devoted,
so successful a publie service. Under all the circumstances of the
case it is pleasant to refer to the entente cordiale which marked
the long continued official relations between these two eminent
public servants. Major Graham felt, we believe, genuine pride in
the success and extended usefulness, as well as in the public

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appreciation of the Chief of his Statistical Department, and in
the valedictory conclusion of his last Annual Report thus alludes to
Dr. Farr’s services: “Lastly, I must express to Dr. Farr, whom in
“ 1842 I had the good fortune to find here presiding over the Statistical
“ Branch, my gratified acknowledgment of the important services he
“ has ever since rendered. He is acknowledged throughout Europe,
“ the United States, East Indies, and the Colonies, as one of the first
“ statists of the day. To his scientific researches I attribute any
“ reputation that may have accrued to the General Register Office
‘ of England and Wales from the time I accepted office in the
* Department.”

On the retirement of Major Graham in 1879, Dr. Farr applied to the

Government to be appointed as his successor, asking to be allowed to
hold, even for a short time, the post of Registrar-General, with which
his name had been so frequently, but erroneously, identified. The refusal
of this appointment to Dr. Farr, and the appointment of Sir Brydges
Henniker as Registrar-General, are matters of such recent history that
they need not be dwelt upon here. The partial failure of health under
which Dr. Farr was suffering at the time, probably weighed with the
Government in deciding not to do what would have been a graceful and
magnanimous act, in recoguition of the distinguished and valuable services
of Dr. Farr. The public and the medical profession strongly sympa-
thised with Dr. Farr in the disappointment he felt at the refusal of his
request for promotion. Immediately the decision of the Government
in the matter was announced, Dr. Farr sent in his resignation, and
applied for superannuation. In a letter he addressed io the “ Times,”
in explanation of the circumstances of his resignation, the following
passage occurs: “ Although warned by the recent state of my health
“that I was in want of rest rather than of increased duties and
“ responsibilities, I was induced, by the hope of enlarged opportunities
of rendering assistance in the approaching Census, and in the promo-
tion of public health and sanitary statistics, to become a candidate for
the post of Registrar-General. Failing to obtain that promotion, I
no longer hesitated to seek that retirement which my friends had
previously urged upon me.”
The official career of Dr. Farr closed on the Ist of February 1880,
when he was superannuated upon an allowance of 800/. per annum,
and soon after his retirement unmistakeable symptoms of softening of
the brain set in, which gradually obscured the intelligence of his highly
organised intellect. He died on 14th April 1883, rather more than three
years after his retirement from the public service. He was buried at
Bromley Common Church, by the side of his wife, whose loss, coming
as it did at a time when his health had been shaken by illness, inflicted
upon him a shock from which he seemed never thoroughly to recover.

The British Medical Association took an early opportunity to mark
the full appreciation entertained by the general body of the medical
profession of the conspicuous talents and public services of Dr. Farr

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The Committee of Council of the Association in the spring of 1880,
soon after Dr. Farr’s superannuation, passed the following resolution :—
“That the Gold Medal of the Association be awarded by the Committee
“ of Council of the British Medical Association to William Farr, M.D.,
“« F.RS., D.C.L., C.B., as an expression of their high appreciation of
his long, unwearied, and successful labours, in behalf of statistical
“ and sanitary science; as a recognition of the light he has thrown
* upon many physiological and pathological problems, and on account
‘¢ of the extraordinary services his work has rendered to the advance-
“ ment of the health of the nation.’ The presentation of the Gold
Medal took place at the 48th Annual Meeting of the British Medical
Association in the Senate House at Cambridge, on 12th August 1880.
The President of the Council (Dr. Alfred Carpenter) addressed
Dr. Acland, who had been deputed by Dr. Farr, in consequence of his
illness, to receive the medal, in the following words :—“ Professor
“ Acland, you have been requested by Dr. Farr to receive, on his
behalf, this Gold Medal, which is the highest honour that the
“ Association has the power to give, or our profession to confer. In
“ conveying it to him, to whom it has been voted, you will kindly tell
“« him that this medal is voted only for the very highest services in the
“ profession. He has given, in the knowledge of all men, these highest
“ services, and they have been long continued; for he has given a
“ life-long labour to sanitary work and to vital statistics—labours which
“ in themselves have had little that was attractive; labours which
“ have brought to him but barren rewards ; but they have been labours
«© which lie at the foundation of all researches in medical science. It
“ is a great grief to the Association that Dr. Farr has been unable to
“ be present in person, and that this, like many other rewards in life,
“ has come when life’s labour is nearly done; but it will be a great
“ solace to him, Dr. Acland, that this will be conveyed to him through
“ yourself, through one who is held in high estimation, who stands so
“ high in public and professional regard, who has spent the greater
“ part of his life in an endeavour to raise the study of natural science
“ in Oxford, and thus place professional education upon a broad basis.”
Dr. Acland, in reply, stated that he would “ to the best of his ability
convey to Dr. Farr, the valued friend of them all, the Gold Medal
«“ which he had just received, and would inform him that it was the
highest testimony which the profession could give of esteem and
‘ regard for the great services he had rendered to the profession and
“ to the country ; indeed, it must be said for services rendered to the
‘© world.” The presentation was made amid the loud cheers of those
present in the Senate House, which was well filled. The medal was
accompanied by an’ engrossed scroll on vellum, bearing a copy of the
resolution.

The following are a few of the honorary degrees and distinctions
which were conferred upon him from time to time in recognition of his
high scientific attainments, and especially for his services to the science

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of vital statistics, und to public health. In 1847 the honorary degree of
M.D. of New York was conferred upon him. In 1852 he was elected
an Honorary Member of the Institute of Actuaries. The distinction
of Fellow of the Royal Society was conferred upon him in 1855 ;
and in 1857 the Royal Medical and Chirurgical Society elected him an
Honorary Fellow in the distinguished company of Dr. Virchow. In the
same year the honorary degree of D.C.L. was conferred upon him at
Oxford. About this time he also received the honour of election as
Corresponding Member of the Institute of France. Ten years later, in
October 1867, he was elected an Honorary Fellow of the King and
Queen’s College of Physicians in Dublin. Lastly, at the time of his
retirement, he was, on the recommendation of Lord Beaconsfield,
gazetted a Companion of the Civil Division of the Order of the Bath.

As soon as Dr, Farr’s retirement from the Registrar-General’s Office
became known, a very general feeling was expressed that the occasion
called for some public recognition of the exceptional value of his
services. With a view to carrying out this project a Committee was
formed, of which the Earl of Derby accepted the Chairmanship, and a
subscription list was opened. The amount subscribed was 1,1821.,
which, at Dr. Farr’s request was invested in Bank of England Stock
for the benefit of his three unmarried daughters, in order to supplement
the very slender provision which he had been able to make for their
support after his death. On Dr. Farr’s death in 1883, the Government
contributed 400/. to this Testimonial Fund, which was then closed, and
the net proceeds invested in accordance with the expressed desire of
Dr. Farr. In an Appendix to this volume will be found a list of the
subscribers to this fund, and the balance sheet of the treasurer, as
audited on the closure of the fund.

That Dr. Farr was a man of undoubted genius few who are really
acquainted with his work coutd fail to recognise. This opinion is only
enhanced by the knowledge of the comparatively slight educational
advantages he enjoyed in his youth, and of the fact that in turning these
slight advantages to the fullest account he was in the truest sense a self-
taught man. He was, however, not only a thorough mathematician
(although no record exists of his ever having had any instruction in
mathematics), but was an accomplished linguist. He spoke French
fluently, and read equally well the German, Italian, and the classic
languages. An appreciative friend of Dr. Farr’s, who accompanied him to
Florence in 1867, when the International Statistical Congress was held
there, remembers with pleasure the respectful and almost affectionate
regard in which he was held by the eminent statistical delegates who met
there, including M. Quetelet and M. Engel. His address, delivered in
French, upon the mortality from cholera in East London in 1866
describing its sudden outbreak, and its as sudden cessation when ihe
supply of polluted water which was its cause ceased, was listened to with
breathless attention.
X xiii

Dr. Farr, moreover, in addition to his special acquirements, was
endowed with a large and open mind. He had been from his youth a
great and general reader, had a constant and insatiable desire for infor-
mation in all branches of knowledge, and had a genuine love of the true
and beautiful in art and literature. He took a liberal, in the best sense
of that word, and broad view of all social and political problems, for his
heart. was large as well as his mind.

Those who had the privilege and pleasure of his friendship, or even
of his acquaintance, enjoy and treasure the memory of the man, quite
apart from the inevitable respect and admiration they feel for his
talents and his services. With scarcely an exception, Dr. Farr has
been invariably spoken of with respectful appreciation. It would
be hard indeed to believe that he could have had a private enemy,
for he was not only essentially modest and unassuming in his
manner, but he was always ready to see and appreciate merit, being
especially free from jealousy of the success or suspicion of the motives
of others. These qualities made him a somewhat bad judge of character,
and exposed him to imposition from scheming speculators, who were
desirous of and too frequently obtained his name and support in the
furtherance of disastrous financial ventures. For this want of worldly
wisdom, and of due caution in putting his actuarial reputation
and his money at the mercy of others, he paid dearly. If he had
possessed more self-assertion, not to say selfishness, and less trust in
others, his worldly success would undoubtedly have been greater, but
his character would have been the less loveable. By all those who
were brought into immediate official contact with him, the memory of the
“dear old Dr.” will long be cherished, and many a kind word and act.
affectionately remembered.

He was devoted to his home ties, and lovingly indulgent to all around
him. He was a delightful and delighted host, and although, in con-
sequence of his extensive and varied information and acquirements, his
conversation was always welcome, he was not what is called a great
talker, whereas he was a thoroughly good listener. His keen enjoyment
of and his evident participation in the pleasures of others, especially in the
pleasures of children, the simplicity of his tastes, and his ready power of
self-forgetfulness when surrounded by young people, were among his
most marked and pleasing characteristics. None who knew him really
well will ever forget the almost magnetic effect of his ever ready,
spontaneous, thoroughly hearty, and most musical laugh.

Through life his capacity for work, and his complete absorption
therein, combined with the rare but invaluable capacity for putting it
aside when he left his study, was alike the source of astonishment and
admiration among his friends. This, however, did not entirely save him
from absent-mindedness, which at times was the cause of amusement
to himself as well as to others, and which is held to be excusable and not
altogether unnatural in those much given to deep mental study. His old
friend Dr. Bain, with reference to this absence of mind, communicates the
XXIV

following recollection: “Not many years ago, after having spent the
previous day and night under his hospitable roof at Bickley, I accom-
“ panied him in a walk to Bromley Common church, where he ha to
“ attend a vestry meeting, with the understanding that I should after-
“ wards accompany him to town. I sat a long time in church, in fact,
“ Tread through the whole of St. Mark, without seeing him come out
“ of the vestry. I had heard one or two doors shut, but did not take
“ much notice, until I thought the meeting was a very long one.
“ Wishing to make my observations, I went to one or two doors, but
‘‘ heard no response to my first gentle, and then loud knocking. I soon
“ realised that J was imprisoned, and made furious attempts to break
“ open the doors, and to reach the high windows, but with no result.
“ The prospect was anything but a pleasant one, for the church was
“ some distance from the road, and no house was near. After a con-
‘€ siderable time, however, I was delighted to hear a key inserted in one
“ of the outlets, and a church attendant appeared, who explained that
“ the gentleman had left the church by another door, adding that it
“ was entirely by accident that he himself had returned, having left
‘“ something behind. I walked quietly into Bromley station, nearly two
“ miles off, and found my worthy friend, who had lost his train, was
“ yeading Lucretius, and evinced no surprise at my appearance, nor
“ apparent recollection of previous events.”

This slight and imperfect. sketch of the life, works, and character of
Dr. Farr is written by one in whose earliest recollections the memory of
his genial face, bright voice, and happy laugh is still vivid, and who
was fortunate and privileged to spend five-and-twenty years in almost
daily official intercourse with him. To those who did not know him
personally the sketch may appear somewhat partially drawn. It has
been written, however, in full confidence that all those who knew him
will see no exaggeration, but only an honest attempt to do justice to his
talents, his work, and his many inestimable qualities as a man.

The portrait of Dr. Farr, which forms the frontispiece to this volume,
is reproduced from a photograph taken, in 1878, by Messrs. Lombardi
and Co., of Pall Mall, London.

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The Epiror.
 

VITAL STATISTICS.

 
CONTENTS

PART J.—POPULATION.

IntTROpUCTION.

1.—Scorr or Enquiry at First Sex Censuses.
2.—UnIon orn REGISTRATION COUNTIES.
3.—HovusEs.—Definition of a House.—Houses building.

4.—Numpers.—Principle of Population.—Law of Population.-~Increase and
Decrease of Population.—Influence of Birth-rate upon Population.—
Censuses and Population Registers.—Period in which Population doubles
itself.

5.—Density AND Proxrmity.—Proximity—Density—Method of calculating
Proximity and Density.

6.—SExgEs.

7..-Acrs.—Census Enumeration of Ages.—Effect of Birth-rate on Ages of
Population.—Effect of Prolongation of Life on Population.—Factors
of Population.—Length of a generation.—Centenarians—Mean Age
of Population.

8.—Civit or ConsucaL Conpition.—Age at Marriage——Duration of Married
Life.—Effect of Alteration in the Age at Marriage.—Proportions of
Married Males and Females at Different Ages.—Effect of Marriage on
Population.

9.—Occupations.—Census Enquiry and Classification.—Double Occupations.—
Industrial Census.

10.—InFIrMiITIES.— Census Enumeration of Infirmities.—The Blind.—-Occupations
of the Blind.—Distribution of Blindness.—Causes of Blindness.—The Deaf
and Dumb.—Congenital Mutism.—Blindness and Deaf-Mutism at Groups
of Ages.

11,—Economic VALUE of PoPULATION.
PART I.—POPULATION.

INTRODUCTION.

PoruaTion, as the natural basis of all vital statistics, necessarily
demands preliminary consideration in any work dealing with that subject.
Our knowledge of the statistics of the English population is almost
exclusively derived from the facts collected at the decennial Census
enumerations, and dealt with in the published official reports. Dr. Farr
may be said to have statistically presided over the three Censuses in
1851, 1861, and 1871, and he wrote the greater part of each of those
three reports. Those who have had cause for studying these and
preceding Census reports cannot fail to recognise the greatly increased
value with which Dr. Farr’s influence invested the later reports. It is
inevitable that the interest of each Census report should be, in a great
measure, superseded by the appearance of the succeeding report. It has,
therefore, been the object in the following selection to choose only
those. portions appearing to possess practical and permanent value in their
relation ‘to one or other of the branches of vital statistics forming the
several divisions of this work. Some of the most valuable extracts deal
with the laws and principles which govern the increase of population, and
with the influence of marriage-rates and of birth-rates upon such increase.
The variations in the proportions of sex, age, and civil or conjugal
condition, are essentially important elements of Census investigations,
and are indispensable to the useful study of marriage, birth, and death
statistics. Scarcely less important, as a branch of the Census inquiry,
are the occupations-of a population, whether viewed from an industrial
standpoint or in their bearing upon the health and mortality of the
people. The next series of selections deals with infirmities, especially
with statistics of blindness and ‘deaf-mutism. Lastly comes an article
upon the economic value of population.

It is necessary to bear in mind, with regard to all Census statistics,
that they are, in England at any rate, simply the tabulated results of
facts furnished by householders in their schedules on the enumeration
day. The imperfect education of a large proportion of householders in
this country (householders, so called, include the head of each separate
family) necessarily impairs the accuracy of much of the information
collected, especially of that relating to occupations. Other causes lead to
inaccuracies in the return of the ages and infirmities of the population.
There is every reason to believe that the facts collected at each suc-
cessive enumeration are more accurate than those collected at the
previous Census, but, while absolute accuracy can scarcely be expected,
there is no good ground for doubting that, with ordinary caution in the
deductions to be drawn from them, Census figures form trustworthy
bases for vital statistics of infinite value, political as well as social. The
inherent defects of Census figures should not, however, be lost sight of,
especially by those who clamour for more detail, and seem to forget or
6 [PART J.

to ignore the uature of the machinery by which a Census enumeration
is effected. Occupation statistics furnished in the Census schedules
can, for instance, never be made to answer the purpose of a thorough
industrial Census. The difficulties arising from double and indefinite
occupations, from the confusion between masters and journeymen, and
between those actually engaged in and those retired from the various
occupations, must tend to depreciate the value of this branch of Census
statistics, so long as these statisties are solely dependent upon information
supplied in householders’ schedules. The obstacles in the way of
successfully dealing with the information thus supplied are boldly stated
in the last Census Report (1881), and should be carefully and fully con-
sidered before the time arrives for making preparation for the next
Census in 1891. For the benefit of those who may be desirous to use
the Census figures ‘for 1881 as a basis for scientific investigation of
the vital statistics of urban or rural sanitary districts during the current
intercensal period, ending with the next Census in 1891, it may here be
stated that the Census report for 1881 gives the sex and age distribu-
tion of the population of each urban and rural sanitary district as
constituted in that year. The civil or conjugal condition of the population
of each of the 47 urban sanitary districts having in 1881 a population
exceeding 50,000 persons is also given in that report. The proportions
of sex, age, and conjugal condition change so slowly that it may be
assumed, without affecting the trustworthiness of the calculations based
upon such assumption, that the proportions found to exist at: the
last Census will be maintained until 1891. ‘This assumption will ren-
der it possible to estimate the numbers of males and of females living
(at each quinquennial or larger age-period) in each year, in every urban
and rural sanitary district, as well as in registration counties, districts,
and sub-districts ; and also to estimate the numbers married, single, and
widowed in each town having a population of 50,000 and upwards in
1881.—(EpirTor.)

1—Scopr or Enquiry AT rirst six CENSUSES.

The inquiries undertaken at the Census of Great Britain in 1851
were of a much more extensive character than those which had been
pursued in the course of any previous Enumeration, as will be apparent
from the following brief summary of the results of each :—

The first Census, taken in 1801, under the superintendence of
Mr. Rickman, showed the number of persons, distinguishing the sexes
in the various Counties, Hundreds, and Parishes of Great Britain ae
number of Houses and of the Families by which they were occupied —
and a rough statement of the occupations of the people, under the three
classes of (1) “ Persons chiefly employed in Agriculture,” (2) “ Per-
“ sons chiefly employed in Trade, Manufactures, or Handicraft.” and
(38) “ Ail other persons not comprised in the two preceding classes.” It
also included an abstract of the Parish Registers from, returns made by
the Clergy, giving in each Hundred, or Wapentake, &e., of England sae
Wales, the number of Baptisms and Burials at every tenth year from
1700 to 1780, and in each year afterwards, and the number of Marriagos
in every year since 1753. : eee

The Census of 1811 was taken upon the same plan as that adopted i
1801, and the same particulars of information were civen - the mail
difference being that in 1811 the number of Families occupied in th
three above-mentioned classes was shown instead of, as in 180] ce
number of Persons ; and in 1811, the number of houses building :
shown separately from the number of other uninhabited Houses. "The
POPULATION. | 7

Abstract of the Parish Registers was also repeated, showing the number
of Baptisms, Burials, and Marriages which had occurred in every
Hundred in each of the ten preceding years.

In 1821 information was for the first time attempted to be supplied
respecting the Ages of the population; but as it was left optional, both
to the Census Officers and to the parties themselves, how far the
investigation should be pursued, the Return upon this point (which
gave the numbers in quinquennial periods up to 20, and thence at
decennial intervals) proved, to a considerable extent, deficient and
unsatisfactory. In other respects the particulars inquired into at this
Census were precisely the same as in 1811.

The inquiry of 1831 embraced several additional particulars, prin-
cipally in elucidation of the various classes into which the people arc
divided by their different occupations. While the classification of 1811
and 1821,—viz., that of Families into the three classes of (1) Those
employed chiefly in Agriculture; (2) Those employed chiefly in Trade,
Manufactures, and Handicraft; and (8) Others not comprised in the
two preceding classes,—was still retained, a further subdivision was
made as to the Male Population of 20 years of age and upwards.
This was shown, in each parish, under the following heads :—

Occupiers employing labourers.
1, Aerated Occupiers not employing labourers.
Labourers employed in Agriculture.
2. Employed in Manufacture, or in making Manufacturing
Machinery.
3. Employed in Retail Trade, or in Handicraft as Masters or
Workmen.
4, Capitalists, Bankers, Professional, and other Educated men.
5. Labourers employed in labour not Agricultural.
6. Male Servants.
7. Other males, 20 years of Age.

The number of Male Servants wrder 20 was also given; and the
number of Female Servants, without any distinction as to age.

In the printed Abstract of the Returns was given, at the end of each
County, a detailed list of the particular Trades or Handicrafts included
in the 3rd of the above classes, and the number of persons employed
in each.

The inquiry as to the ages of the population was not repeated in
1831 beyond the distinction, above mentioned, of males above and
under 20.

At this Census the area of each parish and township was given for
the first time, being the result of a computation made by Mr. Rickman
from maps.

At the Census of 1841 several alterations and additions were intro-
duced. ‘The number of Families was not given, and the statement as
to occupations was not made, as before, for each Parish, nor was the
previous classification adopted. The inquiry, however, embraced several
particulars not before noticed, and the investigation as to those hitherto
given was pursued with greater minuteness and accuracy. Thus, in
each Parish was shown the number of persons who were born within
the County, and of those born elsewhere ; while, of the population of
each Hundred, was shown how many were born in Scotland, Ireland,
the British Colonies, and in foreign parts.

The Ages of the parish population were shown in the two divisions of '
‘under 20” and “20 and upwards”; and the Ages of the entire
population of the Country were shown, under Counties, Hundreds, and
8 [eart I.

large Towns, in quinquennial periods. So, the occupations of the
people were exhibited, under Counties and large Towns, in a very
extensive and detailed classification, in which the precise employment
(if any) of every individual person was stated, and the whole population
was distributed according to their various pursuits. The population
of Parliamentary Boroughs was supplied for the first time; the
boundaries being those assigned in pursuance of the Reform Act. In
other respects the information previously obtained was again given,
and the Parish Register Abstract, though of minor utility since the
introduction of the system of General Registration by Civil Officers,
was again repeated.

At the Census in 1851 it was resolved to exhibit not merely the
statistics, as before, of Parishes, and, more completely, of Parliamentary
and Municipal Boroughs, but also of such other large towns in England
and Scotland as appeared sufficiently important for separate mention,
and of all the Ecclesiastical Districts and new Ecclesiastical Parishes
which, under the provisions of various Acts of Parliament, have during
the last 40 years been created in England and Wales. In addition
also to the inquiry concerning the Occupation, Age, and Biithplace of
the population, it was determined to ascertain the various Relationships
(such as Husband, Wife, Son, Daughter)—the Civil Condition (as
Married, Unmarried, Widower, or Widow)—and the number of persons
Blind, or Deaf and Dumb. Further, under the impression that the
Sth section of the Act would authorise such an inquiry, the design was
formed of collecting statistics as to the accommodation afforded by the
various Churches and other places of public religious worship throughout
the country, and the number of persons generally frequenting them;
and also as to the existing Educational Establishments, and the actual
number of scholars under instruction. It was, however, subsequently
considered doubtful whether, upon a rigid construction, the Census Act
rendered it compulsory upon parties to afford information upon these
particulars; and the inquiry was therefore pursued as a purely
voluntary investigation. It was not deemed necessary to procure, as at
former Censuses, any abstract of the Parish Registers for the ten’
preceding years; the general system of Registration of Births, Deaths,
and Marriages, which had been for that period in full operation,
affording more complete and trustworthy information as to changes in
the aspect of the population referable to the operation of these events.
—(Census Report, 1851, Enumeration, Vol. L, pp. ix-xi.)

2.—Unxion orn ReEGIstRATION COUNTIES.

The Legislature in 1834 * entrusted to the Poor Law Commission the
power of forming new districts, called wnions, without any such reference
iw county limits as was observed in the constitution of the analogous
hundreds, sessional divisions, and lieutenancy subdivisions. These
unions, having staffs of officers, and rating powers, were in 1836 made
the basis of the 626 registration districts in which the births, deaths,
and marriages have been since registered, and the population enumerated.
Each of 608 districts comprises one union; and 18 comprise two to
four, and in the aggregate 40 unions. And as the districts consist of
sub-districts, the sub-districts of parishes and townships, so the districts
were grouped together to form the counties, with which they were
made to coincide as nearly as was practicable without breakine up the

Fh z x : 5 , Db
fundamental unit—the district or union which was presided over by an

 

*4&5 Will. 4. cap. 74, 8, 26.
POPULATION. | 9

elected and ea-officio board of guardians wielding great administrative
and rating power.. The union counties thus constituted differed little
in many instances from the old counties, and in the aggregate only
transferred 1,053,423 out of a population of 22,712,266 from county
to county. For the sake of maintaining the union counties properly
constituted intact, the requisite changes would involve no great sacrifice ;
but should it be held to be desirable, the disparity might in many
instances be greatly und advantageously reduced by well-considered
alterations of the existing unions. The subject was discussed in the
Census Report of 1851; and it will be evident from the following
extract that the new divisions of the country are better suited to
administrative purposes than the old divisions descending to us
from a time when the population was uncivilized, and in number
inconsiderable. ,

“The cause of the discrepancy between the ‘registraticn counties’
and the other counties arises from the circumstance that, in many cases,
the boundaries of the old counties were rivers; on which, subsequently,
at fords and bridges, important towns arose, the markets and centres
of meeting for the people of all the surrounding parishes. These towns
have been made the centres of the new districts, as at them it is most
convenient for the guardians to meet, and the officers to reside. Thus
Wallingford in Berkshire is the natural centre of the district, which is
nearly equally divided by the Thames; and the Thames is here, as it
is in a lower part of its course, the county boundary separating Oxford-
shire from Berkshire. The people of the parishes of Bensington,
Ewelme, Crowmarsh, North Stoke, Berrick-Prior, Warborough, and
Dorchester, on the north side of the river, in Oxfordshire, meet at
Wallingford market, and are in many ways intimately associated with
the people on the south side of the river in Berkshire; hence it was
quite justifiable to unite the parishes so related on both sides of the
Thames in the Wallingford Union—the Wallingford district. The
whole district is placed in the ‘registration county’ of Berks; though
part of it is in the old shire of Oxford. [And this is reasonable, for
if these people are properly associated in one union, they should on
many grounds be united in one county. The same remark applies to
the city of Oxford, which is now partially in Berks; the whole of it
should be transferred to Oxfordshire.] In the same way the greater
part of the other discrepancies is accounted for. The old shire
boundaries often run near towns; and the districts, which have not been
arbitrarily framed, consist of 624 of the towns, with the surrounding
parishes, sub-divided into sub-districts; while the registration counties
are aggregates of the districts which have their central towns within
the limits of the old shires. In the counties which, like Norfolk,
Suffolk, and Essex, were originally well divided, little change has been
made; in others, the defect of the old subdivisions into counties has
been partially modified, without any further substantial innovation than
the substitution of districts for the obsolete hundreds.” (Census Report,
1871, Vol. 4, p. xxxvii.)

3.—HovszEs.

Definition of a house—What is a house? appears to be a question
admitting of an explicit answer. And the enumerators of the United
Kingdom were instructed to class under that category every habitation ;
each separate house comprising by definition ail the space within the
external and party walls of the building. ‘Thus it became impossible
to count either each room or each storey as a separate house, although
LO [PARD 1.

it might be separately occupied or owned, or might even have attached
to it the privileges of voting.

On the continent, each hotel, however numerous may be its occupiers
or tenants, is reckoned as one house; and the English practice was
formally sanctioned, after discussion, by the official delegates of the
various Governments of the world at the London session of the Inter-
national Statistical Congress.*

Scotland is the only country of Europe in which the definition of
“house” has hitherto offered insuperable difficulties. In that country
the population of 3,062,294 souls has sufficient space,—-19,639,377
acres,—giving six acres and more to each inhabitant; while houses in
the open country enjoy the perfect security which is sought within the
walled cities of the continent; yet Scottish families, instead of living
on the earth in pure air, with the sky over their dwellings, in many
instances prefer lying stratum over stratum in flats, opening into a
common staircase,—“a continuation of the strect,” as it has been
called,—which receives the organic emanations of the families on each
floor. In several of the towns they, at the various Censuses up to 1851,
conferred the names of houses on these flats or floors as they would be
called in England, étages as they would be called in France.t And the
Scottish Commissioners, who possessed many local advantages, do not
appear to have been more successful in 1861 than we were in 1851, in
getting the actual number of houses in Scotland.t This must be borne
in mind in comparing the houses of Scotland with those of England and
of other countries.

 

* M. Legoyt, in his repert of the proceedings in Committee, observes :—‘La
section est tombée d@’accord sur la définition du mot ‘maison,’ et sur les faits
intérieurs et cataracteristiques auxquels la maison doit étre reconnue. Elle a
“ refusé notamment Wattribuer cette désignation aux divers étages dont peut se
“ composer une construction affectée 4 Vhabitation, lors mémes que ces étages
seraient occupés par des familles distinctes, et qwils auraient un escalier s¢paré.”
—Rep. on Stat. Cong., p. 153.

J Johnson has been quoted in support of the notion, held by some persons in
Scotland. A “house” he defines as (1) a place where a man lives; a place of
“ human abode” ; (2) “any place of abode,” &c. &c. Now it does not follow that,
because a house is “a place wherein a man lives,” that every place wherein a man
lives is a house; for instance, a tent, a barge, a ship, a cell, or a chamber, is
not a house. In the example which Johnson quotes, “ Sparrows must not build
“in his house eaves,’ Shakespeare finely characterizes the house by its eaves;
the man living under his own roof, not under another man’s “ flat.” Again thers
is the other quoted passage :

“ The bees with smoke, the doves with noisome stench,
“ Are from their hives and houses driven away.”

Here a dovecote is a “place of abode,” but it is not a house in the Census sense ;
and there is a difference between cell and hive. Johnson defines “flat”; and ie
was acquainted with Scotland, yet he nowhere intimates that “a flat” is “a house’:
so that his authority is explicitly against the extension of the name of the part to
the name of the whole of a building.

If any doubt remains on the subject, it will be dispelled by the followine quotation
from Boswell, who so faithfully reflects Johnson’s opinions in the Journal of the
Tour in the Hebrides. .\fter citing a certain baronet, upon the perils of walking
the streets of Edinburgh at night, he adds :— The peril is much abated by the éaxt
“ which the magistrates have taken to enforce the laws against throwing foul water
“ from the windows ; but, from the structure of the Housws in the old town which
consist of many STonies, in each of which a different Famry lives and there
being no covered sewers, the odour still continues. A zealous Scotsman would
have wished Mr. Johnson to be without one of his five senses upon this oceasion
“ As we marched slowly along, he grumbled in my ear, ‘I smell you in the datle 7
‘“ but he acknowledged that the breadth of the street, and the loftiness of th
“« buildings on each side, made a noble appearance. — Boszell’s Lite of Sake
Croker’s edition, p. 270. rege 83

T Report on Cexsus of Scotland, p. xxvii.

‘

.

‘

‘

«

‘
POPULATION. | il

We have, in conformity with the practice since 1801, for the sake of
uniformity, enumerated as houses all the distinct buildings which were
inhabited, as well as uninhabited houses, and houses building; and after
thus avoiding the inextricable difficulties of the “ flats,” we have still
many heterogeneous structures mixed up with houses in the ordinary
sense of that word. ‘The house is a variable unit; it includes in the
Census the hut on the moor, the castle on the hill, and the palace; so
that every one of these structures, and of the intermediate mansions and
cottages, is reckoned as a house. The ordinary house varies in size
and structure in town and country,—in its cubical contents, in its
hearths, in its doors, and in its windows ; so that, to give a correct view
of the accommodation which houses afford the population, and of their
value, and of their sanitary influences, a special inquiry is indispensable.
—(Census Report, 1861, pp. 7-8.)

Houses building.—The houses building were first enumerated in
1811; and the enumeration has been since repeated at every Census.
In a country under depopulation the old houses fall into decay ; many
houses are uninhabited; and few new houses at a Census are
“building.” And as the question, Is England increasing or decreasing
—decaying or flourishing—was seriously discussed during the last
French war, it was thought that the inquiry into the “houses building ”
might assist in its solution.*

Upon comparing the number of “houses building” with the total
numbers standing, this result is elicited:—in 1811 to 1 house building
there were 114; in 1831 the proportion was 1 to 105; in 1861 it was
1 to 144.

This seems to imply that since 1831 this “indication of prosperity ”
has taken an unfavourable turn.

The question requires investigation, as it is by no means so simple as
it appears to be on the surface.

Houses are built to replace old houses, and to provide for the new
families of the increasing population. [f we assume, for the sake of
illustration, that one house in 100 falls into decay every year, so as to
require reconstruction, the 3,431,533 houses of 1851 would be reduced,
by the decay of 328,116, to 3,193,417 in ten years; but the houses in
1861 amounted to 3,924,199, or to 492,666 in excess of the houses in
1851 ; the new houses sufficing to replace the old houses, and to leave
the enormous surplus, must upon this estimate have amounted to
820,782, or to 82,078 annually on an average.

If an equal number of houses is built every year, and they last on an
average the same number of years, the proportion which the number of

houses building bears to the number of houses existing will depend on
the mean time it takes to build a house. Thus, if the houses of a place
amount to 1,000, and each lasts 100 years, the 1,000 houses will be
kept up by the erection of 10 new houses every year ; and if each of the
10 houses is built in a year the numbers “building,” corresponding to
those at the Census, will, on an average, be 10. If each house takes
2 years for its construction, 20 houses building will figure in the Census
return; if the houses are built in half a year on an average, 5 only will
be building, for 5 built in the first half of the year, and 5 in the second
half of the year, make 10 annually. ;

The change in the proportion of the houses building to the subsisting
houses is probably the consequence of the more rapid system of
construction which is now carried on in the towns. Thus if houses,

* Preface to Census Report. 1811, p. x.
12 [Part I.

including huts and cottages, as well as castles and palaces, were built at
the rate of 82,078 a year, then the 27,305 building in 1861 would imply
that they were built on an average in about 4 months. If the houses
were built on such a system as to require 54 months for completion in
1831, and 4 months in 1861, the difference in the proportion of houses
building in 1831 and in 1861 would be accounted for ly this cause
alone. (Census Report, 1861, Vol. 2, pp. 8-9.)

At each Census since 1811 the number of houses “ building” has
been returned. The number increased trom 16,207 in 1811 to 27,444
in 1841, and remained nearly the same in 1851-61, -but in 1871 the
numbers ran up to 37,803. One house was “ building” or being built
to 114 standing inhabited and uninhabited in 1811; to 105 in 1831;
to 144 in 1861; to 120in 1871. The number of houses “ building ” on
the Census day, as we pointed out in 1861, depends not only on the
number erected annually, but on the ¢ime employed in the process, so
that a decline in the number enumerated on one day does not imply a
decline in the number of houses built yearly. The architect there cited
is of opinion that houses on an average are built in six months (1861),
but that is by no means certain. The houses building vary with the
season; and with the facilities small builders find of obtaining advances
of money. Butas we know that houses are built in as short a time now
as in previous Censuses, and as the season of the year has been the same,
it is quite certain that the increase of “ houses building” to 37,803 on
the last Census day implies a rapid increase in the number of new
houses. ‘This is proved, too, by houses inhabited and uninhabited in ten
years having increased by 596,263, that is at the rate of 59,626 new
houses yearly. But new houses were also built in the same period to
replace the houses out of 3,924,199 existing in 1861 that fell to decay
or were taken down; assuming, as was done in 1861, that houses last
about 100 years, and perish at the rate of one per cent. annually, then
at the end of the ten years 375,223 houses must have disappeared. The
new houses built in the ten years replaced these houses and added
596,263 to their number, so about 971,486 new houses bave been built
in the 10 years; of which about 920,194 inhabited were of the annual
value of 14,907,148/., and worth at 15 years’ purchase 223,607,145/.
(Census Report, 1871, Vol. 4, p. xxx.)

4. NuMBERS.

Principle of population—The policy which England, since 1751, has
pursued in respect to population was directly condemned and opposed
by an acute and diligent critic, who endeavoured to establish & new
doctrine, and to deduce, from what he designated “the principle of
“ population,” the most adverse inferences. His doctrine has held such
sway for some years in the works of political economists, and has such
a direct reference to practice, that we shall notice two or three of its
fundamental propositions.

Thomas Robert Malthus was born in 1766 at the Rookery in Surrey
amidst a poor and healthy, but not a very intelligent agricultural popula.
tion. His father, an accomplished speculative man, was one of the
executors of Jean Jacques Roussean, and placed young Malthus under
the tuition of Mr. Graves, the author of the Spiritual Quixote and of
Gilbert Wakefield. After proceeding to Cambridge in 1784 Malthus
became a Fellow of Jesus College in 1797, under the conditions of
POPULATION. | 13

celibacy which still linger as traces of the monastic system in our
universities. In consequencé, apparently, of a friendly controversy
with his father, he wrote and published the first edition of his “ Essay
“ on Population” in 1798; chiefly with a view to combat the doctrines
of Condorcet and Godwin, who held that the human race was perfectible,
and was advancing towards an ideal stanilard of excellency. His
paradox was at direct issue with theirs, as the “principle ot
“ population”? rendered vice and misery, he contended, inevitable
in all ages.

Population, we know, cannot increase indefinitely; its limit is as
absolute as the limits of the world, or of the matter of which the world
is composed; and in Great Britain the rate of increase is retarded by
the premature mortality, the vice, the postponement of marriages, and
the celibacy of the inhabitants. But Malthus went further in his
doctrine; he insisted that the increase of mankind is the chief source
of misery, and that extensive abstinence from marriage, or the repression
of population, is to be regarded as the fundamental condition of human
happiness. Population, he argued, is necessarily limited by the means
of subsistence ; but population increases naturally in a geometrical
progression, oras 1, 2,4,8,..... » while subsistence cannot increase
at a faster ratio in the same time than is expressed by the arithmetical
progression 1, 2, 8,4... . .3 consequently population is checked, and
the checks which repress the superior power of population, and keep it
on a level with the means of subsistence, are all resolvable into moral
restraint [celibacy], vice [Ticentiousness], und misery [famines, plagues,
disease]. Such was in short his doctrine. The ranks of this army—
the population of every country—are full; the supply of the commis-
sariat is limited ; therefore, the number cf annual recruits remaining
invariable, any decrease ef the deaths in battle must be followed by
an equivalent increase in the deaths by famine and fever; or, if the
deaths from all causes are to decrease, the number of annual recruits
must be diminished. Jenner had recently discovered an antidote to the
poison of small-pox. It was declared immediately to be no benefit to
mankind. ‘I feel not the slightest doubt,” says Malthus, “that if the
“ introduction of the cow-pox should extirpate the small-pox, and yet
“ the NUMBER OF MARRIAGES CONTINUE THE SAME, we shall find a
“ very perceptible difference in the increased mortality of some other
“ diseases.” And again: “The operation of the preventive check—
“ wars—the silent though certain destruction of life in large towns
“ and manufactories—and the close habitations and insufficient food of
“ many of the poor—prevent population from outrunning the means of
subsistence ; and, if I may use an expression which certainly at first
“ appears strange, supersede the NECESSITY of GREAT and RAVAGING
“ EPIDEMICS fo DESTROY WHAT IS REDUNDANT. If a WASTING PLAGUE
“were TO SWEEP OFF TWO MILLIONS in ENGLAND, and sIxX MILLIONS
“in France, it cannot be doubted that, after the inhabitants had
“ recovered from the dreadful shock, the proportion of sirrus to
DEATHS would rise much above the usual average in either country
during the last century.”*

“What prevents the population of hares and rabbits from over-
stocking the earth?”? demands a distinguished disciple, in a chapter
on the increase of mankind.f

a

‘

a

 

* Malthus on Population, B. H. chap. xiii.; see also B. I. chapters i. and ii., and
the work, passim.
{ John §. Mill, Political Economy, i. 10. 2.
it [PART I,

One of the corollaries from the doctrine was a plan for the gradual
abolition of the poor laws, by declaring that no child born from any
marriage taking place after « given date “should ever be entitled to
“ parish assistance.”

All that is peculiar in this doctrine, all that is erroneous, and all that
has shocked the public opinion of the country, ever since its enunciation,
flows from a flagrant oversight; which might be pardoned in a young,
hasty controversialist, but should assuredly have been at once taken
into account when it was discovered in the light of Sir James Steuart’s
original analytical work that had been first published in 1767.*
Malthusianism had, however, become a sect; had been persecuted ;
and was modified and softened, but still upheld, by its disciples.

Sir James Steuart, who wrote before Adam Smith, lays down the
fundamental principle of Malthus, but limits it by a preceding over-
ruling proposition. (1.) We find, he says, the productions of all
countries, generally speaking, in proportion to the number of their
inhabitants ; and (2.), on the other hand [as Malthus asserts], ¢he
mhabitants are most commonly in proportion to the food. Steuart then
shows that the food of the world may be divided into two portions:
(A.) the natural produce of the earth; and (B.) the portion which is
created by human industry. (A.) corresponds to the food of animals,
and is the limit to the number of savages. (B.) is the product of
industry, and increases (all other things being equal) in proportion
to the numbers of civilized men. The whole of the chapter on Popula-
tion in Steuart’s work should be consulted. Malihus, it will be observed,
loses sight of this analysis, and throughout his work confounds the yield
of the untilled earth with the produce of human industry ; which
increases at least as rapidly as the numbers of civilized men, and will
increase until the resources of science are exhausted and the world is
peopled.

The population that a country sustains does not depend exclusively
on the amount of subsistence eavisting at any one time. The produce of
a country is limited chiefly by the character of the inhabitants. For if,
as an example, twenty-one millions of men from any part of Europe
were put in the place of the people of Great Britain after harvest, the ,
various produce would not be maintained in succeeding years; and
in the hands of Caffres, of American Indians, or of the wretched
inbabitants of Terra del Fuego, however great the stock of subsistence
may be at the beginning of a ten years’ occupation of these fertile
islands, it is evident that, at the end, both the subsistence and the
pecple would vary with their industry, but would decline, and be,
comparatively to the actual produce, inconsiderable in amount. Future
generations of Britons, if they have genius, science, skill, and industry
—and if they are more numerous-—will necessarily produce more than
the country now yields.

Tt does not follow, as the theory of Malthus assumes, that a diminu-
tion of the number of the people in 1800 or in any other year would
have had for its result the division of a larger share of subsistence
among the survivors; for in that year a failure of the crops was
followed by a severe famine, although the number of families to be fed
was not by one-half so many as the number at present in these islands.
And, conversely, the share of each person’s produce is not diminished
as the population increases; for the share of the produce of. every
kind that falls to a family in the most populous state of America is

 

* The works of Sir James Steuart of Coltness, Bart., published by his son, General
Sir Janes Steuart, 1806, vol. i. i y son, era
POPULATION, | 15

incomparably greater than the share of the Indian hunter's family
when there was not one person to every square mile of territory.

In the rudest state, where men live on fish, or fruit, or game, the
population is rarely limited by the amount of subsistence existing, but
directly by the skill, industry, and courage of the savage; for any
improvement in the use of the net, hook, bow, spear, or weapon is
followed by an increase of the tribe; while any diminution of its courage
or industry is followed by extermination or decay. In the pastoral or
in the civilized statc, the same causes, operating on « larger scale,
produce effects still more striking.

The character of every race of men is the real limit to its numbers in
the world, if allowance be made for accidents of position and time.

Population is often out of the place where it is wanted, or could be
most productive; but the population of the world is not, as Malthus
assumes, redundant; and not only is there a paucity of men of tran-
scendent genius in all countries, but few persons who have occasion
to undertake or who accomplish great industrial, political, warlike, or
other operations ever find that the men of skill, industry, and entire
trustworthiness—of whom they can dispose, either in the highest or
the lowest departments—are superabundant. Every master knows that
good men—and every man that good masters—are scarce.

The idle who will not work, the unskilful who cannot work, and the
criminal classes who cannot be trusted, are, however, it may be admitted,
whether numerous or few, always redundant. But as the disciples of
Malthus, if there were “two millions of such people in Great Britain,”
would not hear the public executioner invoked for their destruction,
neither can we admit the validity of the argument of that writer when
he attempts to reconcile us to the loss of lives by shipwrecks, explosions,
small-pox, close habitations on low sites,—by the ignorance of men, the
fevers of towns, or the blind fury of pestilences,—which are fatal to all
classes of the nation. New births may repair the numbers, but never
fill the places, of the dead.

The assumption that subsistence increases at a rate corresponding to
any arithmetical progression rests on no authentic observations. ©The
produce of this country has never been valued at stated intervals.
Capital, however, increases, it is always assumed, when terms of years
are considered, in a geometrical progression ; and at compound interest
the increase is much more rapid than the increase of population in any
European state. The interest of money, indicating the annual increase
of value, is the produce of property, and bears a rather close analogy to
the increase “ of the means of subsistence.” At 3 per cent. per annum
compound interest the value of capital is doubled in 24 years; anda
population increasing at 3 per cent., which is near the natural rate,
doubles in the same time; while actually the British population has
increased at the rate of 1°329 per cent. annually for the fifty years
1801-51 ; and bas doubled in 53 years. Thus—if we take this indica-
tion—-the means of subsistence have increased faster than the numbers
of the people; for, while the population has doubled, the value of capital
under investment at 3 per cent. compound interest has quadrupled.
The propuce of Great Britain, which in the present state of commerce
is always convertible into the “means of subsistence,” has probably
not increased at a lower ratio; and no one can pretend, in the absence
of the exact facts, that the ratio has been arithmetical.

The assertion falls to the ground that the disappearance of small-pox,
of cholera, or of other epidemics, must be followed immediately by
famine, or by an inerease of other diseases. The principle may hold
16 [PART I.

of “rabbits,” and of animals that have no power of ercating subsistence ;
but its application to civilized men is absurd.—(Census Report, 1851,
Occupations, vol. I., pp. liv-lvii.)

It is true that all plants and animals have the power of multiplication ;
and man in conformity with that law has the power of doubling his
numbers every twenty-five years under favourable conditions, and within
definite limits of space and time, the limit being soon attained without
the exercise of skill and industry in supplying his wants; but his
struggles for the means of living, as a race, were greater at first when
his numbers were fewer than they are now in England. The numbers
of mankind never actually increase as the numbers in the geometrical
series 1,2, 4, 8, 16, 32, 64, 128, 256, 512 ..... indefinitely ; and
subsistence never increases as the numbers in the arithmetical series
1, 2, 3, 4, 5, 6, 7,8, 9,10 ..... indefinitely. But the population of
a country may increase in geometrical progression for a certain number
of years, and so may its subsistence, understanding by that all that
supplies men’s wants. Mr. Malthus found when he wrote that the
population of the United States had been said for a century and a half
to double itself every 25 years; and now it is known by the Census
that the population, after the year 1790, increased very regularly at
the rate of 3 per cent. annually for the seventy years ending with 1860;
at that rate population doubles itself in 234 years. The increase,
however, was not “by procreation only,” but partly by excess of births
and partly by immigration of blacks from Africa, of whites from Enrope.
Population increased in geometrical progression at a certain rate, but
subsistence also increased in geometrical progression ata faster rate;
so that the pressure of population on subsistence grew less and not
greater. In the last 10 years productive labour slackened and the flow
of population ebbed ; during the civil war English emigrants returned
to England ; there was loss of life in the field, and although for lack of
a national system of registration it cannot be set forth in figures, the
marriage and birth-rates must have declined, for the population increased,
not 3 per cent., but 2 per cent. annually between the two Censuses of
1860-70. Yet the produce inercased, the wheat from 173 to 288
million bushels; the value of all live stock from 218 to 305 millions of
pounds sterling.

The increase of produce from 1850 to 1860 may be inferred from
two orders of facts. The number of farms rose from 14 to 20 hundred
thousand, while the area of improved land from 113 grew to 163 million
acres; and the value of live stock rose from 109 to 218 millions of
pounds. Population only increased in those ten years from 28 to 31
millions.*

And in the earlier years, though not recorded, the produce increased
undoubtedly as nearly in geometrical progression as the population
counted at each census ; and if the early censuses prove that popula-
tion increases, the recent censuses prove that subsistence increases in
geometrical progression. Had Malthus had before him the returns of
produce as well as popalation in America, he could scarcely have fallen
into the error of laying it down that, while population increases in a
geometrical, subsistence increases in an arithmetical progression.

There is a limit to the increase of both people and produce: but the
tendency now is, as men endowed with skill, Weapons, tools, and

 

@ *See Journal of Statistical Socicty, Vol. xxxviii, pp. 74-6 53 and United States
ensus,
POPULATION. | 17

marvellous machines are diffused over the world, to create subsistence
faster than population.

Jn the first edition of his work* Malthus lays it down that (1) “ popu-
‘“* lation cannot increase without the means of subsistence,’ that (2)
“* population does invariably increase where there are the means of
** subsistence ;” and (3) ‘that the superior power of population cannot
“ be checked without producing misery or vice.” Shrinking from the
explicit expression evidently implied by his argument that “ the superior
“ power of population cannot be checked without producing misery or
“ vice,” he left out of account the fact that at the prolific age a large
proportion of the women of every civilized population is unmarried and
virtuous; this being only partially recognized in the subsequent editions
under the phrase * moral restraint.” Instead of simply stating that the
population is kept down by any causes that diminish the births and
increase the deaths, he uses in the last edition the vague phrase, “the
“© checks which repress the superior power of population, and keep its
“¢ effects on a level with the means of subsistence, are all resolvable into
“ moral restraint, vice, and misery.”

The theory is as misleading in practice as it is defective in statement,
anil, as expressed, erroneous in fact. It assumes that the restraint of
population is the corner-stone of policy. Had this principle been
accepted by the people, the population of the kingdom instead of
amounting to thirty-two millions would have remained, as it was at the
beginning of the century, sixteen miilions. England, in the presence of
the great continental states, would have been now a second-rate power ;
her dependencies must have been lost; her colonies have remained
unpeopled ; her industry crippled for want of hands; her commerce
limited for want of ships. The legal insurance of the people by the
land against death by starvation, the efforts to stem the tide of epidemics,
the science of healing, hygienic improvement of every kind, must have
languished under the cold shadow of this doctrine ; and in its name the
endeavour to save the lives of children by sanitary measures is even now
denounced as either futile or mischievous. And logically it leads to the
policy of depopulation ; for if increase causes misery, decrease, by parity
of reasoning, causes happiness: this principle of ‘population being the
fewer the happier. It isa policy that diminishes the numbers of the
wise and the good, but has no effect on the masses. Families under this
policy die out. Classes, distinguished for any virtue, that accept the
restraint under vows, provide for its extinction. The hermits and saints,
that forewent ‘ wedded love,” and children, at the same time that they
provided for their own eternal bliss provided for the extinction of
sanctity on earth ; while our universities offered by fellowships, forfeited
on marriage, one of whick Malthus had just acquired at Jesus College,
a premium on protracted celibacy, they discouraged the multiplication of
their ablest men.§ The economists, the misers, the philosophers, in the
same way eliminate prudence, acquisitiveness, and science from the
ranks of their race. They are like flowers all bloom. Low pay makes
the officers of the army and navy perforce Malthusians, and discourages
the propagation of prowess. J*ew aristocracies are self-sustaining ; and
if there is a natural tendency in wealth to accumulate by intermarriage,
that may lead to its dispersion.

 

* There is a copy of the first edition in the library of the Statistical Society.
It was published in 1798, the year after he was made a fellow of Jesus College,
Cambridge, and when he was 32 years of age.

p. 37.
{ 6th edition, Vol. I., p. 24.
§ In 1797. See Memoir in Principles of Political Economy, 2nd edition, p. xxxv.

LB
——

18 [part I.

The state of nations in the present day, and the history of past ages,
prove that the maintenance of equilibrium between subsistence and popu-
lation is a complicated question. It has been left hitherto to the sense
of both sexes. Malthus had the merit of contending that it admitted of
scientific investigation; that its problems should be sought in the
statistics of nations in every stage of civilization ; that it entered into
the national policy, inasmuch as it was a matter that concerned, in the
highest degree, not only particular individuals, but the whole community,
the State. Reduce the constituent roll of a nation too low, and it cannot
struggle with success against other forms of life in nature; it cannot
hold its own in the face of other powers; it can undertake no great
concerted operations; solitary minds in remote dwellings are not
quickened by collision with other minds; the quantity of life is lessened
on the earth,* and the chances diminished of the rise of men of genius,
to whom the world owes progress in the sciences, discoveries in the
useful arts, and triumphs in fine art and literature.

Ill eftects of too many people willing to work can for centuries only be
felt when they are blindly crowded in particular spots, when their labour
is not organised, when their acquisitions are insecure, when their
dwellings are dens, and when the supply of subsistence is not rendered,
continuous, and within due limits equal, by storage, by commerce, by
skilful distribution, and by wise laws: then zymotic disease is spread,
periodic famines are fatal, and the wretched people are on inadequate diet
starved.

The evils. of indiscriminate intermarriage of imperfect natures accumu-
late. Errors on either side of excess or defect are punished as inexorably
by the law of population as they are by the law of gravitation. If tribes
of men will not breed domestic animals, or cultivate the soil, nothing can
sustain them by the side of civilized races. If men and women will not
work they may not eat. If classes of men drink alcohol to excess ; if they
consume impure water ; if they herd in rookeries ; and if they lead idle,
criminal, vagabond lives; they perish. Nature is implacable ; the
degradation of the human race is made difficult; it is stopped by death.
The best races in the end have the best chance of living from generation
to generation, And against the severity of the life struggle have to be
set the excitements of the battle, the energy it calls forth, and the
perpetual selection of finer varieties of the race for survival. England
through its centuries of history owes some of its greatness to this
principle ; it has been led by it step after step up to heights of glory.

The struggle is a consequence, science teaches, of the evolution of the
living matter of the earth into higher forms; and that evolution is not
yet at an end.

Mr. Darwin applies the doctrine of Malthus “to the whole vegetable
“ and animal kingdom”; and recognizing “the struggle for existence
“ amongst all organic beings throughout the world which inevitably
“ follows from the high geometrical ratio of their increase,” he makes it
the basis of a vast generalization.t After discussing the question he thus
concludes, “all that we can do is to keep steadily in mind that each
“ organic being is striving to increase in a geometrical ratio; that each

 

* Sir W. Petty, by a calculation which he describes in one of his Essays on
Political Arithemetic, but which it would be difficult to verify, asserts, in opposition
to “‘some sceptics,” that two mountains of Ireland were as weighty as all the bodies
“ that had ever been from the beginning of the world to the year 1680.” Be this as
it may, the weight of the human race alive at one time does not exceed 60 million
ee for only a small fraction of the surface of the earth exists in the highest form
of life.

t Origin of Species, 8rd edition, Introduction, p. 4, p. 67, and p. 82.
POPULATION. | 19

“* at some period of its life, during some season of the year, during each
‘“ generation or at intervals, has to struggle for Jife and to suffer great
“ destruction. When we reflect cn this struggle we may console
“ ourselves with the full belief that the war of nature is not incessant,
“ that no fear is felt, that death is generally prompt, and that the
“ vigorous, the healthy, and the happy survive and multiply.”

This struggle reigns over the whole animal kingdom ; nor is man,
as is too well known, an exception; but Mr. Darwin modifies the
principle which ascribes the great check of population to “ misery.”
Reason too gives man certain prerogatives; for as we have seen it
controls fertility, thus adjusting in time and place the results to the
infinite varieties of the openings in life, and further, in his humanity man
has a protection against the casualties and misfortunes which overwhelm
inferior species. ‘The human family, the clan, the town, the tribe, the
nation, all acknowledge even now the claims of children, of the sick, of the
wounded, and of the infirm, to help in time of trouble. Few men refuse
to bind up the wounds of their fellow men. (Supplement to 35th
Annual Report, pp. xv—xviii-)

Law of Population—A population increases in regular geometrical
progression when the births exceed the deaths, and the ratio of the
births and of the deaths to the population remains constant. Thus in
England every 100 persons living in 1801 had increased to 182 in
1821; and every 100 persons living in 1821 had increased: to 132 in
1841; the 100 persons living in 1801 had, therefore, increased to 175
in 1841, and at the same rate will amount to 200 in the year 1850, 300
in the year 1879. The mean rate of increase was ‘0141 annually ;
that was probably the excess of the births over the deaths. Grain,
fruit, animals also, increase in geometrical progression; but the increase
of capital, at compound interest, is the most familiar example of this
kind of progression, and may render it intelligible to the general reader.
Thus at 1°41 per cent. increase annually, 160 persons became 182 in
20 years, and 175 persons in 40 years; upon the same principle that
100/., put out at 3 per cent. per annum compound interest in 1801, would
have amounted to nearly 181é. by the year 1821, and to 326/. by 1841.

Some statistical writers have given the 10th part of the increase in
10 years as the avnual rate of increase. According to this mode of
reasoning, as the population of England increased 75 per cent. in
40 years, it must have increased 374 per cent. in 20 years, and 1°9 per
cent. annually ; while the actual increase was 32 per cent. in 20 years,
and 1°41 per cent. apnually; and, by the same reasoning, money that
increased 226 per cent. in 40 years, must have borne an interest of
53 per cent. per annum; while, as has been just stated, money bearing
an interest of 3 per cent. per annum would increase 226 per cent. in
40 years, at compound interest.

The increase in 10 years is derived from the increase in one year, by
multiplying 1 + the annual rate of increase 10 times into itself.
Thus the increase of the population in one year was ‘0141; 1 became
1:0141 in a year; and 1°0141, multiplied 10 times into itself, is
1°1507 ; 20 times, 1°3241. To obtain, therefore, the annual rate
of increase from the increase in 10 years, the 10¢h root, and not the
10th part of the decennial rate of increase (1‘1507), must be taken.*

 

* Let p denote the population at any time; p’ the population at any previous

n
time; » the number of intervening years; then / Fos =rz= 1 4+ the annual
rate of increase. The division of the logarithm of 2 or 3 by the logarithm of r
gives the number of years in which, at “that rate, the population will double, or
triple, &c.
B2
20 [PART I.

a

“It appears that about 19 in 20 of the people in this country are born
in wedlock. In order, therefore, to understand the rate of increase by
birth, it will be necessary to inquire how many persons are married, by
how many marriage is foregone, and how long marriage 15 delayed
after puberty? Inthe two last years (30th June, 1839-41), 123,405
women were married annually; hence it is probable that 113,861
women, who had not been married before, were married annually ata
mean age of 24°3 years; for it appears from the facts cited in the
report that the first marriages of females are nearly 92 in 100 of
the total marriages, and are solemnized at that mean age. Let it be
assumed, for a moment, that ald the 118,861 women married at the
same age—24°3 years—half a ycar earlier or half a year later ; then
if the number of women in the population who entered upon that age
be known, the proportion married will be at once demoastrated. It
appears from the census returns that the number of women who
attained the age in question was about 143,830; and 143,830 is
to 113,361 nearly as 100 to 79; the result therefore is, that 79 in
100 women who attain the marriage age (24) are married, and that
21 in 100 are never married. It has been assumed that all the
marriages are performed at the same age, to make the proposition
more intelligible; but it is evident that the terms of the proportion
between the numbers who do or do not marry will not be materially
affected by the distribution of the persons over the ages indicated by the
registers.

In this investigation I only take the first marriages, because the
first marriages represent the number of persons who marry annually ; the
rest of the total marriages, in a long interval of time, being repetitions
of the act of marriage by the same individuals, many of whom in the
ordinary marriage registers are counted twice ; for the returns show
that by re-marriages about 100 women marry 108 men, and 100 men
113 women.

It is not so easy to determine the proportion of men who do not
marry; but I shall give the results of the same kind of reasoning
applied to men, as has been applied to individuals of the other sex.
It may be deduced from the ratio of the first to the total marriages,
that 123,405 marriages (the average number), imply the annnal
marriage of 108,386 mep, and from the census abstracts that about
182,236 men were enumerated at the mean age (25°5 years) at which
men are first married; so that of 100 men enumerated who attain the
average age at which marriage is consummated, 82 do marry and 18 do
not marry; but the number 132,236 was derived directly from the
number of men enumerated, and should be augmented, to include the
men (soldiers, sailors, &c.) absent, and escaping enumeration at that
age in greater numbers, probably, than at other ages. If we add
7,420 to the males enumerated, on the assumption that the numbers
of the two sexes living at the mean age of 25°5 are nearly equal,
which is probably the fact, it will be found that the proportion of men
who marry is 78, or one less than the proportion which was found for
the female sex. The actual difference, it will be observed, between the
number of men and women enumerated who attain the respective ages
is 11,594; but 4,180 of the number is accounted for by the disparity
of age, as the women living at the age of 25°5 were 139,650, and
not 143,830.

By reason of the re-marriages, the absolute number of women who
marry 1s greater than the absolute number of men; the proportion is
1°000 to 1°046; and, latterly, as 118,361 spinsters, and 108,386
bachelors, have been married annually, the marrying women have been
4,975 a year more numerous than the men; while, as is shown in the
POPULATION. | 21

preceding paragraph, if the number of both sexes at the same age is
equal, the women living at the age 24°3, according to the census
returns, were 4,180 more numerous than the women living at the later
mean age, 25°5 years, at which men marry. The near coincidence
affords a remarkable example of the secret adjustments which exist,
and of the laws which regulate all social combinations. More women
are married than men; but the women are married at an earlier age,
when the number of them living is greater than the number of men
living at the age when men marry; so that, at the respective ages of
marriage, about 79 in 100 of each sex marry. Of 100 women married,
8 were widows; of 100 men, 12 were widowers. It is infinitely
improbable that a husband and wife should die at the same moment ; for
every marriage, therefore, a widow or widower will be ultimately left ;
and if the number of marriages and of married persons remained
stationary in England for a considerable number of years, as 123,405
marriages take place, 123,405 widows or widowers would be left every
year, namely, 61,702 widows and 61,702 widowers, or 50 widows and
50 widowers to every 100 marriages, if the expectation of life in both
sexes were the same at the age of marriage, in such sort that it might
be strictly inferred, when 8 in 100 women married were widows that
8 in 50 widows married again, and by the same rule that 12 in
50 widowers married again. As the number of marriages, however, has
increased for many years, and the expectation of life among women at
the nuptual age is greater than that of men, it is probable that about
1 in 3 widowers and 1 in 4 widows re-marry.

The fact that one-fifth of the people of this country who attain the
age of marriage uever marry, and that the women, though capable of
bearing children at 16, and certainly nubile at 17, do not marry until
they attain a mean age of 24°38, the men until they are 254, proves that
prudence, or “moral restraint,” in Mr. Multhus’s sense of the term,
is in practical operation in England to an extent which had not been
conceived, and will perhaps scarcely be credited when stated in numbers.

The births of 1,006,182 children, or 503,066 annually, were
registered in the two last years (June 1839-1841), when the mean
population (without correction for males absent) was 15,716,775. The
annual rate of mortality calculated on this population in the two years
was *02245, the rate of birth -03201, the excess of the rate of birth
was thercfore ‘00956. But the annual increase in the population in
the 10 years, 1831-41, was ‘01333, or -00377 more than the excess
of the rate of birth over the rate of mortality will account for. As
nearly all the deaths are registered, and the number of immigrants
from Ireland and Scotland can scarcely have been greater than the
emigrants from England, the rate of birth must have been °03201 +
"00877 = °03578 = (02245 + *01333) to account for the increase of
the population, unless the mortality in the two years was much below
the average, which there is reason to believe was the reverse of the fact.
According to this statement, 100,000 persons lost 2,245 persons by
deaths, gained 3,578 by births, and, consequently, increased 1,333 in
the year; 3,201 of the 3,578 births having been registered, and 377
escaped registration.

The annual births were 503,066 + 59,280 = 562,346; and, although
the precise proportion of illegitimate births is not yet known, I shall
assume, from the incomplete information in my possession, that 5 per
cent. (28,117) of the children were illegitimate, which would imply
that 534,229 children were born annually in wedlock, namely 4°7 to

534,229 =

_ and 4°3 to each marriage as

each woman marvel
22 ' [PART I

The latter is the usual, the former the best mode of stating this relatiou ;
for the object is to show the fecundity of women in different countries
at different times; and the second marriages of women are, in this
point of view, only a means of extending the period of childbearing to
its natural term, and they cannot, on the average, be so fruitful as the
first marriages, with which they are confounded. The marriages
increased 1 per cent. annually in the previous 14 years; and, though
we do not know at what date the persons were married from whom the
534,229 births sprang, it would certainly be at a period sufficiently
remote to imply aless number that 113,785. The actual fecundity of
the married women of this country may probably he expressed
accurately enough, if a correction be made for the increase of marriages,
and for the illegitimate children borne before and after marriage by
women who marry, at 5 children to every woman married, and
4°5 children to every wedding. The 5 children replace the 2‘parents,
and those persons who from early death or from other circumstances
bear no children.

The number of women living and enumerated, June, 1840, was, in
round numbers, 1,630,000 aged 15-25; 1,272,000 aged 25-35 ; 900,000
aged 35-45; and these three ages, at which 8,802,000 women were
living may be considered the ages of childbearing, the middle period
being that in which the greater number of children are produced.

The 8,735,000 women living in the 2 years, June, 1839-41, between
the ages 15-45, gave birth to 562,346 children annually: 66 women
preduced 10 children every year: only 1 in 7 women (6°6) at the
childbearing age gave hirth to a child in the year. Children are occa-
sionally borne at 15, or as late in life as 55; but if the mothers of the
562,346 children had all been aged 17-40, there wouid have been only
1 annual birth to 5 women living of that age. It has been calculated
that, on an average, 2 years intervene between the birth of every child ;*
or that of 2 women one has a child every year. After a correction has
been made for unprolific women, the difference between 1 in 2, aud 1 iu
5 or 6, corroborates the previous result, and shows how much, notwith-
standing the increase of population, the reproductive force is repressed
by prudence.

The population of this country may have increased, and may increase
by an augmentation in the number of marriages and births; or by a
diminution in the number of deaths, and the consequent prolongation of
life. The annual number of births may be increased in two ways: by
an increase of the number of persons married, and by earlier marriages,
which shorten the interval elapsing between successive generations.
Thus 113,361 women were annually married (for the first time) in each
of the two years ending June 30th, 1841, when 160,000 women attained
the age of 20. If 10,000 be subtracted for sickness, infirmity, and in-
capacities of various kinds, 150,000 will remain who might have married
and thus have augmented the numbers married by one-third (82°7) per
cent. The increase by birth, exclusive of illegitimate children, is about
3°4 per cent. annually; and if the marriages and births be increased
one-third, or in the above ratio, the increase by hirth will rise to 4:3
per cent., leaving, after subtracting the loss by death, (which shall be
supposed to remain stationary at 2°2 per cent.,) instead of 1:3, the
present rate, 2°1 per cent. annually as the rate of increase, raised to this
height by the greater number of married childbearing women.

a Cea oe ae litigated aoe whether carly marriages are
ian late marriages ; for, if even women who married at a

 

* Dr. Granville and Mr. Finlaison, Parl. Friendly Soc, Rep., 1825.
—

POPULATION. | 23

mean age of 30 bore as many children as women married at 20, it will
be immediately perceived that the annual number of births, and the
rate of increase, will be widely different in the two sets of circumstances.
It may be assumed that at the birth of their children the age of the
mothers will be advanced equally in both cases—six years, for instance,
on an average—from the time of marriage; the mean age at the time
the children are born will consequently be 36 years and 26 years. The
interval from the birth of the mothers to the birth of the children will be 36
years and 26 years; and, according to the same law, the interval from
the marriage of the mothers to the marriage of the children will be
equally 36 years and 26 years. Now, in this case, altogether inde-
pendently of the reduction by death in the 10 years, if the same number
of women continue to marry, and if the expectation of life and the
fecundity of the women remain unchanged, the births will be raised
above or depressed below the present number, in the inverse ratio of 36
and 26 to 30. At present, the interval from generation to generation,
from the birth of the parents to the birth of their children, may be
30 years; in'the case of the early marriages, a generation would be
reproduced every 26 years; of the late marriages, every 36 years; and,
as by the hypothesis, the number born in each generation would be the
same, the number born in a given time would differ in the ratio of the
intervals which separated the generations.

If the annual number of births preserve the same ratio to the
population, a decline of the rate of mortality will raise the rate which
regulates the growth of the population. Reduce, for example, the
annual rate of mortality from 2°245 to 2:000, and you raise the rate of
increase from 1°333 to 1°578 per cent., unless ‘215 be simultaneously
subtracted from the rate of increase by birth, which would be likely
enough to happen in nature. It is scarcely necessary to add, as a
corollary deducible from this statement, that where the births are equal
in two nations, or in the same nation at distant periods of time, the
population will be proportional to the duration of life; that where the
births are 1,000 annually, and the mean duration of life 25 years, the
population will be 25,000 ; but that if the duration of life be by any
means extended to 50 years, the population will ultimately become
stationary at 50,000.

From the incomplete registration of births, the limited number of
facts on which the age at marriage and the proportion of first mar-
riages are calculated, and the complications arising from the increase or
decrease of the population by birth, death, immigration, and emigration,
I do not advance the preceding numerical statements as absolutely
correct or definitive ; and I hope to be able to resume the examination of
these important subjects ata future time, when more extensive materials
have accumulated and have been analyzed. None of these qualifications
will, however, invalidate the general principles; and the facts prove,
beyond all question, that the population of the country is susceptible of
an immense expansion ; that it is voluntarily repressed, and always has
been repressed, to an extent which has not been clearly conceived or
stated; and that the means in the hands of nature, and of society, for
increasing and diminishing the population are simple, efficient, and
quite compatible with our ideas of the benevolence of the divine
government of the world.

Writers upon population have, perhaps, exaggerated the influence
of the increase of population on the strength and prosperity of states ;
but its importance is unquestionable, and it must always be interesting
to understand the laws which regulate the death—the reproduction of
individuals ; and which, iu the midst of the struggles of the antagonist
24 [PART I.

forces of disease and death, the losses by war, want, vice, and error,
ensure the perpetuity and life of nations.

It is not my intention—and it would be out of place here—to discuss
the questions, whether the population of England is increasing too fast
or too slowly? whether any steps should be taken to accelerate or
retard its progress? whether the Government should encourage or
discourage population; or, after obtaining and publishing all the
information that can be procured on the subject, leave public opinion
and private prudence to come to their own conclusion and to take
their own course? I shall merely notice very briefly how the rate of
increase in the population is raised or lowered instinctively ; as the
indications of nature will be found valuable guides by all who scek
to influence the opinions and conduct of mankind.

When the rate of increase is to be lowered, the usual course appears
to be to defer to the extent required the period of marriage. If the
supplies of subsistence were cut off, if science and industry were unable
to convert a larger proportion of the materials of nature into food, and
all the outlets and demands of emigration were closed, the population
might unquestionably be brought to a stationary condition without
increasing the deaths—by reducing the number of marriages. At
present one fifth of the women who attain the age of 24°3 years never
marry ; if one-half of the women who attain that age never married,
and illigitimate births did not increase, the births would ultimately not
exceed the deaths, and the population would remain stationary. But
the same end would be almost as effectually and less harshly attained,
though four-fifths of the women who arrived at the mean age of
marriage continued to marry, if instead of beginning to marry at 18,
none married under 23, and the mean age of marriage were raised to
30 years; for the interval from generation to generation would be
thus extended, the children to a marriage diminished, and the number
of women at 380 would be reduced by the loss of the younger lives.
The reduction to a stationary condition is put as an extreme hypothetical
case, and as one not likely to be called into requisition ; but it is evident
that if the population could thus reduce itself to a stationary condition,
it possesses still greater facilities for reducing the rate of increase any
number of degrees below the present standard, without increasing the
mortality. Ifwe put another purely hypothetical case, such, for instance
that the population of the south midland division of the kingdom is in.
creasing too rapidly ; that the competition among labourers is threaten-
ing to be too severe ; that their wages will not, in the end, support their
families ; that relatively to the means of employment and subsistence—
the land, eapital, and industrial enterprise—the inhabitants are likely to
be too numerous; what, in these circumstances, would be the course
pointed out by vature for those classes most directly exposed to priva-
tion to pursue ? Would it not be to defer the present early marriages ?
And if the 25 in 100 women of Bedfordshire and Huntingdonshire, the
23 in Cambridgeshire, the 22 in Northamptonshire, the 92 in Hertford.
shire, the 18 in Buckinghamshire, who now marry under age, deferred
the period of marriage until they were 21, 22, 23, or 24 years of age
until they had gained some experience of life, and accumulated Sonik
of the means of living, physiologists and economists would probabl
agree in saying, that this increase of the prudence, which is now
operation, would not—except in special cases—be calculated to dete-
riorate the health or intelligence of their families. It is well worthy of
remark and of careful consideration, that the number of persons a
marry under age, as well as the number of marriages and of births, is
muca greater in some counties than in others; but it must not ie
POPULATION. | 25

thence inferred that the population is increasing too fast in those
counties; for it may happen that a population increasing at a slow rate
is increasing too fast, and that another population increasing at double
the velocity is barely meeting the demands for hands and skill—in the
harvest-field of labour. I stated the case of the south midland coun-
ties, therefore, merely as an illustration of the doctrine that, if any part
of the population of this country is increasing too fast, the means of
repression are simple, would not be harsh in their operation, and are at
the command of the immediate sufferers.

The population is increased most naturally by reversing the process
described—by earlier instead of later marriages—while a somewhat
higher proportion of women marry, leaving stili a large residue, in-
cluding all afflicted with hereditary ailments, and thus affording scope
for the selection, which is invariably, though perhaps insensibly,
exercised in large masses, and must tend to elevate the moral and
intellectual, as well as the physical qualities of the race.

Dr. Price, at the close of the last century, excited alarm by a forcibly
drawn picture of the depopulation of the kingdom; and no sooner had
the census demonstrated that Dr. Price’s fears of depopulation were
groundless, than the “increase of population in a geometrical pro-
gression,” enunciated in the theory of Mr. Malthus, turned the gloomy
forebodings of speculators in quite an opposite direction. Both these
writers contributed essentially to the development of the true theory
of population ; both rendered important services to mankind by their
investigations ; but the facts since elicited, and the further prosecution
of the inquiries which they commenced, have shown that while the
study of the doctrine vf population is fraught with instruction, and is
suggestive of prudence, it is calculated to inspire a calmer confidence
in the ordinances of nature, and to confirm our faith in the destinies
of England. The expansion of which the reproductive force in the
population is susceptible, and the progress of science and industry, must
set at rest all dread of popopulation ; which has apparently never pre-
vailed for any length of time since the earliest historical ages. ‘The
population, it has been proved, has increased in a geometrical pro-
gression ever since the first census in 1801: and the rate of progression
has been such that, if it continue, the numbers will have doubled in
1850: double the number of families wili exist, and must be supplied
with subsistence in England: but there will also be double the number
of men to create subsistence and capital for her families, to man ber
fleets, to defend her inviolate hearths, to work the mines and manu-
factories, to extend the commerce, to open new regions of colonization ;
and double the number of minds to discover new truths, to confer the
benefits and to enjoy the felicity of which human nature is susceptible:
If the proposition of Lord Bacon be sound, as it unquestionably is, that
the “true greatness (of a state) consisteth essentially in population and
“ breed of men,” time has confirmed his prescient assertion, “that out
“ of doubt none of the great monarchies, which in the memory of time
“ have risen in the habitable world, had so fair seeds and beginning
“as hath this estate and kingdom.”* If the population of England
had remained stationary from the age of Elizabeth, and had now
not exceeded the population of Belgium; or even if the population
had been stationary from the time that Malthus wrote, the empire

 

* Of the True Greatness of Great Britain, Lord Bacon’s works, vol. i. p. 502. It
is to be regretted that Bacon did not complete this essay; it commences very much
in the manner of Machiavelli’s “ Discorsi,” and was probably intended to infuse a
little courage into James I.
26 [PART 1.

could scarcely have attained its present power, or sustained its present
greatness. Should the time nevertheless come, when the country is
sufliciently populous, and it should be desirable to retard or stop the
progress of population—the analysis of the marriages, births, and
deaths, in connexion with the census returns, will show, as has been
already proved, that this may be effected without raising the mor-
tality. The principle of “an increase of the population in geometrical
* progression” has nothing in it fatal, irresistible, inexorable; upon a
rigorous analysis of the facts, it is seen that it consists of nothing
but an excess of births over the deaths, and becomes a negative
quantity, or “a decrease of population in geometrical progression,”
if the births cease to maiutain the same ratio to the population; and
the births may always be reduced rapidly by retarding the period and
number of marriages: so that the mathematical terror, “a geometrical
“ progression,” cannot alarm any one in the light of day. I do not
desire to disguise or underrate the gravity of the fact, that the popu-
lation of England has increased, as the censuses prove,—and_ the
excess of births over deaths leaves beyond doubt—in a geometrical
progression for 40 years, and at a rate by which, if continued, it will
double every 49 years. But what has called so many millions of
people into existence in 40 years? Why have the English increased
so much more rapidly than other nations? By what force has the
high rate of increase been sustained ; and what gave it the velocity
of this geometrical progression, but the creative energy and intelligence
of the country and race? And can any one fear for ihe conduct and
fate of this people, if they should feel themselves called upon to rear
fewer children—to marry less early than during the last 40 years ? Will
not the same intelligence and energy which increased, diminish the rate
of increase to any extent, when they take the form of prudence ?

I have only discussed the increase of the people so far as it is
immediately connected with and explained by the registered marriages,
births, and deaths. But I may illustrate the practical bearing of the
inguiry by one inference, and by noticing a fallacy which has perhaps
had some influence on the opinions and conduct of practical men.

The growth of a population depends upon ihe excess of births over
deaths ; and the number of births is regulated by the number of mar-
riageable women ; whence it follows that where there is a permanent
demand for labour in colonies, men and women should be induced to
immigrate in equal numbers. Colonies can only he planted by families.
In New South Wales (1841) the number of free females was 40,425,
the number of free males 61,324 ;* 17,551 of the females, and 18,802
of the males were married ; now, if 20,000 persons of each sex were
under the age of 20, it is evident that the free men were to the free
women above 20 nearly as 40,000 to 20,000, and that the immieration
of 20,000 marriageable women might double the number of) marricd
persons,—-double the number of births; which must otherwise remain
less than the deaths until the excess of males has perished. The prin-
ciple holds in all cases. The negro race will probably not experience
a higher mortality in the West Indies, than can be replaced by the
births in faveurable circumstances ;t but the population can only be
permanently augmented by the immigration of females and males in
equal numbers.

 

 

 

 

* Mr. Porter, in Statistical Companion, by C. R. Weld, 1843, Peas

t Major Tulloch bas shown that the deaths were more numerous than the births
and that the black population decrcased in the West India Islands before their
emancipation from slavery.—Arnals of Medicine, vol. i. p. 399, ;

XN,
POPULATION. | 27

The fallacy to which I have referred rests on this doctrine: “ the
population is increasing in a geometrical progression, the means of
subsistence in an arithmetical progression, and unless wars, destructive
epidemics, marshes, dense towns, close workshops, and other deadly
agents, carry off the excess of the numbers born—unless the outlets
“ of life and blood be left open—the whole people must be exposed to
“ a slow process of starvation.” This has been considered by some the
doctrine of population. The nature of the increase in geometrical
progression has been already examined; and there is no evidence
whatever to prove that while capital increases in geometrical progression
(compound interest) the subsistence and power of the people of these
islands have increased, or will increase, in arithmetical, and not in
geometrical progression. It is not known how much subsistence has
increased in the last 40 years ; and it is pure empiricism to pretend to
say that the rate of progression has been, or will be arithmetical, if
anything more be meant by that formula than the plain incontrovertible
fact that the increase of subsistence is limited. But independently of
these considerations, and of any matters of controversy which it would
be inconvenient to advert to here, the facts in the previous part of this
paper dispose of the fallacy,—which, if it cannot be employed by any
but the most depraved to sanction the destruction of life, might slacken
the zeal of some in ameliorating the public health, by lending a colour
to the dreadful notion that the excess of population is the cause of all
the misery incidental to our condition or nature; and that the popu-
lation might at the same time be diminished and saved from starvation,
by epidemic diseases, unhealthy employments, or pestilential localities.
What are the facts? An increase of the deaths can only diminish the
population if the number of births remain stationary. It hus been
shown that the number of births may be increased to an incredible
extent ; experience has proved that the births almost mvariably increase
when the mortality increases; and it will be seen, in the Tables of the
Report, that where the mortality is greatest, the births are most
numerous and the population is increasing most rapidly. An increase
of the mortality is therefore no sen, Are establishing an equilibrium

aon
RRR

between subsistence and population. ‘Whe more, in fine, the doctrines
of population are studied, the more deeply must be impressed upon the
mind the sacredness of human life, and of the safeguards by which it
has been surroumded by God and the laws., (Fourth Annual Report,
pp. 133-46.) )

~~

It is not intended to discuss here what has been sometimes called the
Law of Population, further than briefly to state how the increase of
population depends on many elements, which vary and produce various
results—sometimes identical in the mere numbers which they present
at the census, but different under all other aspects.

he numbers, and consequently the increase or decrease, of people in
arcivilized country, depend upon the age at marriage and the age cf the

parents when their children are born—the numbers who marry, the .

fertility of the marriages—the duration of life—the activity of the
migration flowing into or out of the country. These acts more or less
influence each other, and in the present state of statistical observation,
the precise effect of a change, in any one of them involving others
cannot be determined.” 1t will be sutficient to indicate the effect of a
change in cach elemerit, while the others remain constant. ~

1. The numbers of the population bear a definite relation to the
duration of life, or to-the mean lifetime. Thus, if the mean lifetime of
28 [pant I.

a population is 30 years, then if the births are 100,000 a year and
remain uniform, the population will be 80 times 100,000, or 38,000,000.
Now, the births remaining the same, let the lifetime be gradually
extended to 40 years; then the population will become 4,000,000; or
if the lifetime is extended to 50 years, the population, from the exten-
sion of life alone, will rise from ¢hree to five millions. The deaths,
upon this hypothesis, will be equal to the births; and the same in
number when the population is five, as when it is fowr, or three millions.
It is probable that the mean lifetime of the great body of the population
did increase from the year 1801 to 1821, when the increase of population
was greatest in Great Britain.

2. The interval from the birth of one generation to the birth of their
descendants of the generation following, bears also a definite relation
to the numbers, which increase as the interval is shortened. Thus, if
the population increases at the rate of 1°329 annually, and if the inter-
vening time from generation to generation is 33} years, it follows that
the increase from generation to generation is 55 per cent. ; or that every
1,000 women are succeeded, at the interval of 334 years, by 1,553
women; every ¢wo couples, male and female, by three. If the interval
is contracted, and the increase from 1,000 to 1,553 takes place in 80
years, the annual rate of population increases, simply on this ground,
from 1°329 to 1°477 per cent.; and, as we assume by hypothesis that
the births and the lifetime remain the same, the population would be
ultimately one-ninth part more numerous than it was under the former
conditions. Early marriages have the effect of shortening the interval
between generations, and tend in this way to increase the population.

3. An inerease in the fertility of marriages will evidently cause an
increase in the population.

4. In ordinary times, a large proportion of the marriageable women
of every country are unmarried, and the most direct action on the
population is produced by their entering the married state. Thus in the
South Eastern Division, comprising Surrey, Kent, Sussex, Hants, and
Berks, the number of women of the age of 20 and under the age of 45
amounted, at the last census, to 290,209; cf whom 169,806 were wives,
and 120,408 were spinsters or widows. 49,997 births were registered
in the same counties during the year 1850, or 10 children were born in
1850 to every 58 women living in 1851. Of the children, 46,705 were
born in wedlock, 3,292 were born out of wedlock ; consequently, 36
wives bore in the year ¢ez children, and of 366 unmarried women of
the same age (20-45) ten also gave birth to children. A change in the
matrimonial condition of a large proportion of the 120,403 unmarried
women, out of 290,209 women at the child-bearing age, would have
an immediate effect on the numbers of the population ; and, if continued
by increasing the rate of birth to the living through successive
generations, would operate on population like a rise in the rate of
interest on the increase of capital.

5. The effect of migration on the numbers of the population is evident.
It is probable, that the immigration of Irish has contributed to the
increase of the population in England; and it is certain that the emigra-
tion from the United Kingdom contributes largely to the increase of the
population of the United States. The emigrants are a self-perpetuating
body in healthy climates; and they increase faster abroad than the
general population at home, as they contain an excess of the population
at the reproductive age; so that, if their numbers are added together,
it is certain that we get in the aggregate, a number much below the
number of survivors. The population of the United Kingdom, iveluding
the army, navy, and merchant seamen, was 21,272,187 in 1821, and
POPULATION. | 29

about 27,724,849 in 1851; but, in the interval, 2,685,747 persons
emigrated, who, if simply added to the population of the United
Kingdom, make the survivors and descendants of the races, within the
British Isles in 1821, now 380,410,595.

6. Finally, the numbers of the population are increased by an abun-
dance of the necessaries of life ; and reduced by famines, epidemics, and
public calamities, affecting the food, industry, and life of the nation.
The pestilences of the middle ages—the famine, the influenza, and the
cholera of modern times—-are examples of one class of these agencies ;
the security, and freedom which England has latterly enjoyed, are
examples of the beneficent effect of another class of influences, not only
on the happiness of the people, but also on the numbers which the
country can sustain at home, and can send abroad to cultivate, possess,
and inherit other lands.

All these causes affecting the increase of the population of Great
Britain, and the precise extent to which each operates, will ultimately
be known by means of a continuous series of such observations as have
been commenced at this census.—(Census Report, 1851 ; Enumeration,
Vol. I, pp. xxxi-ii.) cece Saati

Inerease and Decrease of Population—The natural increase of popu-
lation, instead of proceeding at the actual rate of about 1°38, would, it is
said, be in the end 1°8 per cent. annually ; it would go on indefinitely,
and would double the population every 39 years; at the natural rate
actually prevailing, upon this hypothesis the population will double itself
in 55 years. This question has, therefore, to be discussed.

Mr. Malthus calculated that the unrestrained principle of population
would fill not only the earth with men, but people all the planets of all
the suns that shine in the visible universe.* And latterly the President
of the Health Officers of London, finding that the proportion of children
that die under five years of age is more than 40 per cent. of the total deaths
in England and Wales, remarks :}|—“ If ‘this were not so, the increase
“ of population would be prodigious; for it is the means whereby the
annual excess of births over deaths is kept down to the reasonable
“* proportion of 12°8 per 1,000 of the population. If it reached to 18 per
“1,000 * * -the population would be doubled in rather less than 40
‘years. Consider for a moment the consequences of this. * * In 40
“* years the population of England and Wales would be over 45,000,000
“« * * in 120 years * * it would be near 182,000,000. * * This
sort of thing could never last; for in about 240 years the population
of England and Wales, unless it was exported in huge masses, would
“ reach to rather more than 1,550 millions, and it would be as thickly
« placed over the whole country as it is in London at the present moment.”
At the rate here called ‘“ reasonable,’ the population by the hypothesis
would double itself every 544 years, so that the time in which the dreaded

ee

.

 

* Malthus had the following passage in one edition of his Political Economy :
“Tf any person will take the trouble to make the calculation, he will see that if the
necessaries of life could be obtained without limit, and the number of people could
be doubled every 25 years, the population which might have been produced from a
single pair since the Christian era would have been sufficient, not only to fill the
earth quite full of people, so that four should stand upon every square ysrd, but to
fill all the planets of our solar system in the same way, and not only them, but all
the planets revolving round the stars which are visible to the naked eye, supposing
each of them to be a sun, and to have as many planets belonging to it as our sun
has.” (Quotation from Malthus’ “ Principles of Political Economy,” p. 227, in
Godwin on “ Population,” p. 484. I do not find the passage in the second edition
of the “ Principles ”].

+ On the Estimation of Sanitary Condition. By H. Letheby, M.B., pp. 20-21.
30 [PART I.

catastrophe would overwhelm this nation could only be deferred 87 years
by the continued Herodian sacrifice. On a par with this is Dr. Price’s
illustration of the power of compound interest: “One penny put out at
“ our Saviour’s birth to five per cent. compound interest would in the
“ year 1791, have increased to a greater sum than would be contained
“ in three hundred millions of earths, all solid gold.”’*

There is evidently something singularly seductive in these applications
of the abstract doctrine of series in geometrical progression to actual
facts: even Justice Blackstone is led by geometrical progression to make
the following statement :—

“The doctrine of lineal consanguinity is sufficiently plain and obvious ; but it is
at the first view astonishing to consider the number of lineal ancestors which
every man has, within no very great number of degrees; and so many different
bloods is a man said to contain in his veins, as he hath lineal ancestors. Of these
he hath two in the first ascending degree, his own parents; he hath four in the
“ second, the parents of his father and the parents of his mother; he hath eight in
the third, the parents of his two grandfathers and two grandmothers ; and by the
same rule of progression, he hath an hundred and twenty-eighth in the seventh ;
a thousand and twenty-four in the tenth; and at the twentieth degree, or the
distance of twenty generations, every man hath above a million of ancestors, as
common arithmetic will demonstrate.’ This is further explained in the note.
This will seem surprising to those who are unacquainted with the increasing
power of progressive numbers ; but is palpably evident from the following table
of a geometrical progression, in which the first term is 2, and the denominator
also 2; or, to speak more intelligibly, it is evident, for that each of us has two
ancestors in the first degree; the number of whom is doubled at every remove,
because each of our ancestors has also two immediate ancestors of his own.

¢

«

”

Number of Number of

Lineal Degrees. Ancestors, Lineal Degrees. Ancestors.
1 2 11 2,048
2 4 12 4,096
3 8 13 8,192
4 16 14 16,384
5 32 15 32,768
6 64 16 65,536
7 128 17 131,072
8 256 18 262,144
9 512 19 524,288
10 1,024 20 1,048,576

‘ A shorter method of finding the number of ancestors at any even degree is by
* squaring the number of ancestors at half that number of degrees. Thus 16 (the
number of ancestors at four degrees) is the square of 4, the number of ancestors at
‘ two; 256 is the square of 16; 65,536 of 256; and the number of ancestors at 40
« degrees would be the square of 7,048,576, or upwards of a million millions.”
[Chitty’s Blackstone’s Commentaries, 21st Edition, Vol. 2, pp. 203-204.

«

Mr. Malthus argues that population, if unrestrained, will double itself
every twenty-five years{ ; but let it be assumed that the doubling period
is lower, or equal to 834 years—that is the mean interval between two
generations—according to the common reckoning, then, beginning at one
end of the series, a pair in 40 such periods (1,333 years) will yield more
than a million millions of descendants; and beginning at the other end
and proceeding backwards, according to Mr. Justice Blackstone each
descendant has more than a million millions of ancestors !

The fallacy that deceives Blackstone in the latter case is the want of
continuity in the law of the series; a man has, it is true, four ancestors

 

* Price’s Observations on Reversionary Payments, vol. I. p. 314,

7. Let tie first term, m the number of terms, and 7 the rate; then evidently
arirz=ar.

{ Which implies an annual rate of increase of 2°81 per cent.
POPULATION. | 31

in the second degree, because the marriage of brother and sister is prohi-
bited and there is a fusion of four bloods; but as the marriage of first,
second, and every order of cousins is permitted under this law, no more
than four ancestors are indispensable to the fortieth man in descent ;
without the prohibition the whole of the human race might evidently be
traced up to two ancestors—and two bloods. The mind is led on
throngh the first step, as Blackstone was, to the inference that because
aman has a father and a mother, and 2 grandfathers and 2 grandmothers
—he must have 8 great grandfathers and great grandmothers, and so on ;
which is not necessary, and if pursued far enough becomes improbable,
absurd, impossible.

The hypothesis of increase of population in geometrical progression
had been advanced before,* but Malthus in his practical applications of
it brought it home to the public mind, and led to further researches,
and to exciting controversies, Godwin—a man of genius-—whose work
on Political Justice had suggested the controversial essay of Malthus in
1798, answered it in his Enquiry concerning Population, and Sadler
collected a great many facts in his work.f The facts at the disposal of
the respective writers were numerous, but they were incomplete, and in
England the statistical facts we now possess respecting the conjugal
condition of the men and women living at the several ages were then
entirely absent, as the information in the early censuses was meagre.
All that is further wanted now in the English Birth Schedule to clear
up this vital question conclusively is the entry of the ages of the mother
and father at the birth of their children, and the order of the births.{
Instead of discussing the principle of population and the hypothesis of
increase in geometrical progression—which its authors have reduced to
absurdity—I propose to state enough of what is known to prove that a
reduction in the rate of mortality can be attended by none but the most
salutary effects to the nation.

Population is sustained when the births equal the deaths in the same
time ; when the deaths exceed the births population declines, and when
the births exceed the deaths population increases.. Migration is here
left out of account. The balance is affected by the changes in each of
two variables; thus, if the population of England was stationary the
deaths would be at the rate of 2°447 per cent., the births 2°447 also;
the difference is zero ; but the population increases, as we have seen, so
the deaths are at the rate of 2°242, and the births not only equal but
surpass the deaths in every 100 of population by 1:264, which is there-
fore the natural increase. The mean lifetime in England is 41 years.
Should it become as long as it is in the healthiest districts it will be
49 years; and instead of 1 death and 1 birth to 41 living there will be

, 1 death and 1 birth to 49 living, the latter implying an annual rate of

2°041. An increase of the years men live involves a decrease of the
annual mortality, but not necessarily any increase of population; for the
birth-rate may fall to an equivalent extent.

The death-rate of a population is under control, but not to the same
extent as the birth-rate, which depends on voluntary marriage and
fertility, which have hitherto been marvellously regulated so as to meet
generally the demand for men. Thus, England has an increasing

 

* Voltaire, after giving it as his opinion that the population of Europe had tripled
since the time of Charlemagne, adds with his incisive common sense: “ J’ai dit
“ triplé, et c’est beaucoup; car on ne propage en progression géométrique. Tous
“les caleuls qu’on faits sur cette prétendue multiplication sont des chiméres
“ absurdes.” Dict. Philosophique, Art. Population.

+ Godwin on Population, 1820. Sadler on Law of Population, 2 Vols., 1830.

{ Done in the Registers of our Australian Colonies.
82 [PART I.

industry and a vast colonial empire to people, so the births are
numerous. In France the death-rate in the ten years was 2°36,
differing a little (0°12 in excess) from that of England; but the birth-
rate was only 2°63 in France instead of 3°51 as it was in England.
France had no colonial demand for population, and so the population
was not depressed by a high death-rate but by a low birth-rate. The
increase of population was only 0°27 per cent. per annum.

Many species of animals have, as the geological records of the
world show, perished; and man could never have survived the perils of
his early historic, to say nothing of his prehistoric, life had his race not
been endowed with a reserve of reproductive force sufficient to repair
the recurrent wastes of famines, wars, and plagues. At the present
hour in England half of the women of the child-bearing ages are
unmarried; and though the annual births maintain an actual excess
over the deaths, they are kept down to half their possible number. A
flow of prosperity in the country is immediately followed and marked
by the launch of a whole fleet of marriages. The ruin of an industry
or the depression of a trade implies a stagnation of marriages. There
are thousands of couples always on the look-out, ready to embark as the
prospects brighten.

It has been observed that after the ravages of plagues the births
increase, so the aching voids are filled up as regards mere numbcrs.
Under ordinary conditions an increased death-rate is attended by an
increased bivth-rate, so as either to maintain the population stationary
or increasing, according to the exigencies of the case. This is only
possible within certain limits, for an excessive death-rate is attended
with such waste that it cannot be overtaken by the births; the popula-
tion declines, or is only sustained by immigration. We have the means
of establishing this law by English observations——(Supplement to
35th Annual Report, pp. ix.—xii.)

Influence of Birth-rate upon Population—The births, again, are
under control to an extent which has not yet been duly appreciated, but
is now rendered clear by the census. This will be shown by an
examination of the facts. Leaving unregistered births out of account,
the number of children registered as born in wedlock during the ten
years 1861-70 was 7,043,090; the wives, all between the ages of 15
and 55, were more than three millions one hundred and fifty thousand,
and the number of unmarried women of those ages was full two million
seven hundred and ninety thousand, who bore only 457,006 children in
the ten years. Butas the greater part of the children of this country
are borne by women of the age 20-40 we may take them here as the
basis of calculation, and then to every 100 wives of that age 35°87
children were born annually (1861-70); while to every 100 spinsters
and widows living of the same age only 3°34 children were born. But
in 1871 the number of wives enumerated at the age 20-40 was
2,080,991, who at the above rate would give birth to 746,452 children
in the year. And the number of spinsters and widows of the same age
was 1,423,360, who, if married with the same fertility as the wives,
would in that year have borne 510,559 children, but at the actual
registered rate only bore 47,540 children, leaving 463,019 over.

The married women are to some extent a selected class, and so,
striking off 333,931 from the unmarried women of the age 20-40, there
are left 3,000,000 married or marriageable women, living through
1861--70, who at the rate actually observed among the wives would have
borne 10,761,000 children, instead of 7,500,096. ;

At the birth rate cited, to every wife of 20-40 a child is born nearly
every three years (2°8) ; butin some counties the mean interval between
POPULATION. | 33

each birth approaches 24 years, and looked at physiologically it might,
after allowing for wives with no children and other drawbacks, be
reduced to two years, which, with the additional marriages, would have
the effect of doubling the number of births. There is, therefore, no
doubt that even in England the number of births in wedlock admits of
great expansion, and would receive it in the event of great demands on
the resources of the nation to fill up its ranks from losses in war, from
the ravages of a decimating plague, from the efflux of a great emigraticn ;
or to meet any extraordinary development of commerce and industry.

Then, as only 78,225 of the young women of the ages 15 to 21 are
wives, of ages ranging in number from 151 at 15 to 48,652 at 20, there
remains a further reserve of 1,246,743 maidens unmarried; so that
England is in truth fertile in men, ferax hominiwm, and holds an ample
reserve to meet whatever demands may be made upon her by fate in the
future. (Census Report, 1871, vol. 4, pp. xv.-xvi.)

Censuses and Poputation Registers—In the intervals between two
Censuses there is a continual inflow and outflow of people of all ages,
some entering the gates as visitors, some as settlers, some as new-born
infants; and others leaving it as travellers, as emigrants, as passengers

“to that “country from whose Dourne no traveller returns.” If we had
had such registers of population as have been recommended by the
Statistical Congress, starting from the nominal list of the Census of
1861, the numbers who came into the country in any way would be
added to the register, and the numbers who left would be struck off; the
difference between the incomers and the outgoers, added to the numbers
of 1861, should, when the balance is struck, equel the population of the
Census of 1871.

Unfortunately, no such population register exists ; but it does not
follow that we have no means of determining approximately the inward
and outward movement of the people. Statistics is in some respects, in
the present day, dealing with men like trigonometry dealing with lines
and angles, able to deduce from certain given data others of which there
is no trace; from a basis of observed facts other facts can be determined ;
thus by means of the English Life Table, the number of persons
enumerated at the several ages, the number of persons born in other
countries at successive Censuses, and the number of English birth in
other parts, it is possible to determine the income and outgo of people
from the English and Welsh divisions of these islands.

For the exact determination, accurate enumerations of the population,
complete registers of births and deaths, and true returns of all emigrants
and immigrants, ure required. We may assume that the enumeration of
the population was rather more complete in 1871 than in 1861 or 1851;
but this may be left out of account. The births have been more fully
registered every year since the Act came into operation in 1837, yet
some are still missed; but the births in the preceding ten years can be
very accurately calculated from the number of their survivors enumerated
under ten years of age on the Census Day. That has accordingly been
done, and the calculated can be compared with the registered numbers
in the three decennia, 1841-71. (Census Report, 1371, Vol. 4,
p. Xxiii.)

The finally revised results of the eighth decennial Census show that
on the 3rd April 1871 the total population of England and Wales was
22,712,266, having increased by 2,646,042 persons, or at the rate of
13°19 per cent. since the Census of 1861. This the largest decennial
increase, relatively as well as actually, that has taken place since

Cc
34 [PART I.

1831-41; and some, at least, of the causes which have led to this arrest
of the tendency of the population to increase at the decreasing rate
observed from 1811 to 1861 will no doubt be elucidated when the
analysis of the conditions, occupations, and birth-places of the people is
completed. But the effect of a particular cause or set of causes in
augmenting or diminishing the rate of increase between any periods can
at the utmost be traced approximately so long as the marriage, birth, and
death registers, an obviously defective record of emigration, an entire
absence of knowledge respecting immigration, and a Census taken once
only in every ten years, are the sole available guides. The interest of the
public at large in statistical inquiry is as yet undeveloped sufficiently to
justify an attempt to establish a Population Register,* or a record of the
migration of every person going into or coming from Scotland, Ireland,
or elsewhere beyond seas; and it is of little use to speculate upon
the nearness or remoteness of the probability of obtaining statistics
complete enough to demonstrate the part played by each of the many
factors concerned in producing a growth or decline of the population.
(34th Annual Report, p. vii.)

Period in which Populaticn doubles itself.t—The rate at which the
population of Great Britain increased from 1801 to 1851 is such, that
if it continue to prevail uniformly the population will double itself
every 52°5 years; in England and Wales the period of doubling on
the same hypothesis is 51:0 years. (Census Report, 1851; Enume-
ration, Vol. 1, p. xxx.)

5d. DENSITY AND PROXIMITY.

Proximity.—The population may be looked at in another point of
view. Every person is in direct or indirect communication with other
persons surrounding him ; and the extent, intimacy, and number of the
relations between people depend very much upon the degree of their
proximity. If the persons, houses, villages, towns, are twice as far
apart from each other in cne country as they are in another, the force
and interaction of the two communities will differ to an inconceivable
extent. Proximity can be expressed with the same precision as density
of population, upon the same hypothesis of equal distribution; and its
relative value in different countries and districts is equally interesting.
Thus, the people of England were, on an average, 152 yards asunder in
180], and 108 yards asunder in 1851; the mean distance apart of their
houses was 864 yards in 1801, and 252 yards in 1851. On the line of
proximity depends the distance which an enumerator, or a messenger
who has to call at every house, travels on his mission. A messenger
to deliver 1,000 letters at 1,000 houses of average proximity in 1801
would travel 206 miles (362,000 yards) ; in 1851, to deliver 1,000 letters
at 1,000 houses of average proximity he would travel only 143 miles
(252,000 yards). The population on the same area has doubled; the

 

* Population registers are kept in Sweden, Belgium, and Holland. By a decree
of His Majesty the King of Italy, dated 4th April 1873, a register of the fixed popu-
lation is to be established in that country : it is to consist of three parts, one relating
to houses, one to families, and one to individuals. “For each person the register is to
show the name, surname, and sex ; the names of his parents; the place and date of
his birth ; his civil condition, whether single, married, or widower, and if married
the name of his wife, ulterior changes of condition being duly posted up ; his rank,
profession, or occupation ; his residence ; his declared civil domicile ; anda reference
to the folio relating to families under which he will be found inscribed.

t See also Principle of Population, last paragraph but one on p. 15; and Law
of Population, note to p. 19, for formula to calculate the number of years in which
a population will double itself.
POPULATION. | 385

proximity has increased--the separation has diminished—in the ratio
of 8 to 2. In the London division the mean proximity in 1801 was
21 yards, in 1851 it was 14 yards. The population on the same area
increased 146 per cent., or in the proportion of 100 to 246; the
difficulty of personal communication, of delivering letters, parcels,
goods, to every person—expressed by multiplying the distance from
person to person into the numbers—increased only 57 per cent., or in
the proportion of 100 to 157. (Census Report, 1851; Hnumeration,
Vol. i. p. li.)

Density.— Density implies degree of proximity of people to each other ;
but it may be convenient to express explicitly this important relation
of nearness, of neighbourhood which differs so much, not only in foreign
countries, and in colonies, but in English counties. The proximity may
be here given in a few illustrative instances. It is deduced by dividing
first the area of a country by the population. Now the acreage of
England being constant and the population increasing, the number
of acres to a person is continually diminishing; thus the number of
acres to a person was 4'12 in 1801 and 1°64 in 1871; and going back
to a period for which there is a probable estimate of population, the end
of Elizabeth’s reign (1600), there were then 7°71 acres of land to each
person living. The acres of land to each person in the three successive
periods were 7°71, 4°12, and 1°64 acres, and the proximity expressed
in yards was 208, 153, and 96.

It will be noticed that the difficulties of intercommunication between
all the individuals of a population do not increase as much as its
numbers ; for if the population of a county has increased four-fold the
distance to be travelled by a messenger proceeding from person to person,
or from house to house, is only doubled; and generally the distance to
be travelled in going from person to person in two equal counties is
inversely as the square root of the numbers on the same area. This
has an important bearing on every kind of intercommunication. The
distance to be travelled in going from person to person in England and
Wales, if the 9,060,993 persons living in the middle of the year 1801
had been equally distributed would have been 781,086 miles; while the
distance to be travelled in visiting the 22,782,812 living in the middle
of 1871 would only have been 1,238,558 miles.

The mean distance from house to house in 1801 was 364 yards; in
1871 only 221 yards. On the hypothesis of uniform distribution the
distance to be travelled by a postman, for instance, in visiting all the
houses would have been 325,744 miles in 1801, and only 536,345 miles
in 1871.

It will be seen how much the concentration of the people in houses
dimninishes the distance to be travelled; it is reduced in the ratio that
the square root of the number of persons to a house bears to unity.

The concentration of houses in cities while it increases the proximity
of masses of the people diminishes ihe distances to be trayelled in
visiting the houses of those cities, and at the same time econoniises the
connecting roads and all the other channels of communication. (Census
Report, 1871, Vol. 4, p. xxviii.)

Method of calculating Density and Proximity—Let the area of a
place be expressed by A in any superficial units, and the population

by P: then A= D = mean population on thore several units. This is

cenerally called the density of population, and by M. Prony the specific
population. It enables us to express with precisicn the notions conveyed

c2
36 [PART I-

vhen we say this country is populous, that is thinly peopled, that is a
lesert ; the value of D in the lutter case being zero.

We have taken a square mile as the measuring unit of area in the
able, which implies that although the number of people may differ on
very square mile of a country, still on an average of the whole the
umber is as there stated. ‘Thus the populousness of the several
countries can be compared.

Now, instead of dividing the population (P) by the area (A), we may

livide the area (A) by the population, and then p= the mean area

o each person. It may be called, for the sake of convenience, the
weality of the population ; it is the mean number of acres or hectares,
iquare yards, or any other units expressed ly A, to each unit of popu-

ation, a= jy, 80 a is the reciprocal of D, Divide the area by the

A
Touses (H) and we have y= a’ = areality of Houses.

The nearness of house to house or of person to person varies in every
vart of a country, but assuming that the mean areality is given, the mean
wroximity of each person can be at once determined, as the proximity
‘aries in the ratio of the square roots of the areality.

Thus the areality of the population of England in 1871 is expressed
ny 1°64 acres, or of 7,928 square yards to a person ; in 1801 it was
9,934 square yards to a person; and the proximity of person to person,
vhich was 96 in 1871, was 152 in 1801.

Assuming that there were five persons to a household in 1801, and
he same number in 1871, then the proximity of the households is found
vy multiplying the proximity of persons by the square root of 5. It
vould be 339 in 1801, and 214 in 1871.

Again, as persons are grouped together in houses, houses are grouped
ogether in towns, and if the areality of towns is determined by the
ame convention as in the case of persons and houses, the proximity of
ewns can be determined by the same method.

A
The general formula for proximity when the areality p=4 is

‘iven is—

= ( oe jiat= a

34
92
+ = isa constant, and log ¢ = 0°0312347.
32

Nore.—The degree of proximity may be expressed by taking contact
3 unity and dividing this unit by the distance from person to person.
Census Report, 1871, Vol. 4, p. xxviii.)

6. SEXES.

Sex proportion of Pspulation.*—The enumeration of the population
f England and Wales at the various Censuses shows that there is an
Xcess of females living over males living, and it is noteworthy that this
xcess is greater now than it was some years ago.

 

* This subject, with special reference to its effect upon the death-rate of a population,
‘as discussed in a paper by the Editor, read before the Statistical Society in 1874 on
The value of Death-rates as a Test of Sanitary Condition.”
POPULATION, | 37

Number of Maues trvine to every 100 Fematus tivine (exclusive
of the portion of the Army, Navy, and Merchans Seamen abroad).

 

To 100 Females
Census Years. the Number of Males
in England and Wales.

 

Mean of 1821-31 96°35
1831-41 95°87
> :1841-51 95-80
59) 1851-61 - 95°51
» 1861-71 94°96
” 1871-81 - 94°84

 

 

 

 

Thus to every 100 women living in England and Wales at the
Censuses of 1821 and 183} the mean proportional number of men living
_ was 96°35, but this number fell in 1841 and 1851 to 95°80, and fell
' still further in 1861 and 1871 to 94:96.

This disparity in the proportion of males and females living is attri-
butable to the higher rate of mortality, and the much greater amount
of emigration among males than among females. The emigration returns.
of 1877 show the relative proportion of the sewes of emigrants of
English origin ; when they have been published for a series of years
they will throw some light on this interesting point. The number of
male emigrants of English origin in 1877 was 39,829, and of female
23,882. (40th Annual Report, p. xx.)

7. AGES.

Census Enumeration of Ages—The ages of the British population
were first returned in 1821: in 1801 and 1811 “age” formed no head
of inquiry. In 1821 the answers to the question of age were “ purposely
“ left optional, both as regarding the returning officer, and the persons
** to whom the question was to be proposed by him.” Yet the returns
of ages, under this voluntary inquiry, embraced 8 ninths of the persons
enumerated; and where no returns were made it was apparently the
fault of the overseers, rather than of the people; for the omission was
not in individual returns, but in whole parishes and townships. In 1831
the number of males of 20 years of age and upwards was demanded ;
and the inquiry extended no further in this direction. In 1851 the name
and age of each person were written in a schedule, either by the head
of the family or by the enumerator; as indeed had been done, with a
little less accuracy, in 1841.

The ages of 52,565 vagrants and others were not stated in 1841, and
nearly as many ages of the same classes were, probably, omitted in 1851;
but as it is necessary for the purposes of calculation to distribute the
numbers proportionadly over the several periods of life, it was deemed
most convenient to carry out this distribution at once, by inserting their
probable ages in the books, with distinctive marks to indicate the inter-
polation. With this qualification, the numbers, as they were returned,
38 [part I.

of males and females separately, under 5 years of age, of 5 years and
under 10 years, and for each subsequent quinquennial period of life
up to 100, are given in the Tables for each of the 11 divisions, the
52 counties, the 624 registration districts, the 2,190 sub-districts of
England and Wales; for the two divisions, the 32 counties, and some
towns of Scotland; and for the Islands in the British Seas.

Mr. Rickman noticed that in 1821 and 1831 the number of males
under twenty years of age and the number of ¢wenty years of age and
upwards were nearly equal; and this proportion has since been regarded
as invariable, or it has been assumed that the males of the age of
twenty and upwards are equal in number to a fourth part of the whole
population. The Census of 1851, however, reveals a very different
state of things. (Census Report, 1851; Occupations, Vol. 1, p. vi.)

In 1251 the precise age at the last birthday of each person in this
country was, under the Census Act, for the first time demanded; and
the opinion which we entertained, of the probable general accuracy of
the returns within well-defined limits, is confirmed by the tabular results.
The mean age of the females, as they are returned in England, exceeds
the mean age of the males by ¢en months; so that the tendency in
wornen to understate their ages has only operated on comparatively
small numbers ; and there is no doubt of their general truthfulness.

A comparison of the series of numbers living at different ages, and of
the numbers of males and females at the same ages, confirms this view;
but it indicates, at certain ages, some evident mis-statements, which a
comparison with the returns of ages in 1841 enables us to calculate and
define. Persons of the age of 20 in 1851 must have been 10 years of
age in 1841, and persons of the age of 25 in 1851 must have been of
the age of 15 in 1841; and as there is a certain number of losses by
death, it is evident that, excluding the effects of migration, the numbers
at the age 20-25 in 1851 must be less than the numbers living at the
ages 10-15 in 1841, of whom they (20-25) are the natural survivors.

What are the statements which the abstracts of ages express ?

1841. The number of girls, age 10-15, was - 1,003,119
1851. The number of young women, age 20-25
was, as stated in the returns = - - 1,030,446

Now, as the first number could never have swollen in the ten ycars to
the magnitude of the second, we are driven to the hypothesis that in 1841
and 1851 the heads of families returned several thousands of ladies of
the higher ages at ihe age of 20-25; and the hypothesis is confirmed
by comparing the diminished numbers returned at the age of 30-35 in
1851 with the numbers returned as 20-25 in 1841, where it is evident
that the latter number is in deficiency as much as the former number is
in excess.

1841. The number of young women of the age of

20-25, as stated in the returns, was - - 973,696
1851. The number of women of the age of 30-35,
as stated in the returns, was - 768,711

(Census Report, 1851 ; Occupations, Vol. 1, pp. xxiii-iv.)

Effect of Birth Rate on Ages of Population.—If the numbers of births
in each year were equal, and if all men lived a hundred or any other
definite number of years, the numbers that, at a Census, would be found
living at each age, would be equal; so the old men would be as
numerous as the young men, and as the children, in the population.
The great disparity in the actual numbers living at the five ages shows
POPULATION. | 39

conclusively that few of the people of this country have hitherto lived
the natural lifetime. Thus to a hundred thousand children and young
people under the age of 20 there are only 68,593 of the second age
(20-40) ; 36,895 of the third age (40-60); 14,803 of the fourth age
(60-80) ; and 1,355 of the fifth age.

The whole of these differences is, however, not due to premature
death, but to the gradual increase of births (Census Report, 1851;
Occupations, Vol. 1, p. xvi.)

The population is now younger than it would be by the natural
standard ; but as one of the causes of the depression of age operates
with more force in other countries where the mortality is greater, the
people would be on an average older in Great Britain than elsewhere,
were it not for the interference of the increase of births within the last
hundred years, by which the proportion of children and young persons
has been so much increased that it may be questioned whether the
people of any country in Europe are so young as the people of England
and Scotland.

The English Life Table enables us to show what the distribution of
the population would have been in 1851 if the mortality had remained
uniformly at the same rate, and the births had been stationary. To
100 persons at ages under 20 years the proportions at four vicennial
ages, commencing at 20, 40, 60, and 80 years, would, upon this hypo-
thesis, be 81, 63, 33, and 3; while the actual proportions are 69, 37,
15, 1.

One practical consequence may be immediately deduced from this
fact :—Although the births of Great Britain and the mortality remain
stationary, the population will go on increasing ; for the same number
of births which, within the 20 years 1831-51 have produced persons
under 20 years of age, will produce nearly an equal number in the next
20 years; but the survivors at the ages 20-40 will be many more than
the number now living at those ages; and the numbers at each succeed-
ing age will increase until the population ultimately amounts to forty-
one times the births.

The First Census of Great Britain, it will be recollected, was taken
in 1801. The ages of the population were first discriminated in 1821.
Only a portion of the deaths and births in England were returned, as
burials and baptisms according to the rites of the Church of England,
up to 1837, whea the Act for the Registration of Births, Deaths, and
Marriages came into operation. Even since that date a certain number
of births has escaped registratiov, and the accounts of the immigration
and emigration are incomplete, so that, through the want of data, the
investigation of the profound change that has been wrought in the
constitution and distribution of the population as to age is attended with
extraordinary difficulty. ‘The general nature of the change can, how-
ever, be satisfactorily explained.

Assume that a small community of 4,114 persons has been sustained
for a long period by 100 annual births, and that the mortality has been
such that the numbers at each years of age, from the first to the tenth,
are found at a census to be 90, 83, 79, 76, 75, 74, 73, 72, 71, 71, and
slowly diminish, so that there are 66 in the 21st year, 53 in the 41st
year, and so on decreasing to the last age. Now, let the births from
any cause suddenly increase, and instead of LOO be 200 annually, then
the population will increase, and if a census is taken at the end of 20
years it will be found that the population under 20 years of age is,
instead of 1,449, twice that number, or 2,898. While the numbers of
40 [PART 1.

the population under the age of 20 years were to the numbers of
the age of 20 years and upwards at the first census as 1,449 to 2,665,
the proportions at the second census will be as 2,898 to 2,665. The
births remaining the same, if a third census is taken at the end of forty
years the numbers under 20 years will be found to be still the same as
at the second census (2,898); but the numbers at the age 20-40 will
be doubled, and instead of 1,204 be 2,408. The proportional numbers
under—and at or above 20 years of age—will be as 2,898 to 3,869.
Finally, at the end of a century the population will consist of 8,228
persons, of whom 2,898 will be under 20 years of age, and 5,33 will be
of the age of 20 years and upwards. The population at each age will be
in the original proportions ; but all the parts of which the whole number
is composed will be doubled. The disturbance in the proportions of the
youthful and the adult population will be greatest for some years after
the increase of births commences, and will gradually disappear as the
wave of population advances, unless the number of births increases every
year, and maintains the population in an intermediate stage between the
first state and the last change in the illustration. The community will
in successive periods contain an excess of boys ; of boys and youths; of
boys, youths, and young men; of persons in the first (0-20), second
(20-40), and third (40-60) ages ; and the general temper, strength, and
intellectual state of the population will exhibit, to the eyes of the
attentive observer, corresponding changes. Some such change as that
here sketched has taken place in Great Britain; but the increase of
births, at first gradual in the last century, has since proceeded at a rate
accelerated but variable in the several classes of the population and in
the different parts of the British Isles. (Census Report, 1851; Occu-
pations, Vol. 1, pp. xix-xx.)

 

‘Effect of Prolongation of Life on Population—The prolongation of
the life of generations, as well as the increase of births, tends to increase
the numbers living at one time; that is, the numbers of the population.
Thus, of 100,000 children born in Liverpool, only 44,797 live to the
age of 20, while in Surrey that age is attained by 70,885 out of the same
number of children born: the probable lifetime is about 6 years in our
unhealthiest towns, 52 years in Surrey, and other comparatively healthy
parts.* In Manchester, where the mortality is high, 100,000 annual
births only sustain, at the ages 20-40, a male population of 38,919 ;
while in all England and Wales, where the mortality is now much lower,
the same number of births produces a constant force of 61,215 men at
that age; and at other ages similar disparities in the numbers living
exist. Now, the mortality was not much less in all England formerly
than it is now in Manchester ; and the great diminution in the mortality
of England evidently took place at such a period of the last and present
centuries as left proportionally more survivors at the ages 20-40 in 1851
than at the corresponding ages in 1821, for the dangers and logs of life
incurred by the generations born in the 40 years 1781-1801 were
greater than those which were encountered by the generations born in
1811-81. (Census Report, 1851; Occupations, Vol. 1, pp. xxii-xxiii.)

Factors of Population.—Leaving immigration out of account, the
numbers found by the Census living in the country at any age depend
on two totally distinct factors . (1) on the numbers born in the year of
their birth, and (2) on the numbers of them that (a) die or (4) leave the

 

* See Registrar General’s 5th Report, 8vo. pp. 46, 47—In Manchester 100,000
children born are reduced to about half that number (49,910) in six years.—-Regis-
trar General’s 7th Report, p. 334. :
POPULATION. | 41

country between the date of birth and the date of enumeration. The
mean ages of a population may therefore be reduced in three ways: (1)
most obviously by a high rate of mortality shortening their lives,
inasmuch as numbers living at the advanced ages will all thereby be
reduced ; (2) by the emigration of adults in undue proportion; and
(3) less obviously but as certainly by increase of births, for then the
numbers at advanced ages are fewer than they should be in proportion
simply because the numbers of children born years ago, of which adults
are the survivors, were fewer than the children born in recent years.
Thus the 806,722 men of the age of 50-60 in the year 1871 are the
survivors of the 1,689,578 boys of the age of 0-10 when the Census of
1821 was taken; and if the boys of that early age had amounted in
1821, as they did in 1871, to 2,896,209, the 806,722 men of 50-60
would have been raised in the same proportion to about 1,400,000, the
expected number of surviving men at that age half a century hence.—
(Census Report, 1871, Vol. 4, pp. xii—xili.)

Length of a Generation—The Egyptians, or the Greeks, discovered
that there was an average interval of a hundred years between the
births of children and the births of their great grandfathers; or that
the interval in ascending a genealogical table from the birth of the son to
the birth of the father was about 334 years. This time, called a
generation, has been found to agree with modern observation ; ‘ but,”
says Sir Isaac Newton, who adopts the computation, “if the reckoning
“ cf generations proceed by the eldest sons, they are shorter, so that
three of them may be reckoned at about 75 or 80 years; and the
reigns of kings are still shorter, because kings are succeeded not
“only by their eldest sons but sometimes by their brothers; and
“ sometimes they are slain or deposed, and succeeded by others of an
“ equal or greater age, especially in elective or turbulent kingdoms.”
“Kings reign,”* he adds, “oue with another, about 18 or 20 years
“ apiece.” Many of the errors of the ancient clironologies arose from
the confusion, under the term “ generation,’ of the long complete
life of man with the portion of that life extending to the birth of the
next generation; or with the reigning years of kivgs in times of violence
and often of anarchy. Generations overlap each other so that a man
who completes his life lives nearly 663 years contemporaneously with
his children, 334 years with his grandchildren, and many years with
the great, grandchildren of the eldest branches of his family; his
direct influence extends to the second, third and fourth generations,—
(Census Report, 1851; Occupations, Vol. 1, pp. xv—xvi.)

6

a

¢

Centenarians.—Many instances are cited of men living in the ancient
world more than a hundred years; and Lord Bacon in his History of
Life and Death, quotes as a fact unquestioned that a few years before
he wrote, a morris dance was performed in Herefordshire, at the May-
games, by eight men, whose ages in the aggregate amounted to eight
hundred years. No populous village in England was then without a
man or woman of fourscore years uld. In the seventeenth century, some
time after Bacon wrote, two Englishmen are reported to have died at
ages greater than almost any of those which have been attained in other
nations. According to documents which are printed in the Philosophical
Transactions of the Royal Society, Thomas Parr lived 152 years and
9 months, Henry Jenkins 169 years, The evidence in these extra-
ordinary instances is, however, by no means conclusive, as it evidently
rests chiefly on uncertain tradition, and on the very fallible memories of

‘

* Newton’s Works, tom. V. pp. 37-40.
42 [PaRT I.

illiterate old men; for there is no mention of documentary evidence in
Parr’s case, and the births date back to a period before the parish
registers were instituted by Cromwell in 1538.

Until the system of Registration and the Census have been for many
years in operation, the evidence of extreme ages must remain indecisive ;
but there can be now no doubt that some of the twenty-one millions of
people in Great Britain have lived a century; which may therefore be
considered the circuit of time in which human life goes through all the
phases of its evolution.—(Census Report, 1851; Occupations, Vol. 1,

pp. ix—xii.)

In the Report of 1851 we questioned the value of the evidence
alleged in support of some historical instances of extreme longevity, and
since then the instances investigated tend to show that while a certain
number of individuals in each generation live, as the ancients discovered,
100 years (seculum) or more, the number of such cases is exaggerated
among the illiterate in every country where birth registers are not kept.
Tt must not, however, be assumed for a moroent to be impossible that a
small remnant out of a vast number of people should live over a century.
The probability is the other way; for under an ascertained law the
numbers of a generation fall off at a rate of mortality continually
increasing, but yielding a series of lives terminating at no definite point ;
and man goes through successive changes, which are not completed in
less than a hundred years, to which term a perfect life may in ages to
come approximate, All that is here insisted on is that these excep-
tional instances are now rare, and require the support of strong evidence,
which should only be accepted after having undergone the searching
criticism of competent inquirers. The Census itself, by recording the
ages every ten years, tends to check the disposition to put on the dial
of life as age advances, and it is probably to this that must be ascribed
the progressive diminution since the year 1841 of recorded centenarians,
rather than to any decline of their actual numbers. The persons of the
age of 100 and upwards when the ages were first returned amounted in
1821 to 216, and in 1841 to 249; in the two Censuses following to
215 and 20L; in 1871 the number fell to 160, to 41 men and 119
women. Many of these men and women must have been born before
1771,—before Lord Liverpool, a prime minister now historic, was born
—in the early part of the reign of George III.; and in those years the
births certainly exceeded the births previous to 1721, of which the
centenarians of 1821 were the survivors.

 

NuUMBERS RETURNED of the age 100 and upwards.

 

 

 

 

 

Sex, 1821. 1841. 1851. 1861. 1871.

Males 68 83 78 55 41
Females 148 166 137 146 119
Total 216 249 215 . 201 160
Born in or before - 1721. 1741. 1751. 1761. 1771.

 

 

 

 

 

 

 

 
POPULATION. | 43

The regisiry of Baptisms in the church since the sixteenth century
and the civil Registration of Births in operation since 1837 have led to
a more exact knowledge of the ages of the population in England than
in some other countries, and if the people had all been taught to read
and write, ihe ages would have no doubt been returned ag accurately as
they have been in Sweden. As it is, a certain excess has been thrown
on the decennial years, 50, 60, 70, and so on, at the expense of the
contiguous ages. These inequalities are rectified in the graduated
table, where the numbers are distributed at the several ages by the
method of differences, which takes into account the law of the decre-
ment of the living in England, either by age or emigration. The numbers
between the ages of 15-25, and every successive decenniad, agree with
those returned, for no attempt has been made to correct any but
accidental mistakes.— (Census Report, 1871, Vol. 4, pp. x—xi.)

The interest which attaches to cases of reputed centenarianism has
induced me to bring together into one view the particulars of such cases
as were recorded in the death registers of 1871. From time to time
I have to announce in my Weekly, Quarterly, and Annual Reports the
deaths of persons whose ages as stated in the registers, amount to or
exceed 100 years. It will not be deemed superfluous by those who
take note of the newspaper correspondence which so frequently follows
the announcement of a case of extreme longevity, for me to remind
the public that the district registrars have no authority, even if they
had the means and the leisure for so doing to investigate the truth or
otherwise of the statements as to age made by the legal informants of
deaths; the informants are alone responsible for the correctness of
those statements. As a most able and painstaking writer upon this
subject in his recent work remarks: “The Registrar-General has no
“ alternative but to tell the tale as it is told to him.”* Jn 1871 the
deaths of 69 persons were registered at the following ages, as stated by
the informants ; 27 at 100, 17 at 101, 10 at 102, 5 at 108, 3 at 104,
2 at 105, 2 at 106, 1 at 107, 1 at 108, and 1 at 109 years. Of these
reputed centenarians 25 were males and 44 females. From 1861 to
1871 inclusive the registered deaths at 100 years of age and upwards
have amounted to 855, namely, 231 males, and 625 females; so that on
an average 21 men and 57 women ‘go to their graves every year with
the renown of centenarianism attaching to their memories. And the
Census returns show that about 180 persons out of the entire population
would, on enumeration, return themselves as having attained their
hundredth year of life; the annual rate of mortality at this advanced
stage would therefore be about 43 per cent. By the English Life
Table the mortality at the ages 100 and upwards would be 58 per
cent., and that implies 116 deaths annually out of 200 living. There
is evidencet that it would be unsafe to attempt to draw any precise
conclusion as to the limits of the duration of human life from the
unverified statements of individuals in the death registers; all that
may be said with certainty is that instances such as that of Jacob
William Luning, whose death in 1870 at the age of 103 years was
clearly established by documentary evidence submitted and published
in the Weekly Return, show that the limit of life is not absolute at 100
years, however exceptional may be the cases in which it is exceeded.

It is worthy of note that the experience of Life Assurance Societies
in this country supplies only one example of an insured life completing

 

* «uman Longevity,” by W. J. Thoms, F.S.A.

t Mr. Thoms gives examples of 30 cases investigated by him: 4 only of these
turned out to be demonstrably centenarians ; 4 were doubtful; 22 are either disproved
absolutely or are shown to be unsupported by proof.
4+ [PART I.

its hundredth year, namely that of Jacob William Luning above referred.
to. The difficulties attending an investigation of cases of reputed cen-
tenarianism are no doubt considerable, but the question is‘one of scientific
importance.— (34th Annual Report, pp. xviii-xix.)

Mean Age of Population.—The mean age of the English population
has remained constantly since 1851 at 26°4 years. This is the same
result as is obtained by adding up the ages of every persons living, and
dividing by the total number of such persons. The mean age of males
was less than the mean age of females by 0°8 of a year, for the
mean age of the males was 26°0, of the females 26°8 years. The
mean age in England of the people of 20 years and upwards remained
als) very constant ; it was at the three last Censuses 40°4, 40°7, and
40°8 years. .

The fact to observe is that the people of England, which calls herself
Old, are younger than the people of many cther countries, and certainly
younger than the people of the countries of stagnation, not because life
is shorter, but because the births, instead of remaining stationary, are
continually increasing, and infusing youthful blood into the people.
The emigration of adults also reduces the mean age of those left.

The mean natural age of the people living, deduced from the Life
Table, is actually 82:1 years—of the males 31°77, of the females 32°33.
That would be the actual age of the population had there been no
migration and had the births remained constant.—(Census Report, 1871,
Vol. 4, p. xiii.)

8, Crvit or ConsuGaL ConpITION.*

Age at Marriage.—Marriage is the institution by which the popula-
tion is primarily regulated; and while it is the great adjuster of the
numbers it is at the same time the guardian and the educator of the
generations to come. To the urns of Death all contribute; but with
the annual marriages and the births the great mass of the population,
the young and the old, have nothing directly to do. These events are
under the control of about one fourth part of the population in the
prime of life. The fertility of marriages is determined first by nature,
and, in the second place, by the age of women at marriage, as is
evident, in spite of all controversy. If the marriaze age of women
become 20, or 80, or 35, the number of years of marriage and of
children to a marriage changes ; so does the interval between genera-
tions, and the probability that the parents will both live to rear and to
launch their offspring in the world under favourable auspices.

Men and women intermarry at all ages ; but eight in ten of the brides
and bridegrooms at their first marriage are between the ages of 20 and
30, when growth is completed and the frame has attained maturity,
the mean age of both sexes at their first marriage is 25—the bride-
grooms being 252, the brides 24,°,, according to the registers. The real
disparity is probably about a year.

Mean Acr of Persons who Marutxep in 1861-70, above the Age of 15 ine

 

 

Bachelors Spi oe
AGE. Bachelors. | Widowers., and Spinsters. | Widows. ne
Widowers. Widows.
15 and upwards - 25°65 42°40 1 27°80 24°30 Burl) 25°60
|

 

 

 

 

 

'* For further extracts bearing upon statistics of marriage, see Part II., pp. 67-83.

 
POPULATION. ] 45

Mnan Acu of Persons Livine in 1871, above the Age of 15 Years.

 

 

 

 

 

 

| .
AGE. | Bachelors. | Husbands.) Widowers. Tre a Wives. | Widows. ae
EN. y | %
. i a io
i & we ! 16% ‘ ee ital i ais
oe 5 25°30 43°10 | 59795 | 37°00} 26-50 | 40°60 : 58°90 | 37°60

 

 

 

 

 

 

(Census Report, 1871, Vol. 4, p. xviii.)

Duration of Married Life-——The mean time that a couple of such
lives survives can be calculated; it is 27 years; that is the probable
duration of married life, during which children enjoy the protection of
both parents; who may, therefore, both expect to see their first surviving
child attain the mean age of marriage. But there is the further mean
life-time of the surviving parent, which in the case of the father is 9°44
years, of the mother 11°31. The duration of the longest life is 47°84,
during which both parents, or one, may be expected to survive, and to
look after the interests of their children.

‘The proportions of the married couples to the widowers and widows
would be expressed by the above numbers ; there would be to 27 married
couples 9 widowers and 11 widows; whereas in consequence of
re-marriage the actual number of widowers is less than 3, of widows 6,
to 27 married couples. This disruption of families by the death of one
parent and by the survival of another, and the reparation by re-marriage,
is of so much social importance that by way of further illustration it may
be mentioned that to 2,940,782 couples first married at the same ages as
now rule, if there were no re-marriages there would be living 1,024,769
widowers and 1,227,769 widows ; but in the actual distribution such large
numbers lose these titles by re-marriage that the existing widowers are
398,202, the widows 879,173, and ihe married couples, represented by
wives living, 3,948,527, the latter including, therefore, large numbers of
re-married widows.

The mean age of the married population is 41°85 years, and the mean
age at marriage being 26°70 years, the mean term of existing married
life is 15°15 years. Upon an average husbands and wives have lived so
long together. This term is reduced by the increase of marriages raising
the proportion of the younger married couples to the whole; for the
mean age of the married at the above ages by the English Life Table
would be 44°33 and the mean term of existing unions 17°63 years.
—(Census Report, 1871, Vol. 4, pp. xviii-xix.)

Effect of Alteration in the Age at Marriage—The age of marriage
being of prime importance, it may be interestiug to show what the
effect of any great alteration would be, such for instance, as Aristotle,
one of the greatest naturalists that ever lived, proposed: for certain
reasons he lays it down that the man should marry at 37, the woman at
18. The effect of this would be to reduce the joint mean marriage life-
time to 24 years, while the widowers would be 4, the widows 18, to 24
married couples; so the proportion of widows would be augmented
to an extraordinary extent, and orphans, and still more fatherless
children, would be multiplied. This would seriously affect the nurture
of the offspring of such marriages, ezpecially among free workmen
and artizans. All late marriages increase the proportional number of
orphans. It is evident then that the problem is much more complex
than those economists who take the people to task for marrying early
imagine; and on the theory of the survival of the fittest it is probable
46 [PART I.

that nature’s many solutions of the problem as to the most suitable age
to marry yield, if not the best, at least as good results as Aristotle’s.
Plato in his Republic asserts that the citizens should be the offspring
of women of 20-40, of men of 25-55, which is in close accordance
with existing facts. (Census Report, 1871, Vol. 4, p. xix.)

Proportions of Married Males and Females at different ages.—
Without the sanction of the laws of physiology, or of common sense, a
girl may—but in the present day rarely does—marry at the age of 12, a
boy at the age of 14, under the existing laws of England; but the
consent of parents and guardians is required in certain cases where either
party has not attained the age of twenty-one; and the proportional
numbers of either boys or girls who marry under the age 20 is happily
small, The mean age at which marriages are first contracted in England
and Wales is 25°8 years for males, and 24°6 years for females; while
54 in every hundred brides, and 54 in every hundred )ridegrooms, are
20 and under 25 years of age. As the marriages subsist on an average
about 27 years, the numbers and proportions of persons in the married
state increase as age advances, until they are reduced by the rapid disso-
lution of marriages by death. Thus, under the age of 20, of 100 youths
only 0°4 are married ; at 20-24 the proportion amonst men rises to 20:
at 25-30 to 54; at 30-85 to 71; at 35-40 to 78; at 40-45 to 80; at
45-50 to 81—in 100 at each age respectively. The proportional number
of men in the married state declines after 55 and 60 rather rapidly, so
that at the fifth age of 80 and upwards only 37 of 100 men have wives.

With respect to women, the proportions differ from those above ; for
at 15-20 the married are 2°5 per cent. of the whole number of that age
living ; at 20-25 the proportions rise to 80 per cent. ; at 25-30 to 57;
at 30-35 to 70; at 85-40 to 75 per cent., which is the highest proportion
ever attained, as among women it never happens that more than 3 in 4 at
any age are in the married state, while of men 4 in 5 at the age 40-50
are married,

At the age 40-45, of 100 women 74 are married; and the proportion
falls to 52 per cent. at the age 60-65, and to 12 per cent. at the fifth age
of 80 and upwards, for then only 12 in a@ hundred women have
husbands.

The proportional numbers of the persons in the married state at
advanced ages are sustained by remarriages of widowers and widows;
and as the widows remarry much less frequently than widowers, the
comparison of the relative proportions of the married in both sexes shows
that widowers enjoy a portion cf the married life of men of 35, anda
very considerable proportion of the married life after the age of 55.—
(Census Report, 1851; Occupations, Vol. I., p. xxxi.)

Effect of Marriage on Population.—In every part of Great Britain a
large number of men and women who live to advanced ages never marry.
Of the population at the ages of 20 and upwards, about 1 in ten men
and 1 in eight women may be referred to this category; or in Great
Britain one in ten of the survivors of the young men now living, and
one in eight of the survivors of the young women now living, will die as
bachelors and spinsters if they live to the age of 60 and upwards;
besides the great numbers who die unmarried at younger ages.
Celibacy, as well as marriage without children, is therefore to be
considered the natural state of a portion of the population ; for under no
circumstances that can he conccived will the whole of the people marry.
Certain duties of the most exalted as well as of the humblest kind in the
world are most efficiently performed by these classes ; and although the
POPULATION. | 47

proposition, that “the best works and of greatest merit for the public
“ have proceeded from the unmarried or childless men” may not be
absolutely true, as it is put by Bacon*; they haye unquestionably
contributed their full share to public works, which often absorb the
powers of the mind to an extent that would embarrass him that in
“wife and children has given hostages to fortune.” There is also
evidently a large number of both sexes in this class who from infirmity
and diseases, either acquired or hereditary, cannot marry, and some who
have a total disinclination to marriage.

The British population contains a great reserve of more than a million
unmarried men, and of more than a million unmarried women, in the
prime of life, with as many more of younger ages ; and if the whole of
the population were married the births in Great Britain would be 2°3
times as numerous as they are if they bore the same proportion to the
wives at different ages as they do now.

From the state of things which the Census discloses it is evident that
the strength, the rate of increase, and the colonization now proceeding
can be sustained by the marriages of only a part of the population;
hence it follows, that if by any judicious means the increase of the
incurably criminal, idle, insane, idiotic, or unhappily organized parts
of the population can be without cruelty repressed, under a system
of religious discipline, to a greater extent than it is at present
by the selection that pervades, more or less, the whole system of
English marriages,—the character and good qualities of the race
will be immeasurably improved, without checking ithe tide of popu-
lation or the increase of numbers. Hitherto the flower of the
British youth have been in ignorance sent to the alluvial lands of the
tropics, where our race cannot live, or where it inevitably degenerates;
while, in defiance of the principles of physiology, and of the doctrines
that are inculcated on the breeders of the inferior animals by the Royal
Agricultural Society,—convicts have been thrown broadcast over some
of the healthiest colonies in the world, and may now, without due
precaution, multiply at home, like the forgats in France, and prove a
leaven of social disorder and disorganization.

The proportion of children to a marriage, and consequently the popu-
lation, are regulated, not so much or so immediately by the numbers of
the people who marry as by the age at which marriage is contracted.
The mothers aad fathers of nearly half of the children now born are
under 30 years of age; and if all the women who attain the age of 30
should marry, and none should marry before that age is attained, the
births would decline to about two-thirds, and if the marriage age were
postponed to 365 the births would fall to one-third part of their present
number: so the population would rapidly decline ; firstly, because the
number of births to each generation would grow less ; and, secondly,
because, as the interval between the births of successive generations
would increase, and the duration of life by hypothesis remain the same,
the numbers living contemporaneously, in other words, the population,
would be further diminished. The age at which first marriages
take place necessarily varies according to circumstances in ditferent
populations and in different classes of the same population ; in the eldest
and youngest sons of noble families ; in the various rising or declining
professions; among skilled artizans, and labourers.—(Census Report,
1851; Occupations, Vol. L., pp. xliv—vii.)

 

* Bacon’s Essay—VIIJ. On Marriage and Single Life.
48 [PaRT I.

9.—OcCUPATIONS.

Census Inquiry and Classification.—In 1801, at the first Census, this
braneh of inquiry was very simple. The total population of England
and Wales, exclusive of army, navy, and merchant seamen, was simply
classed under three heads, after excluding 443,235 not returned as of
any occupation; namely, 1,713,289 persons chiefly employed in agri-
culture ; 1,843,353 persons chiefly employed in trade, manufacture, vr
handicraft; and 4,873,103 persons not employed in either of the
preceding ways, including probably children and indefinite numbers of
women.

In 1811-21-31 for persons families were substituted : thus in 1821
it appeared that 847,957 families were returned as chiefly employed in
agriculture, 1,159,975 as chiefly employed in trade, manufacture, or
handicraft, and 485,491 as not comprised in either of the two great
classes. In 1881 a further important step was taken in the right
direction ; the defective character of the classification by families grew
evident; so the several occupations of males of 20 years of age and
upwards employed in retail trade orin handicraft, as master or workmen,
were separately returned.

In 1841 the name, age, sex, &c., and occupation were returned as a
“each man’s description of himself,” and the results were published in
Alphabetical Tables, with a synopsis under a few heads, showing the
number of males and females under 20 and above 20 years of age.

In 1851 special instructions were given to the enumerators ; these
were extended again in 1861 and 1871, so as to guard against mistakes
and vagueness; and in the three Reports the two sexes have been
classified under their respective occupations, with distinctions of age.

The classification by families is of some use in simple populations,
where labour is not much divided; but in England the members of the
same family,—the husband, wife, and children—are often engaged in
different occupations, even when the children are at home. Our classi-
fication is in principle a classification of each individual under his
principal occupation on the Census day. The distinction of age enables
us to compare the number living in each well-defined occupation with
the number dying registered at the corresponding ages; and thus to
determine the influence of employment on health and life. The age is
important in another way, as showing whether the persons employed in
any particular manufacture, or trade, or profession, are children, young
men or old; and by the relative numbers at early or advanced ages, at
what period professions are entered, or whetier they are increasing or
decreasing. It thus increases the value of the return of occupations
tenfold ; yet singularly enough, England is the only country where this
attempt at a complete classification of the population according to occu-
pations and age has been carried into effect. This is probably in part
due to the mechanical difficulties of the analysis, which can only be
executed adequately by a number of well-trained clerks. In France the
population was for some time classed in large groups, as formerly in
England, showing the number of individuals living directly or indirectly
by the several professions. This is no doubt an interesting view of a
population, but to carry it out would be a matter of no ordinary difficulty
in England, where it would not be easy for either man or woman to
return the precise number of individuals living on his professional
earnings. And there would necessarily be many men, women, and
children living on the earnings of more than one individual of more than
one profession ; so that they would often be returned twice.
POPULATION. | 49

Interesting as this information might be, if it could be obtained with
tolerable accuracy, it is of infinitely less value than a return of the
individuals in each separate occupation. Thus, in the return in question,
the force of the army would not be shown, inasmuch as the wives and
children would be confounded with the soldiers and officers on whom
the country relies for its defence. This defect has been felt in France,
and in the last Census the persons directly engaged in the several
professions are distinguished from their so-called families. But to obtain
this information the ages of the people in the several professions have to
be sacrificed.— (Census Report, 1871, Vol. IV., pp. xxxviii-ix.)

Double oceupations—Double occupations are as great a source of
difficulty as the varying degrees of the subdivision of labour in the
manufacturing and other districts. The same person is a member of
puliament, a magistrate, a landed proprietor, and an occupier of land ;
in a lower circle, an innkeeper and a farmer ; a maltster and a brewer ;
a fisherman in the season, a farmer or a labourer in the rest of the year.
The enumerators were instructed to this effect, that “a person following
“ more than one distinct trade may insert his occupations in the order
“ of their importance ;” and in the classification the first occupation
was generally taken.

The whole population had to be passed in review, and every man had
to be referred to some one head, although his time might be passed in
two occupations ; but if a class thus sometimes obtains more constituents
than it deserves, it on the other hand often sustains counterbalancing
losses.

The first and most obvious distribution of the population is into the
two great groups of (1) those who work, and of (2) those who pro-
fessedly have no definite occupation. After a due correction has been
made for the persons who are infirm or who have retired in advanced
age from their trades or professions, the number of the latter class in
this country will not be found to be numerous.

It would be out of place here to insert a disquisition on the principles
of classification ; to attempt to show the impracticable nature or the
imperfections of other classifications ; and to vindicate in all its details
the arrangement that has been adopted. But this arrangement possesses
one advantage that should not be overlooked: it is not a mere arrange-
ment on paper such as that of the people into producers, distributors,
and consumers; but an arrangement in which it has been found prac-
ticable to find a place for every one of the twenty-one millions of people
in Great Britain, and in which we can pass them rapidly and distinctly

in review. (Census Report, 1851, Occupations, Vol. I., pp. Ixxxii-iii.

Industrial Census.—A Census in the most extended sense, and as it
has been understood in some countries, embraces an enumeration of the
visible property and of the annual produce; it includes, therefore,
industrial and agricultural statistics. ‘The present Census was restricted
by the Act to an enumeration of the population, and of certain circum-
stances illustrative of their condition and occupations. No attempt
could therefore be made to enumerate the number of manufactories,
shops, or separate properties in the country ; but in connexion with
occupation it was thought desirable to distinguish masters from men,
and for this purpose to ask the masters in trade and manufacture to so
distinguish themselves by writing “master” after the names of their
respective occupations, and by adding the number of men on the Census
day in their employ. Farmers, who are masters of a particular occupa-
tion, were requested to state how many acres of land they occupied,
and how many labourers they employed, with a view of giving a

D
50 [PART I.

definite idea of the term “farmer,” and of laying the foundation of a
further inquiry.

‘This information can evidently only be made perfectly accurate by a
careful and laborious revision on the spot; but, in the absence of this
revision, the returns furnish information of so much interest on a matter
so imperfectly understood, that it was thought proper in 1851 to
construct tables showing the size of farms in each county, together with
the number of labourers that were employed.

The return of the masters in trades is imperfect; all the masters have
not. so returned themselves ; and it can only be rendered complete in
the event of the Census being extended to an Inquiry into the Industry
of the country. (Census Report, 1861, Vol. 3, p. 29.)

10. INFIRMITIES,

Census enumeration of Infirmities—An inquiry into the numbers
of the Blind and of the Deaf-and-Dumb in Great Britain was instituted
for the first time at the Census of 1851. Notwithstanding the great
interest attaching to these classes, both in a sozial and a physiological
point of view, the statistics of blindness and deaf-muteism in this
country have not hitherto advanced beyond estimates and conjectures
founded chiefly upon returns obtained in foreign states, or the limited
experience of a few public institutions. Great disadvantages have
resulted from this entire absence of authentic information, not only to
socicty at large, but more especially to these afflicted persons, on whose
behalf the appeals and efforts of philanthropy, unsupported by a reference
to facts illustrative of their numbers and condition, have lost much of
their intended effect.

Before noticing the chief results of the inquiry, it may be proper
to state the mode in which the information was acquired. ‘The plan
adopted was the very simple one of including in the “Householder’s
“ Schedule” left at every house to be filled up with the required
particulars relating to its inmates, a column in which was to be written
the word “Blind” or “ Deaf-and-Dumb” against the name of any
member of the family so afflicted. In the performance of his duties, the
enumerator was required to use the utmost care to prevent omissions,
and when such were detected he was to supply the defective information,
either from his own knowledge or the statements of credible persons,
as far as he might be able. Owing to the difficulty of ascertaining the
existence of dumbness in extreme infancy, the number of cases returned
under that head must necessarily be slightly deficient ; but as no motives
are apparent to induce an intentional suppression of facts usually well
kuown beyond the limits of the household, it may be presumed that the
returns of the Blind and Deaf-and-Dumb, although subject in common
with the other branches of the inquiry, to accidental omissions, are on
the whole tolerably complete.

It was not thought desirable to divert the attention of the persons
making and collecting the Census returns from the great and essential
points of the general enumeration by any attempt to obtain, with respect
to these special classes, information «s to the circumstances of their
affliction—such as whether it was congenital or acquired ; nor was it
found practicable at a later pericd to enter upon a further investigation
of the cases in reference to these and other questions of undoubted
interest. In Ireland, the Census Commissioners had fortunately no
difficulty in pursuing the subject to its full extent. By means of that
admirably organized body, the Constabulary force, and eminently aided
POPULATION, | 51

by the experience of the Assistant Commissioner, Mr. Wilde, who has'
paid great attention to the subject, they were enabled successfully to
follow up each case ; and they have embodied the results in a Report,
recently presented to Parliament, which forms an extremely valuable
contribution on a branch of vital statistics hitherto comparatively
unexplored.* (Census Report, 1851, Occupations, Vol. I., pp. eviii-ix.)

The Blind.—In Great Britain and the Islands of the British Seas
there are 21,487 persons—11,273 males and 10,214 females—returned
as totally blind. The number in England and Wales is 18,306 of both
sexes ; in Scotland, 3,010; and in the Islands of the British Seas, 171
persons. ‘These numbers furnish a proportion relatively to the whole
population of 1 blind in every 975 persons in Great Britain, 1 in every
979 in England and Wales, 1 in 960 in Scotland, and 1 in 837 in the
Channel Islands and the Isle of Man.

These results admit of favourable comparison with the relative
numbers in Ireland, which, according to the Census, are 1 in every 864
inhabitants. In the level portions of Europe, comprising Belgium,
Hanover, parts of Germany, and the plains of Lombardy and Denmark,
the proportion is stated to be 1 blind in every 950 inhabitants—but
slightly differing from the average of Great Britain. In more elevated
regions the proportion is considerably lower ; but in Norway it is found
to be 1 in every 482 inhabitants.

In reviewing the distribution of the Blind over the different parts of
Great Britain, it should be remembered that the institutions which have
been established for the reception and instruction of persons deprived of
sight are located in the principal cilies and towns. Where, however,
the towns are very large, the inmates of these establishments only
slightly affect the proportion which the Blind bear to the general
population. Thus in London, notwithstanding the number of cases
brought from other parts, the proportion is 1 blind in every 1,025
inhabitants. Other large towns present the following results :—

Manchester - 1 blind in every 1,107 inhabitants.
Liverpool ] ay - 999 55
Birmingham 1 5 » 1,181 5
Leeds” - 1 55 » 1,208 os
Sheffield - 1 és » 1,141 <

It has been generally considered, and is no doubt to a certain extent
true, that crowded dwellings and other circumstances attendant upon
dense populations, by inducing diseases of the organs of sight, have
caused a greater amount of blindness in towns than in rural localities.
It has also been thought that blindness has been increased by many of
the employments followed in populous manufacturing towns. But
whatever may be the influences prevailing in towns, it is clear from the
returns that a much larger proportion of blind persons is found in
agricultural than in manufacturing and mining counties. For example,
in Wilts, Dorset, Devon, Cornwall, and Somerset there is an average of
1 blind in every 758 inhabitants; in Essex, Suffolk, and Norfolk, 1 in
888; and in the northern counties of Scotland, which include the
Highlands, 1 in 823, The highest proportion, 1 in 665, is observed in
Herefordshire.

 

* The Report is entitled,—“ Census of Ireland for the Year 1851.—Part III.
Report on the Status of Disease.”

+ Census of Ireland—Report on the Status of Disease, p. 41.
D2
52 [PART I.

In striking contrast with these are the following manufacturing or
mining counties :—
Yorkshire, West Riding - 1 blind in every 1,231 inhabitants.

Cheshire and Lancashire 1 - » 1,167 <5
Durham 1 5 » 1,163 3
Staffordshire - - 1 55 » 1,082 as

Conclusions unfavourable to the rural districts should not, however,
be deduced from a mere comparison of the Blind to the population
living at all ages. Blindness is a common infirmity of extreme old age,
and an examination of the ages of the Blind shows that nearly one-half
of the persons deprived of sight are above 60 years of age. It follows,
therefore, that in those localities in which the largest numbers of old
men and women are living, the largest proportion of the Blind will be
found. In the great seats of manufacturing industry the population
generally is much younger than in most of the agricultural counties,
where, as shown in a former section of this Report, persons in large
numbers, and especially females, are living, in circumstances favourable
to longevity, at very advanced ages. Thus, in the counties presenting
the highest and lowest proportions of blind persons, the influence of age
is sufficiently apparent :—

 

Proportion | Proportion
per Cent. per Cent. Population
Counties. of Population | of Blind aged | at all ages to
aged 60 Years} 60 Years One Blind.
and upwards. | and upwards.

 

 

Hereford - - 10°5 61°1 665
Wilts, Dorset, Devon, Cornwall, and

Somerset 9°0 53°7 758
Essex, Suffolk, and Norfolk 8°8 50-1 888
Northern Counties of Scotland 9°3 54:7 823
Yorkshire, West Riding - 6-1 43°1 1,231
Cheshire and Lancashire 5:4 31°8 1,167
Durham - 6°3 52°8 1,163
Staffordshire - - 6°0 42°0 1,082

 

 

 

 

 

 

The proportion of the Blind aged 60 and upwards to the persons
living who have attained that age, shows how close a connexion exists
between blindness and advanced years :—

Proportion of Brinp Persons to 100,000 living.

 

 

 

Buinp.
To 100,000 living at
CounriEs.
All Ages. 60 to 80. Bo und
upwards,
Hereford - - 150 748 2,019
Cornwall - 137 596 3,120
Devon - 136 609 2,942
Dorset : 132 608 2,800
Somerset 129 618 1,887
Wilts - 121 643 1,705
Yorkshire, West Riding 81 475 2,002

 

 

 

 

 
POPULATION, | 53

So, in other counties, according to the proportion of old and young
persons living, a greater or less amount of blindness is generally
observed. But, while the question of age is of great importance in
investigating the distribution of blindness, it will not explain all the
variations presented in the returns, as in some localities other influences
are doubtless at work.

In the early years of Jife the numbers of the Blind are not large. Of
the 21,487 blind persons in Great Britain, only 2,929, or less than
14 per cent., are under 20 years of age~—a circumstance tending to show
that cases of blindness at birth are not very common. Between 20 and
60 ycars of age there are 8,456 persons, or about 39 per cent. of the
whole number; while 10,102 persons, or 47 per cent., are at the
advanced ages above 60. These facts point to the conclusion that
blindness in many cases may have arisen as a natural infirmity attendant
upon old age.

Of the persons in Great Britain returned as blind 11,273 are males
and 10,214 females. Accidents and diseases resulting in loss of sight
are more likely to arise in the employments followed by males than
in those of females. The proportions are 110 males to 100 females in
Great Britain, and 113 males to 100 females in England and Wales. In
Scotland the females returned differ but slightly from the males, a result
probably traceable to the preponderance of aged women in that country.
Compared with the general population, we find to every 10,000 living
in Great Britain 11:0 males and 9-5 females blind. In England the
proportion is nearly the same. To every 10,000 inhabitants of Scotland
there are 10°7 males and 10-2 females blind. The males generally
exceed the females until 70 years of age is attained ; from that period
of life the blind women are much more numerous. The disproportion
of females af, all ages is greatest in Monmouthshire, Devon, Cornwall,
Hereford, and Huntingdon. The Irish returns show a proportion of the
sexes the converse of that observed in Great Britain, namely, 111 females
to 100 males. (Census Report, 1851, Occupations, Vol. 1., pp. cix—xii.)

Occupations of the Blind—The returns do not admit of a rigid
distinction between the employments followeil by the Blind and those
subsequently acquired by them. Jnstances are common of blind persons
being engaged in pursuits apparently quite incompatible with loss of
vision. The employments taught in the institutions for the Blind are
usually basket-making, sack and net making, knilting, and music.
Most of the other occupations detailed in the Tables must be regarded
as those followed previous to blindness,

The present or previous occupations of the Blind have been classified
in Tables for each sex, distinguishing the ages in quinquennial periods.*
This affliction, it will be seen, is not confined chiefly to particular
classes and trades, but exists amongst all ranks, and in a great variety
of employments. None of the great branches of manufacturing industry
seem to be peculiarly liable to it; indeed the small numbers returned
against cotton, linen, silk, woollen-cloth, iron, and earthenware are
remarkable, when the immense amount of labour employed in these
manufactures is considered. Factory workers are, however, mostly
young persons; and none wouid be employed in the midst of machinery
with any defect of vision.

Amongst the items which present the largest numbers in the classifi-
cation of employments are Agricultural Labourers, of whom there are
907 ; Labourers not otherwise described, 512; Chelsea Pensioners and
Soldiers, 586; Greenwich Pensioners, 70; Farmers, 505; Domestic

 

* See Summary Tables, Census Report, 1851, pp. eccii-cecix,
54+ [PART I.

Servants (chiefly females), 438: Weavers, 295; Coal-miners, 198 ;
Copper and Lead miners, 68; Stone and Limestone quarrier, 51. Of
the class described as “ Annuitants” aud “ Living on Alms” there are
1,062 ; and 2,833 blind Paupers are returned in workhouses without
any statement as to previous occupation. Of the Blind following
employments presumed to have been acquired after loss of sight there
ave—musicians and teachers of music, 535; mat, sacking, and net
makers, 127; and knitters, 92. With respect to 2,853 males and 5,960
females, no returns respecting their actual or previous pursuits are
made. (Census Report, 1851, Occupations, Vol. I., p. exii.)

Distribution of Blindness—Blindness it is supposed becomes
gradually more prevalent as the equator is approached from the poles,
and fixed ratios of the blind to the sighted have even been assigned to
different parallels of latitude. No sufficient data exist, however, for any
certain conclusions of this nature ; and although the prevalence of blind-
ness in tropical countries is well known, we believe the fact may be
ascribed to causes which exercise a more powerful influence than
climate. In countries where the masses of the people are badly fed and
lodged, where sanitary laws are disregarded, and where there is little
knowledge of ophthalmic surgery, blindness will always be common, and
it will be little modified by the circumstances of mere geographical
position. In the subjoined ‘lable we give the latest statistics accessible
to us relating to foreign countries and to a few of our colonial posses-
sions. It will be observed that in Norway the ratio is as high as 1 blind

Ratio to PoruLation of the Brinp in the undermentioned Countries.
(From the Report on the Status of Disease in Ireland, 1861.)

 

 

. Ratio to an | Ratio to

Countries. Population, Countries. | Populations
Norway - | Lin 540 | Newfoundland 1 in 1,426
Treland - 1 ,, 864 | Wurtemberg 1 ,, 1,486
Savoy - - 1,, 884 | Denmark - 1 ,, 1,523
Piedmont - 1 ,, 887 | Hanover 1 ,, 1,579
France - - 1,, 938 | Holland - 1» 1,663
Scotland - oe 1 ,, 960 | Oldenburgh 1 ,, 1,720
England and Wales 1,, 979 } Prussia - 1 ,, 1,788
United Kingdom 1 ,, 994 | Nova Scotia 1 ,, 1,788
Hesse Darmstadt 1 ,, 1,231 | Prince Edward’s Islands- | 1 ,, 1,880
Belgium - 1 ,, 1,233 | Bavaria : 1_,,; 1,986
Saxony - - 1 ,,1,386 } United States 1 ,, 2,470
Sweden 1 ,, 1,419

 

 

 

 

 

to every 540 inhabitants, or nearly two to one as compared with Great
Britain. In the American States the ratio of blind to the whole popu-
lation is Lin 2,470, and of blind slaves to all slaves, 1 in 2,616 ; in several
of the southern states between 26 and 38 degrees of latitude the propor-
tion is much lower, tending to show that climate has here had little or no
direct influence. But it must, be borne in mind that in the United
States, and in several of our own colonies, where the people are largely
recruited by the immigration of young and healthy persons, the blind
will naturally be in a low ratio to the rest of the population. Persons
labouring under deprivation of sight, like the sick, the maimed, and the
decrepit, rarely emigrate; and, apart from this circumstance, the com-
paratively small proportion of aged persons in the population of these
POPULATION. | 55

countries will sufficiently account for the inconsiderable numbers of the
blind.

With regard to the distribution of the blind in different parts of
England, the recent returns lead to the same conclusion as those of 1851,
namely, that this affiction is more common in the rural districts than in
those chiefly devoted to manufacturing, mining, and commercial
industry. For example, in the south-western countics, comprising
Wilts, Dorset, Devon, and Cornwall, the average proportion is 1 blind
in 793 inhabitants ; in the eastern counties (Essex, Suffolk, and Norfolk)
it is 1 in 902, and in North Wales 1 in 880; these parts of the country
being for the most part agricultural and pastoral. On the other hand in
the north-western counties (Cheshire and Lancashire) the ratio falls to
1 in 1,253; in York, West Riding, it is 1 in 1,296; in Durham 1 in
1,252; and in Bedfordshire, where young persons are largely employed
in the straw-plait manufacture, 1 in 1,325. But to whatever causes the
high ratios in the agricultural counties are due, it is certain that the
crowded dwellings and defective sanitary arrangements of large towns,
combined with the occupations usually carried on amongst dense masses
of people, are extremely conducive to diseases resulting in loss of sight.
The lower proportions observed in the manufacturing and mining
districts must therefore be mainly ascribed to immigration, and the
comparative youthfulness of the population in those localities. Loss of
sight being greatly influenced by age, part of the excess of blind persons
in the rural districts is owing to the fact that they contain a larger pro-
portionate number of persons in advanced life than the towns and manu-
facturing districts ; while the immigrants into the latter are chiefly
young persons who labour under no physical disability to interfere with
their employment in the factories, in domestic service, or in trade as
apprentices and work-people. (Census Report, 1861, Vol. 3, pp. 43-4.)

Causes of Blindness —The mode of procedure adopted in taking the
Census precluded the enumerators from pausing in the performance of
their appointed task for the purpose of making special inquiries, which
would be of great interest if they could be efficiently carried out, in
reference to the blind; such as the causes of their infirmity and the
period of life at which it commenced, their circumstances with regard to
instruction, and their means of support. An attempt was made, for the
first time, upon this occasion, to ascertain the extent of congenital blind-
ness, by means of an instruction in the Householder’s Schedule, to the
effect that persons blind from birth were to be sn described ; but whether
the information thus obtained may be regarded as tolerably complete and
satisfactory we are not prepared to say. It appears that the term “born
blind ” is often applied to children losing their sight in the early years
of life as well as to those actvally blind from birth; and no doubt the
difference is slight between those who never beheld the light and those
who lost the faculty of vision before they had used it long enough to
acquire permanent impressions. ‘To what extent the vague employment
of this teryz; thus sanctioned by popular usage and similarity of con-
dition, has affected the value of the statistics of the born blind, we are
unable to state; but it is not improbable that while some of the persons
making the returns would use the words ina popular sense others would
restrict them to their literal meaning, and that imperfect information
would be the result,

Small-pox has undoubtedly been one of the most prolific causes of
blindness in England. Of 1,456 pupils received into the Liverpool
School from 1791 to 1860, no less than 250, or more than one-sixth, are
said to have been blinded by small-pox; and of the pupils admitted to
the London asylum a large proportion hal been deprived of sight by the
56 [PART 1.

‘ame disease. Purulent ophthalmia, with which the new-born infant is
requently attacked a few days after birth, is a disease quickly destruc-
ive of sight unless arrested by careful treatment. Many other forms of
lisease result in this calamity; but happily the great advances made in
he knowledge of the anatomy of the eye have enabled surgeons to treat
successfully many of the structural causes of blindness, and to restore
ight in cases which, not many years ago, would have been considered
1opeless. If all diseases of the cye cannot be traced to their origin,
here can be no doubt that the bulk of them, when not attributable to
idvanced age, are induced by the unhealthiuess of dwellings, the want
of cleanliness, bad or insuflicient food, and other well-known causes of
shysical deterioration, as well as by every description of overwork
nvolving a considerable strain on the organs of vision, whether that of
he student, the needlewoman, or the mechanic. ‘To these undoubted
vauses of blindness must be added the various accidents to which all
slasses, and the labouring classes in particular, are constantly exposed,
‘Census Report, 1861, vol. 38, pp. 44-6.)

The Deaf and Dumb.—In Great Britain 12,553 persons (6,884 males
ind 5,669 females) are returned as Deaf-and-Dumb. Of this number,
10,314 are in England, 2,155 in Scotland, and 84 in the Islands in the
British Seas. The proportion which the Deaf-and-Dumb bear to the
zeneral population in Great Britian, is 1 in every 1,670, in England 1 in
1,738, in Scotland 1 in 1,340, and in the Islands 1 in 1,704. These
iumbers and proportions would be slightly increased if allowance were
nade for the omission of infants, with respect to whom, owing to the
lificulty of ascertaining the existence of deafness and consequent
nuteism in the first years of life, the returns are unavoidably imperfect.
Che above numbers will therefore be received as an under-statement of
he actual state of Deaf-dumbness. But as the same defect of necessity
oxists in the returns of other countries, no erroneous conclusions will be
‘ormed from using them for the purposes of comparison. ,

According to the most recent returns, the average proportion of the
Deaf-and-Dumb to the population of Europe generally is found to be 1
nevery 1,593 persons.* In Holland, Belgium, and other states present-
ng chiefly a flat surface, the proportion is much smaller than in Norway
vad Switzerland ; indeed, in some of the Swiss cantons, where cretinism
s prevalent amongst the mountain passex, there is ] Deaf-mute in every
206 inhabitants. In Treland, the average is 1 in 1,380 persons ; and in
he United States of America, where however, the returns are admitted
o be very defective, 1 in 2,366.

 

‘Ratio to Porutation of the Duar and Dump in the under-mentioned Countries.
(From the Report on the Status of Disease in Ireland, 1861.)

 

 

 

Countries. Ratio to Countries. Ratio to
Population. Population.
Savoy - lin 443 | Hanover . - | 1in 1,450
Piedmont - 1, 563 | Saxony - - -| 1,, 1,629
Wurtemburg 1 ,, 901 } England and Wales i ,, 1,640
Ireland - 1 ,,1,026 | France - -| 1 7 1,671
Norway - 1 ,, 1,200 } Bavaria 1 ,, 1,774
Scotland 1 ,,1,311 | Denmark - 1 yy 1,920
Prussia - - 1 ,, 1,334 | Belgium 1, 2,277
Sweden . 1 ,,1,360 | Holland - 1 ,, 2,714
United Kingdom 1 ae

 

 

 

 
POPULATION. | 57

Looking at the distribution of the Deaf-and-Dumb over the face of
Great Britain, we find them to be more common in the agricultural and
pastoral districts, especially where the country is hilly, than in those
containing a large amount of town population. The Northern Counties
of Scotland, which include the wild and mountainous region of the High-
lands, present the highest average,-—1 in 1,156 of the population; then
the South-Western Division of England, with 1 in 1,393; followed by
the Southern Counties of Scotland, 1 in 1,480; and the Welsh Division,
1 in 1,542. We have already seen that the South-Western and Welsh
Divisions of England and the Northern Counties of Scotland contain the
largest proportional number of blind persons.

Cretins, most of whom are Deaf-mutes, ave found in some of these
localities ; the disease of crctinism is also accompanied by mental
imbecility in a greater or less degree.

The proportion of Deaf-mutes is lowest in the Northern Division of
England—1 in 2,058 inhabitants ; and in the North-Western Division
(Cheshire and Lancashire), where a nearly similar average prevails—
1 in 2,014.

Although as a general principle a greater degree of prevalency of
Deaf-dumbness seems to exist in rural and hilly localities than amidst
urban and manufacturing populations, yet exceptions are remarked on
applying this test to the counties, and the smaller sub-divisions com-
posing them. The following English counties, for example, present
widely different results, scarcely to be explained by a reference to their
physical or geographical peculiarities :—

 

Yorkshire, East 1 deaf-and-dumb in every 2,231 inhabitants.
Riding.

Monmouthshire -1 5 3 2,300 ss

Kent (£atra-Metro- 1 5 2,343 35
politan).

Durham - 1 9 3 2,480 ey

Huntingdon - - 1 33 - 3,016 3

Hereford — - 1 Deaf-and-Dumb in every 1,054 inhabitants.

Worcester - -1 3 5 1,160 5

Derby - -1 3 is 1,272 3

Cornwall - -1 8 e 1,278 oe

The relative numbers of the sexes are in all countries much more dis-
proportionate amongst the Deaf-and-Dumb than amongst the Blind. In
Great Britain and in England and Wales there are 121 -male Deaf-mutes
to 100 females ; in Scotland the inequality is somewhat greater, namely,
125 to 100 females; in the Islands in the British Seas there are 121
males to 100 females. The Irish Returns give the reversed proportion
of 111 females to 100 males.

In every 10,000 of the general population of each sex in Great Britain,
6°7 males and 5°3 females are*Deaf-and-Dumb. But while the returns
for the whole country exhibit a larger proportion of males, the reverse
obtains in some localities; thus in Berks, Bedford, Salop, Derby, and
Monmouth, more females are returned than males relatively to the
numbers living of each sex.

Of the 12,553 Deaf-mutes, only 783, or 6°2 per cent., had reached
60 years of age,—a fact showing the unfavourable position of this class
as regards length of life ; while those under 20 years of age, although the
numbers are unquestionably deficient, amounted to 47 per cent. The
incompleteness of the returns for the years of early life, arising from the
uncertainty which must cxist with respect to infants, and the natural
58 [parr 1.

ndisposition of parents to form a painful conclusion on the subject
vhile the slightest grounds for doubt exist, has already been adverted to.
A rongh estimate of the omissions from this cause may be made by
issuming the Deaf-mutes under 5 years of age to bear the same pro-
vortion to the general population of the same age as the persons aged
> years and upwards bear to the residue of the population. There were
nu Great Britain, of 5 years of age and upwards, 18,222,518 persons, of
vhom 11,993 were deaf-and-dumb. If a like proportion existed amongst
he populution under 5 years of age (2,736,959 persons), 1,801 Deaf-
nutes, instead of 560, would have been returned under the first quin-
juennial period of age. The addition of 1,241 cases would raise the
vercentage of those under 20 years of age to 52, and that of the ages
ibove 20 to 48; but as the omissions would not be so frequent in the
ourth and fifth years of age as in the earlier years, the supposed number
o be added is probably too large. (Census Report, 1851, Occupations,
Vol. 1, pp. exili-xv.)

Congenital mutism.—Very little success attended the attempt to
scertain at the Census the number of congenital cases of Deaf-mutism,
xy means of an instruction in the householders’ schedule to the effect
hat persons deaf-and-dumb “ from birth” should be so described. In
aany instances the fact was duly noted, but it was evident that in many
thers the instruction had escaped notice, or the person filling up the
eturn was unable to give the information. Even the schedules of more
han one institution for the class under consideration were altogether
ilent on this point. As incomplete statistics would be of no value, we
onsidered the partial information not worth the labour of extracting. In
reland, where a further investigation of every case of Deaf-dumbness
eturned at the Census was made by the constabulary and police, much
ifficulty was experienced in ascertaining whether the individuals were
orn deaf or not. From a large number of facts derived from the
xperience of various institutions in Europe and America, collected with
auch labour by Mr. D. Buxton, Principal of the Liverpvol School for the
Jeaf-and-Dumb, that gentleman has arrived at the conclusion that it is
opeless at present to expect to establish any fixed ratio between cases
f congenital deafness and those which have resulted from accident or
rom disease acquired after birth. Another writer, who is connected
rith the London School for the Deaf-and-Dumb, states that out of 3,050
vell-authenticated cases within his own knowledge, 2,241 were born deaf,
59 resulted from various diseases, and with respect to 50 no positive
iformation could be obtained; and adding to these the results of
,805 other cases in different institutions and countries, he concludes
hat the actual preponderance is about 60 per cent. on the side of the
ongenitally deaf, while 40 per cent. are accidentally deaf:

‘The causes of congenital mutism have engaged the attention of eminent
hysiologists and pathologists, but they are still enveloped in much
bscurity. One thing appears certain, that the organic defect which
esults in real deafness from birth is always incurable. Among the most
ommon causes assigned for the appearance of congenital deafness in
unilies are fright and morbid mental impressions on the part of the
rother during gestation, consanguinity of the parents, and the trans-
uission of the defect itself, or of the predisposition to it, from parents to
aeir offspring. (Census Report, 1861, Vol. 3, pp. 56-7.)

Blindness and deaf mutism at groups of ages.—On comparing the
ges of the Deaf-and-Dumb and of the Blind with those of the general
opulation, the most opposite results are shown with respect to these
vo classes. In the case of the Blind, the numbers increase at each
POPULATION. ] 59

period from infancy to old age, after 55 very rapidly, and nearly in the
same ratio as the general mortality. Of the deaf-and-dumb, the highest
proportions are at the periods of age rauging between 5 and 25 years,
and the numbers then gradually diminish as the ages advance.

Provortion of the Brinn and the Drar-x1xp-Dump at DirrERENY AGES
to the Mary and Femane Poruiarion in 1861.

 

 

 

 

 

 

 

To every 100,000 living at each age, the proportion of

Years of Ace. BLInp. Drar-anp-DuUMB.
Maies. Females. Males. Females.
ALL AGES. 104°8 88°5 70:0 | 52°4
o- 21:6 17°5 21-9 | 19°2
5- 27°8 23-4 85°2 66'1
10- 41°8 31°3 98°4 70°8
15- 49°7 36°5 83°6 59°9
25- 74°7 42°2 73°3 52°6
35- 104°0 62°7 68°1 471
45- 148°8 101°4 67°2 54°8
55- 263°4 216°6 64°7 54°6
65- 558°3 504°3 59°9 49-4
75- - 1216°6 1233°4 59°6 43°2
85 und upwards 2468°5 2321°9 61°5 63°1

 

 

 

 

The increase in the proportion of the Blind at the higher ages is the
result of the additional numbers every year becoming blind. And the
rate of increase after puberty is governed by the same iaw as that which
governs other sickness. The facts relating to deaf-and-dumb children
under the age of 5 are from their nature imperfectly recorded. The
diminution of the proportion of the Deaf-and-Dumb after the age of 15
can only be accounted for by their mortality being at a higher rate than
that of the general population. (Census Report, 1861, Vol. 3, p. 58.)

11. Economic VALUE OF PoruULATION.*

Various attempts have been made to estimate the amount and the
increase of the capital of the United Kingdom. The most recent
attempt of the kind has been made by the chief of the statistical depart-
ment of the Board of Trade. The value of the most important part of
the capital of the United Kingdom and its increase have yet to be
determined; I mean the economic value of the population itself. To this
I propose to call attention briefly.

As lands, houses, railways, and the other catagories in the income tax
schedules are of value, because they yield annual returns; so, for the
same reason, and on the same principle, the income of the population
derived from pay of every kind for professional or other services and
wages can be capitalized ; not precisely, it is true, unless the income of
every person living were returned at least as nearly as the incomes
subject to income tax; but sufficiently near to the true value to show

 

* See also “ Cost, and the Present and Future Economic Value of Man”, pp. 531-7,
60 [PART I.

hat the value of the population itself is the most important factor in the
vealth of the country. ,

It will be sufficient to state here that the capitalization of personal
acomes always proceeds upon the determination of the present value at
ny age of the future annual earnings at that and all future ages;
ence the value of future wages rises from the date of birth, when It is
notable quantity ; is highest in the labouring classes at the age of 25 ;
nd declines as age advances, until in extreme age, when no wages are
arned, it disappears. The living by the Life Table are most numerous
a childhood, and gradually fall off till they are all extinct; and so in
he population enumerated at the Census the numbers decline from the
rst year to the ultimate year of age. While the rates of wages rise
apidly from birth to the age of manhood, and afterwards decline, the
umbers living constantly decline. ‘Taking a series of observations on
he wages of agricultural labourers* some years ago at different ages ;
elermining their value by a Life Table at five per cent. rate of interest
or each age; and multiplying the numbers living by these values, it is
ound that the mean gross value at all ages is 3492. But the mean
alue of the subsistence of the labourer as child and man, determined
y the same method, is about 199/.; and deducting this sum from 3494.,
here remain 150/. as the mean net value of the male population, esti-
rated by this standard of the agricultural labourer. To extend the
alue to the whole population, including females, the standard might be
owered from 1502. to 1102. a head.

Then multiplying the population of the United Kingdom by 110 we
ave as the aggregate value £3,640 million; this including only as
auch of the income as approximates in annual amount to the wages of
gricultural labourers. Only a small part of it is subject to assessment
mder the income tax schedules. The gross assessment under the
ucome tax affords the means of estimating the value of incomes
xeeeding 1002. a year under Schedules D. and H.; excluding com-
upies, mines, and works, these profits and salaries amountg to £214
allion a year, to which about £92 million a year may be added for
ncomes above 80/. and below 100/. a year; thus making the aggregate
£ such incomes £306 million a year; which when the assessments of
3. farmers’) are added becomes £3738 million a year. Deduct the hulf
f this revenue as due to external capital, and as required for the
ecessary sustenance of farmers, tradesmen, and professional men and
here remain £186} million a year as pure profit; which cannot be
apitalized as a perpetuity inasmuch as the interest is limited by the
ives of the producers, but taking life contingencies into account may be
apitalized at ten years’ purchase. This makes the value of these
neomes £1,865 million. Allowing £255 million for the part of the
neomes of about a million people paying the income tax previously
alued in the £3,640 million, and for other deductions, £1,610 million
emain, which, added to the £3,640 million already obtained, make
25,250 million.

“Thus by capitalizing the earnings, fees, salaries, wages of the profes-
ional, mercantile, trading, and working classes, £5,250 million are
btained as an approximation to the value which is inherent in the
‘eople, and may be fairly added to the capital in land, houses, cattle or

 

* See Journal of the Statistical Society, Vol. xvi., pp. 42-43 Extracts from this
aper will be found on pp. 531-7 of this volume.

+ Mr. Giffen makes the value of the capital in other forms £8,500 million; making
rith the value of the population itself, £13,750 million. See Journal of the Statis-
ical Society, Vol. xli., pp. 1-31.
POPULATION. | 61

stock, and other investments. The amount would be increased by
taking into account the rise of wages, and the income omitted in the
returns of Schedule D. With au industrial Census an accurate estimate
can be made of this most important part of the capital of the country.

The minimum value of the population of the United Kingdom, men,
women, and children, is 1597. a head; that is the value inherent in
them as a productive, money-earning race. The incomes chiefly under
schedules D., E., and B., raise the mean value from 110/. to 150/. (see
above).

Again, it must be borne in mind that the value under Schedule A. is
dependent upon the population ; where there is little population land
itself is of little value. The increase of the value of house property is
directly due to the increased numbers and earnings of the inhabitants.
The railways yield no profit where there is no population. ‘Lhe profits
of quarries, mines, ironworks (Schedule D.), and other concerns are
mainly due to the skill and industry of the masters and men who work
them. Upon the other hand the products of human industry are
multiplied a hundredfold by the tools, machinery, steam power, and all
the appliances which capital commands and represents. Should the
population of a country decay, the value of its capital might sink to the
vanishing point.

What I wish further to point out is that during the 39} years this
office has existed there have been added to the population of the United
Kingdom 7,619,759 people who, valued as land is valued by the annual
yield of net protit, constitute an addition of £1,212 million to the wealth
of the nation. :

The value of labour—that is of working men—varies, and is greatest
where there is the greatest facility for profitable use, and where it is in
greatest demand. Thus a large stream of the population of England
flows to the Metropolis; and England is to the United Kingdom what
the Metropolis is to England. So the populations of Ireland and
Scotland flow into England, where they find more profitable employ-
ment, and are of more value than they are at home.

For the same and other reasons large armies of the population of the
United Kingdom passed into the colonies and the United States; during
the thirty-nine and a half years (1837-76) the excess of births over
deaths was nearly 16 millions, of which nearly 8 millions augmented
the ranks of the population at home, and more than 8 millions settled in
other lands; chiefly in the midst of the old English stock of the
United States and in the Colonies extending from Canada in America,
to Africa and to Australasia.

Of the 8,013,267 people who must have left the country, only about
6,580,000 are accounted for by the Emigration Commissioners, whose
returns were imperfect in two ways; they neither included the whole of
the emigrants nor recognised emigrants returning recently in large
numbers.*

The emigrants are chiefly adults married and unmarried; the men
greatly exceeding the women in number. <A few infants accompany
their parents. Valuing the emigrants as the agricultural labourers have
been valued at home—taking age and service into account—the value of
emigrants in 1876 was 1751. per head.

If we may venture to apply this standard to the whole period it will
follow that the money value of the 8,000,000 people that left England,
Scotland, and Ireland in the years 1837-76 was £1400 million, or on an

 

* See Census Report, 1871, where this was first demonstrated; and Emigration
Report, 1877. :
62 [PART I.

werage about 35,000,000/. a year. In round numbers taking into
account their aptitude to earn wages in future years at the home rates
the annual industrial army that went out was worth at starting
35,000,000/. Many of the emigrants are skilled artizans, and con-
siderable numbers are returned as farmers, gentlemen, professional men,
ud merchants; some of whom no doubt carried away a certain amount
of capital which is not here brought into account.

The policy of the people of this country has thus been a policy of
progress ; instead of resting ax they were in 1837, they have added
since that year on an average of J92,873 souls annually to the population
ut home, and sent 202,868 sons and daughters to seek their fortune
vbroad in other fields of labour. The women, instead of to 644,214
children, who would just replace the population removed by deaths,
have given birth to 1,039,987 annually, at a certain loss of their own
ives with intermingled sorrows and joys such as befall mothers in
rearine children: while the men instead of expending the whole of
their gains on themselves have devoted a large share to their wives and
families ; besides that, as we have seen, the external wealth of the country
aas increased, as the nation has, without conquering territory or levying
aeavy contributions on its European neighbours.

The value of men varies with their earnings, which differ considerably
in the colonies from the earnings of agricultural labourers at home ; and
om the whole before the civil war the emigrants to the United States
xot higher wages, and at the same time gave a higher value to the
‘erritory.

It may be contended that emigration is a loss to the mother country.
[t seems so. It is like the export of precious goods for which there is
io return. But experience proves that simultaneously with this emigra-
sion there has been a prodigious increase of the capital of the country,
especially in recent years. Wages have risen, and the value of the
abourer has risen in proportion. In Norfolk, where wages are inter-
nediate between the rates in the north and south, the rise has apparently
een about 20 per cent.; so a fifth may be added to the estimated value
of the workman, When the man leaves the village where he was horn
und bred, he leaves the market open to his fellows; he removes to a
ield where his work is in demand, and carries his fortune with him.
[t is the same when he emigrates to the colonies. His parents in
‘earing him have expended their gains in the way most agreeable to
hemselves. They have on an average five children, instead of two or
three, or none. Taking a wider view, the emigrants create articles of
wimary use with which in exchange they supply the mother country ;
they have sent to England in the 89 ycars wheat, cotton, wool, gold to
he value of hundreds of millions. What is of still more vital impor-
‘ance, they grow into new nations; they multiply discoveries; by
confederation they will be to the Anglo-Saxon race outposts of strength
icross the Atlantic, in the Pacific, in South Africa, and in Australasia
m the flank of India. And, moreover, to all it is an advantage to speak
t wide spread language, and thus to be in social, literary, and scientific
‘communion with millions of the same race. ‘he increasing numbers
mable them, advanced as they are in the arts, in the sciences, and in
‘ivil government, to do more for the good of kindred races; and to
mdow them with advantages which could not be attained in other ways
or centuries. They govern India.

The economic value of a population depends very much on their
‘command over the powers of nature; which they acquire by education,
?ut barbarians in possession of the land, the mines, the manufactures,
he machines, the ships, the triumphant position of these islands on the
POPULATION. | 63

sea between two continents, and what would be the result? Another
Asia Minor, Egypt, or Syria? ‘The better educated the English people
become, the more skilful they will become, and the more valuable in an
economic sense they will be. The clever artisan is worth more than
the rude labourer. Now the art of reading and writing their own
language is by no means proof of complete education, or of any
technical training, but it is a proof that men in possession of it are
preparing to enter on the heritage of thought, and knowledge, and
sentiment, which men of all ages have bequeathed to mankind, and
which is enshrined in the writers of un admirable language.

In 1837 not more than 58 in 100 men and women possessed this art ;
but there has been progress, and I have year by year assiduously noted
the increase of their numbers in the 39 years, so that I am now able to
report, that instead of 58, eighty-one in a hundred write their names in
the marriage registers.

Tt is evident that there are other elements on which the economic
value of the working population depends ; and foremost among them
stand health and long life. The longer men live, and the stronger they
ave, the more work they can do. Epidemic diseases in rendering life,
render wages, insecure. These diseases are most fatal in cities whither
the population—to secure all the advantages of the division of labour—
have been congregating every year in increased numbers: villages have
become populous or have grown into towns; so the population has been
growing denser. And that by a definite law, other things being equal,
tends to increase weakness, sickness, and mortality. ‘There have been
counteracting agencies in operation in the thirty-nine years. Asiatic
cholera was epidemic in England in 1831-2; influenza followed at
intervals in 1833, 1837, and 1847; and laid thousands of the population
low; in 1848-9 the cholera epidemic in England and Wales alone was
fatal to fifty-three thousand people ;* its ravages in every corner of the
kingdom were described; the conditions of its diffusion and fatality
were brought to light, and the further investigations of the slighter
epidemics of 1854 and 1866 prove that this plague is under the control
of science. Other epidemics have since been fatal especially to children,
and fever has struck at princes and peers as well as peasants; but upon
the whole the great zymotic diseases have been quelled. Plague in its
various forms has been kept at bay by a series of defences based upon
minute precautions, In some epidemics I found it necessary to publish
daily particulars respecting deaths in the Metropolis. By pursuing such
inquiries, year after year, not only many of the causes that induce
sickness and destroy life have been discovered, but observations of the
same kind have shown that their removal has been followed by health
and longer, more vigorous life. The economic value of the population
of several towns has been increased by sanitary measures. ‘Ihe truths
established, the facts ascertained, the remedies discovered in the thirty-
nine years past await their full administrative applications in the years
to follow; and the savings of time wasted in sickness, as well as of
precious lives prematurely lost in youth and manhood, will enhance the
value of the population to an incalculable extent. The famines so fatal
in Ireland are not likely to recur; part of the population has emigrated
to England or to America, and the intelligent landowners of Ireland,
through the extension of the Poor Law, now insure their countrymen
against death by starvation. The same beneficient law has in the
thirty-nine years been extended to the Highlands of Scotland. Every
improvement in health recorded makes it clearer and clearer that the

 

 

* Registrar General’s Report on Mortality of Cholera in 1848-9.
64 [Part 1.

zloom of sickness and premature death flies away before sanitary
neasures ; and when the qualified health officers whom the Universities
ire offering to examine, are in suitable positions under enlightened local
wthorities all over the country they will no doubt prove as efficient in
oreventing as their medical brethren are in treating sickness. The
‘esult on human happiness cannot be calculated ; but a future Industrial
Sensus will show in a very definite shape its effect in raising the
‘conomie value of the population. The mean lifetime by the English
iife Table is 40°86 years; by the Iealthy Life Table it is 49°0 years,
vhich is attainable in every well organized State. It is fair to assume
hat if a fifth part be added to the mean lifetime, at least a fifth part
vill be added to the worth of a living and labouring population. Upon
his estimate £1,050 million will be added to the economic value of the
iopulation of the kingdom. Its value will increase with its numbers,
nd so will the value of its emigrating thousands.—(39th Annual Report,

ip. vi-x.)
65

CONTENTS

OF

PART IL.—MARRIAGES,

INTRODUCTION.

1.—MarriaGE AND Prosperity.—Causes of Fluctuations in the Marriage-rate.—
Marriage-rate, Form of Marriage, and Commercial Prosperity.—Depression

of the Marriage-rate by the Cotton Famine.—Summary of Fluctuations
of the Marriage-rate, 1839-77.

2.—MARRIAGES IN SUCCESSIVE GENERATIONS.

3.—MAaRRIAGE SEASONS.

4,—AceEs aT Marriace.—Statement of Ages in the Marriage Register —Marriage
of Minors.—Marriage-rates of Bachelors, Spinsters, Widowers, and
Widows.

5.—MarRiaGes AND RELIGIOUS WORSHIP.

6.—CERTIFIED PLACES OF WORSHIP.

 
67

PART IL.—MARRIAGES.

INTRODUCTION.

MarriaGe statistics possess value and interest from several points of
view. Apart from their relation to and influence upon the birth-rate, and
their influence upon the increase of population,* these statistics throw
useful light upon various social and political problems. Marriage-rates
directly afford a trustworthy test of our national well-being. Dr, Farr
called them a barometer of national prosperity ; and indirectly the
Marriage Register supplies the most reliable measure of the progress of
Elementary Education.

Although, as appears from some of the following extracts from
Reports written by Dr. Farr, statistics based upon more or less reliable
returns have been constructed for earlier periods, marriage statistics
of a really trustworthy character date, in England, from the passing of
the Civil Registration Act in 1837. The Registrar-General’s Annual
Reports contain tolerably uniform statistics relating to the 46 years 1838-
88, and there is no good ground-for doubting that the registration of
marriages has been fairly complete throughout that period. The
marriage-rate, that is the proportion of persons married in England and
Wales, during these 46 years has ranged between 17°9 per 1,000 persons
living in 1853, and 14:4 in 1879; the mean annual rate in the whole
period being 16°3 per 1,000. A careful consideration of this long series
of annual rates fully justifies Dr. Farr’s description of the marriage rate
as the barometer of national prosperity. Periods of commercial
prosperity or inflation are consistently marked by high marriage rates,
and those of depression as consistently by low rates. The relation,
however, between the price of wheat and the marriage-rate has not been
so persistently maintained in recent years, and it has been pointed out
in the later Annual Reports of the Registrar-General that the marriage-
rate in England moves in far more constant relation with the amount
and value of British exports.

The simple proportion of persons married to the total population,
while it affords a fairly accurate measure of the marriage-rate in any
nation or community in a series of years, cannot be trusted as a means
for comparing the respective marriage-rates in different nations or
communities in which the ‘proportions of sex, age, and conjugal condi-
tion may present very wide differences. In order to obviate the effect
of this disturbing influence, marriage-rates for comparative purposes
should be based upon the estimated numbers of bachelors, spinsters,
widowers, and widows respectively living at different groups of
ages. Examples of the methods adopted by Dr. Farr for this pur-
pose will be found on pp. 78-80. The Census Report for 1881 shows
the required numbers enumerated in counties, and in each of the urban
sanitary districts having at the date of the Census a population exceeding

 

* On pages 20-21 and 44-47 of Part I., dealing with tbe Statistics of Population,
will be found several extracts bearing upon the influence of marriage on the increase
of population, and dealing generally with the statistics of its civil or conjugal
condition.

E2
68 [PART II.

50,000 persons. For smaller populations the calculation of detailed
marriage statistics would be useless labour. The age proportions of a
population, and also the proportions of the single and the married,
shange se slowly (except in rare cases), that for all practical purposes it
may safely be assumed that during a current intercensal period such
sroportions remain the same as those found to prevail at the last
vensus. The amount of error involved in such an assumption would
xe too small to seriously detract from the value of marriage rates based
ipon numbers estimated by this method.

Qne of the most unsatisfactory features in the marriage statistics
oublished by the Registrar-General is the still incomplete return of the
ages of persons married. It appears from the last published Annual
Report relating to the year 1883, that in 29,582, or 14°32 per cent. of
che 206,384 marriages recorded during that year the age of one or both
of the persons was omitted from the register by the officiating minister,
the information in the age column being only “minor,” or “ full age,”
is the case might be. Such a description of the age is unfortunately
ndirectly sanctioned by the Registration Act, and so long as this is the
‘ase it is to be feared that the return of ages will be incomplete. The
missions are practically confined to Church of England marriages,
ind no difficulty arises in obtaining this desirable information in all cases
with rare exceptions) recorded by the civil registrars of marriages in
lissenting places of worship and in register offices.

The last few extracts in this section bear upon the changing pro-
oitional relations between the Church of England and other religious
lenominations, as exemplified by the marriage returns, and by the
egisters of certified places of worship and of places certified for
aarriages.

The educational statistics based upon the signatures in the Marriage
tegister will be found in Part VI., at pp. 517-22.—(Epiror.)

1.—MARRIAGE AND PROSPERITY.

Causes of Fluctuations in the Marriage-rate.—The number of mar-
jages in a nation perhaps fluctuates independently of external causes,
ut it isa fair deduction from the facts that the Marriage Returns in
ingland point out periods of prosperity little less distinctly than the
unds measure the hopes and fears of the money market. If the
me is the barometer of credit, the other is the barometer of
wosperity, present in part, but future, expected, anticipated, in still
reater part.

(1.) As a war diminishes the marriages by engaging great numbers of
yen at the marriageable age, an excess of marriages naturally follows
eace, when the militia, soldiers, and sailors, with small pensions, are
ischarged. ‘This is seen in the peace of Paris, the peace of Amiens,
nd the peace at the close of the last war. Manufactures and commerce
o England have hitherto entered into renewed activity on the cessation
f wars : markets are thrown open, and great numbers of people obtain
mployment, which has more to do with the increase of marriages than
he mere discharge of great numbers of men from the public service
ad pay.

(2.) The growth of domestic animals is affected by comparatively few
‘icissitudes ; and there is little fluctuation in the supply of meat. But
he crops of grain in a country vary largely ; the prices vary still more ;
thile the wages of the bulk of the population have a limited range.
“ears of plenty are years of prosperity for the people; and the marriages
MARRIAGES. | 69

increase, with a few exceptions, when provisions are cheap. As
abundance is one of the causes that multiply, dearth is one of those that
diminish the number of marriages.

(3.) The establishment of new, or the extension of old, employments
promotes marriages: the cotton manufactures, the canals of the last
century, the railways of the present day, are examples. In fact, an
increase in their incomes is taken by the generality of people for the
beginning of perennial prosperity, and is followed by a multitude of
matriages.

(4.) The periodical epidemics of speculation are accompanied by an
increase of marriages. Great numbers of people, of all classes, fancy
themselves growing wealthy while shares are rising ; and in the gambling
transactions of the Stock Exchange, if some are ruined, others are
enriched. The apparent improvement in the position of the small
capitalists, the increased wages of the working classes, where the specu-
lation involves the employment of labour, and perhaps the spirit of
speculation itself, lead many to embark in matrimony,

(5.) The nation is sometimes extraordinarily sanguine. A statesman
of genius, like Lord Chatham, at the head of affairs, produces the same
confidence in a country as the presence of a Cesar, Napoleon, or
Wellington, on an army. Great victories, the joy of peace, large finan-
cial or political measures, new discoveries in science, new applications
ef the powers of nature, the opening of kingdoms and continents to
commerce, raise public feeling to a state of exaltation long before the
slightest improvement in the material condition of the population is
realized by those measures that are likely to have ultimately that effect.
Such periods of public exaltation are almost invariably accompanied by
an increase in the number of marriages.

In fine, the great fluctuations in the marriages of England are the
results of peace after war, abundance after dearth, high wages after want
of employment, speculation after languid enterprise, confidence after
distrust, national triumphs after national disasters.

The causes that increase and the causes that diminish marriage differ
in energy ; they admit of various combinations; they sometimes neutra-
lize each other ; and the marriages express the result of all those forces
on the public conduct of the people.

I shall now inquire very briefly into the value of the Marriage Returns,
and of other measures of public prosperity. An increase in the con-
sumption of malt, hops, wine, spirits, coffee, tea, sugar, and tobacco,
from which about 28,000,000/. of the revenue of the country are derived,
implies an increase in the expenditure and wages of the working people ;
as an increase in the imports of raw silk, cotton, wool, tallow, and
timber, is an evidence generally of more active manufacturing enterprise.
The Marriage Returns express the same facts. Now it is invariably
observed, that any extraordinary increase of marriages, or any augmen-
tation in the consumption either of the comforts, stimulants, or neces-
saries of life, not always within the reach of the great mass of the
population, is followed by a corresponding falling off. The ship raised
on the crest of the wave is not surer to plunge than this prosperity to
subside. ‘Eating and drinking, marrying and giving in marriage,”
preceded a great historical catastrophe; and it is evident from the facts
already adduced, that though a nation may be rising, it never behoves
the wise and sober to be more on their guard, more alert, or more liberal
in giving good counsels, than when thousands of the people are setting
up in business, establishing families (for every marriage is the founda-
tion of a family), and consuming an unusual amount of luxuries. This
“ prosperity” may be the dawn of progress, or the riotous forerunner of
70 [PART Il-

ruin. To distinguish the two kinds of “ prosperity” is difficult, but
not impossible ; and in the national life they are always intermingled
in different proportions at different times. The usual course in the
crisis appears to be this. Capital accumulates until the outlay of the
surplus in the ordinary business of the country yields little profit. The
thrifty grocer, the farmer, the cotton-spinner, or the merchant, with his
routine system and limited market, finds that his business will bear no
more capital. Ingenuity is taxed to discover new sources of employ-
ment and production. The discovery, after many failures, is made.
The capital, invested in the new mines, factories, cultivation, commerce,
yields large profits. This gets noised abroad. More capital is invested
in similar undertakings, or undertakings suggested by the new principle.
Capital is then drawn from ell employments at low profits. Expecta-
tions are raised. Tradesmen and merchants take capital from their
usual business to embark for the new El Dorado. Professional men and
annuitants anticipate and invest part of their incomes. The public
enthusiasm is fanned by unprincipled sharpers. Scrip and paper money
afford extraordinary facilities for speculation. Men with no capital buy
and sell shares; men with little capital go beyond their limits ; and men
of large capital undertake responsibilities to which no capital is equal.
Large numbers of people are employed. Wages, salaries, fees, fly about
in every direction. “Eating and drinking, marrying and giving in
marriage,” go on at an accelerated rate. All this series of facts is in the
rough party estimates of debate confounded with substantial progress
under the name of “prosperity.” It is evident, however, that the new
source of production remains through all; that the first investments are
exceedingly profitable; and that in the end the speculation becomes a
pure destruction of capital; for a nation, like an individual, can run
through its property by the waste of the holders, their want of prudence,
their improvidence in paying wages which the profits of production will
not repay, or by the extravagant expenditure of wars, the only great
speculations in which governments have hitherto engaged. The farmer
may be running out his land, the grocer reducing his stock, the cotton-
spinner letting his machinery fall to pieces for want of repairs, the car-
penter selling his tools, while there is an increase in their expenditure,
or even their income, if by this term is understood the surplus of the
cash receipts over the outgoings of ordinary business in any given year.
The capital of a country—its fertile soil—its horses, cattle, and provisions
—its machinery and tools—its houses, ships, buildings, furniture, goods,
merchandize, silver, gold—the slow accumulations of a thousand years,
each “bearing fruit in its kind,” with skill and labour eternally renewing
and extending itself—may be wasted year by year, brought low, and
destroyed ; and while the destruction is going on, the expenditure of the
nation may be increasing instead of diminishing. The prodigal is con-
verting its estate into an annuity for a short term.

The reason of the depression that invariably follows a period of pros-
perity is in the nature of things. Wealth may be suddenly destroyed;
but a sudden creation of wealth is impossible; for it is the produce of
skill and labour, and though skill moves per saltwm in inventions, human
labour advances slowly, as generation follows generation. Where a new
force like steam is placed at man’s disposal, its introduction to profitable
uses is slow. But in the crisis of “ prosperity” a nation believes itself
rich that the year before found it a hard thing to live ; and on this high
pitch regulates its expenditure. For man’s course is determined by
opinion ; and opinion uninformed by science is full of delusions, way-
ward, and prone to exaggeration. The happy agriculturist has been
known to be disturbed by the fertility of Egypt, shake before the rustle
MARRIAGES. | 71

of the wheat waving over the plains of Hungary or Russia, and be over-
whelmed in imagination by the endless produce of the vast valleys of
the Mississippi. The “commercial mind,” on the other hand, full of
imagination, is excited by the sudden opening of great territories to
trade : witness the effect of the treaty with France in 1787 ; the opening,
as it is called, of the Continent of Europe, at the peace of Amiens, and
the peace of 1814 ; the opening of South America by Mr. Canning in
1823-5 ; the opening of Asia recently through the Indus and China.
Commerce sees these vast continents covered with customers; sets hands
to work, freights her ships, and, as she expects, finds millions in want of
her wares, and quite willing to accept them; but without anything of
value ihat they are able or willing to give in exchange for the new
untried commodities ; men, whether civilized or savage, having generally
ways enough to dispose of their i income, and little left to experiment in
new pleasures. The merchandize becomes a drug. It is sold for a
fraction of its cost price, or given away; and in perishing often feeds
the germs of a distant future trade. Some native commodity is displaced,
or the industry of the population is stimulated to produce exchangeable
articles for a profitable commerce.

In the invariable decline following an increase of marriages they have
never fallen back to the original numbers. Population has increased
faster than the marriages. The same may probably be said of the
energies and productive powers of the country. And if it is true that
depression always follows “prosperity,” the converse is equally true.
The agriculture of England, by improvements in its methods, and its ex-
tension in breadth to lands before uncultivated, has, through good and
bad seasons, dearth and abundance, steadily advanced. Manufactures,
aided by new powers and machines, have made still more progress ; and
commerce, through periods of languor and paroxysms of speculation, has
increased, enlightened by science, having at command multiplied facilities
of receiving information, as well as new agents of intercommunication.
with the world. And thus England has hitherto held on her way
through ages: sometimes prosperity has shone on her, and all the winds
have been favourable ; then heaven has been clouded, or the gulf-streams
of time have carried ther aside, or adversity has hung over her; but,
amidst all the vicissitudes and chances of the voyage, her true onward
glorious course has still been held.

Mr. Pitt, in 1786, estimated the population of England and France at
8 millions and 24 millions. The power and wealth at the disposal of
both countries has increased in a faster ratio than their population. The
population of the United Kingdom was about 16 millions, of France 27
millions, in 1801. In 1846 the population of the United Kingdom was

Marriace Ratt in Eneranp, 1796-1845.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Living to One Annual Annual Mar- | Women livin
Marriages Marriage. riages to100 | to One Annua
Years. B Do 7
to 100000 Ages | Women living. Marriage.
peck of
une. 7
Males.| Fem. | Persons. Women.
1816 1836 1816 1836
to to to to
1836-1845 1533 63°1 65°2 128°3 1825 1845 1825 1845
1826-1835 1588 60°9 63°0 123°9
1816-1825 1607 60°8 62°2 123°0
1806-1815 1637 60°7 61°1 121°8 15-45 3°596 | 3°277 | 27°8 30°6
1796-1805 1716 67°2 3 115°5 20-50 4°168 | 3°722 | 24°0 26°9

 

 

 

 
72 [paRT IL.

about 28} millions; of France about 35 millions. The increase in the
relative strength of this empire, from the time of Chatham and Pitt, when
England had to hive Hessians or other mercenaries, is immense. At the
present time there are not less than 7 millions of men in these islands ;
and 5 millions of men well able to bear arms.

It is a fact well worthy of attention that the proportion of marriages
to the female population has progressively diminished from 1°716 per
cent. in the 10 years 1796-1805, to 1°533 per cent. in the 10 years
1836-45. The proportion of marriages to the population in each period
of 10 years is shown in the accompanying Table. While the marriages
increase in prosperity, it is a general rule that the proportion of
marriages to the population decreases as the mortality decreases; and
that marriage takes place later as life becomes longer. (8th Annual
Report, pp. 26-80.)

Marriage-rate, Form of Marriage, and Commercial Prosperity.—
The marriages after banns were as five to every one by licence. The
proportion of marriages after banns to those by licence is less than it
has ever been in any year, except 1847, since 1841; and it is evident
that the pressure of the high prices of provisions, and of other cireum-
stances, depressed the poorer classes of society more than the classes
who usually marry by licence. Upon comparing the proportional num-
bers of marriages by licence ‘and after banns, it appears that when the
price of wheat is low or moderate the proportion of marriages by banns
preponderates to the greatest extent.

It may be assumed that the marriages by licence represent the
marriages of the higher and middle classes of society, and that those
after banns represent the marriages amongst artizans and labourers.

If the facts for the 14 years are arranged in the order of the prices
of wheat, it is seen that the marriages among the higher classes were
relatively rather more frequent in the five years when the prices were
highest than in the five years when the prices were lowest ; while the
marriages were most frequent among the classes who marry by banns,
when the prices of wheat were low; and as these classes are the most
numerous, they regulate the general result.

There is less fluctuation in the marriages of the rich than in the
marriages of the poor, and the rise has hitherto not been simultaneous
in the two classes; so that the difference in the proportion of marriages
by banns and marriages by licence is a very sensitive test of the
condition of the lower classes.

The cost of the marriage licence is on an average about 50s., while
the usual fee for the publication of banns is oxe shilling ; and the other
marriage fees vary in the same direction, but not in the same proportion.
If we exclude the persons married “ not according to the rites of the
“ Established Church,”—who‘are sufficiently well represented in respect
of wealth by those who are married in the church by licence, and after
batins—the population is thus voluntarily divided into two great classes,
(1) those who are willing to pay 50s. for a licence, and (2) those who
marry after banns ; the numbers of the two classes on an average of 14
years being to each other as one to 5°35. These facts afford some
guide in estimating the relative numbers of two great classes of society,
which are well marked, but are not divided by specific names. The
licences cost about 54,000/., the publications of banns not less than
5,400/. in the year. (17th Annual Report, pp. ii-iv.)
MARRIAGES. | 73

High prices of wheat depress marriage among the classes (five out of
six) who marry by banns, to a greater extent than they depress marriage
among the remaining sixth of the people marrying by licence. Con-
sequently, as the annual average price of wheat was higher (74s. 8d.) in
1855 than it was in any of the 15 years since 1811, the proportion of
marriages by banns to the marriages by ficence should be lower than it
was in any of those years. This is found to be the case, and the pro-
portion was 4°883 marriages by banns, to 1 marriage by licence in
1855. The principle that was announced in the last report, is thus
confirmed by the experience of another year. (18th Annual Report,
p. iii.)

The proportion of marriages by banns to those by licence was 5°24 to
one. Wheat was at an average price of 53s. 3d., which may be termed
“intermediate.” By comparing groups of years, distinguished as dear,
cheap, and moderate, it will be seen that those when moderate prices
ruled were most favourable in the general opinion of the unmarried for
laying the foundation of domestic establishments. The year 1860 helped
to confirm that result. If licence and banns be taken as the respective
badges of capital and labour, it may be shown that in years of middle
and low prices marriage was most frequent in the working classes; in
years of high prices it was most frequent in the middle and upper classes ;
but in the “intermediate” priced year of 1860 the marriage-rate was
remarkably well maintained amongst rich and poor alike. (23rd Annual
Report, p. v.)

Depression of the Marriage-rate by the Cotton Famine.—In Lan-
cashire the marriages, which were 6,315 and 6,127 in the third quarter
of 1860-1 respectively, declined to 5,475 in that of last year. The
following are some of the more important districts in that county, with
the number of marriages in the quarter ending 30th September of each
of the last three years :—

1860. 1861. 1862.
Bolton : - 287 - 301 - 236
Bury 229 - 185 - 167
Chorlton S 142 - 128 - 140
Salford 161 - 154 - 141
Manchester - - 1,194 1,157 - 1,018
Ashton - 350 - 865 - 220
Oldham 243 - 221 - 184
Rochdale : - 218 - 221 158
Burnley - - 204 - 184 - 175
Blackburn - - 338 306 - 243
Preston - - 298 257 - 249

The marriages in Stockport, in Cheshire, show a clear decrease in
1862; they were 291, 301, and 204. It has been stated that Ashton-
under-Lyne stands at the top of tho scale of pauperism ; and if marriages
are expected to be fewest where distress is greatest, the returns fully
justify that expectation. In Ashton the decrease on the two previous
summers was no less than 38 per cent. Next in respect of decrease is
Stockport, where it was 31 per cent. The marriages of Rochdale
decreased 28 per cent.; of Chorley 28; of Leigh 24; of Blackburn 25;
of Oldham 21; of Bolton 20; of Bury 19; of Manchester 13; of
Salford and of Haslingden 11 per cent. In Preston and Burnley they
decreased 10 per cent., and in Wigan the decrease was 9 per cent.
74 [PART II.

Chorlton showed a slight increase. When the marriage returns for the
year are completed, they may be compared with the amount of pauperism,
namely, the proportion which the persons relieved from the local rates
and the funds of Relief Committees bore to the whole population.
(25th Annual Report, pp. xxix-xxx.)

Summary of Fluctuations of the Marriage-rate, 1839-77.—Some of
the general causes which have contributed to the fluctuation in the
number of marriages in England and Wales during the past thirty-nine
years may be referred to.

In the ten years, 1839-48, preceding the period when the Act
relating to free trade came into operation the average price of wheat
was high, 58s. 7d. per quarter, and there were great fluctuations in the
marriage rate.

In the first five years of the decade the average price of wheat fell
gradually from 70s. 8d. per quarter in 1839 to 50s. 1d. per quarter in
1843; but the hopes and prospects of the people were depressed, so the
marriage-rate declined from 15°9 in 1839 to 15:2 in 1843. The most
noteworthy events of the period were the Chartist riots in 1839, and the
turn-out of cotton spinners and great general distress in 1842, when the
depression reached a crisis and expressed itself in the lowest marriage-
rate (14°7) recorded since the commencement of civil registration.
Previously to 1842 the country had suffered from four successive bad
harvests.

In the second half of the decade (1844-48) the marriage-rate rose, but
the potato disease in England and Ireland, and three deficient harvests
in 1845, 1846, and 1848, together with a commercial panic, brought the
rate down to 15°8 in 1847, the year when 10,000,000/. were voted for
the relief of the Irish who were suffering from famine. During these
ten years just reviewed (1839-48) the quantity of wheat imported into
the United Kingdom, and retained for home consumption, never exceeded
12,000,000 cwts.

In the five years 1849-53 the mean marriage-rate was high; it
increased from 16°2 in 1849 to 17°5 in 1852, and notwithstanding the
very deficient harvest in 1853, the rate rose to 17°9 in that year. This
is the highest marriage-rate on record. During this period (1849-53)
the duty on corn was reduced to Js. per quarter ; gold was discovered
in Australia, the great exhibition was opened, and owing to free trade
the quantity of foreign wheat imported began to increase; in 1853 it
reached 20,913,000 cwts.; the average price of wheat was low, and in
1851 reached a minimum price of 38s. 6d. per quarter.

The five years 1854-8 witnessed some events of great importance; in
1854 there was an extremely good harvest, but war was declared against
Russia, and the year 1857 was memorable for the Indian mutiny and
for a great commercial panic ; all these events had a depressing effect
on the prospects of the community, and the marriage-rate declined from
17:2 in 1854 to 16°5 in 1857 and (notwithstanding a good harvest) to
16:0 in 1858.

In the decade 1859-68 the annual marriage-rate was 16°8. In the
first five years of this period, although provisions were cheap, the
mariage-rate fell to 16°38 in 1861, and to 16°1 in 1862, when great
distress prevailed in the cotton districts of Lancashire, owing to the
temporary disruption of the United States; in both these years the
harvest was deficient. For the first three years (1864-6) of the second
lustre, the marriage-rate was high, and the price of wheat comparatively
low, but the effects of the rinderpest which broke out in 1865, and
was not stamped out as an epidemic until about the middle of 1867, and
MARRIAGES. | 75

the great monetary panic in London in 1866, soon made their impression
on the rate, and it fell from 17°5 in 1866 to 16°5 in 1867, and to 16°1
in 1868, the year of the Abyssinian war. The year 1866 was memorable
as the commencement of a period of commercial depression which lasted
until the end of 1870. From the year 1868, owing to the ravages of the
cattle plague, both beef and mutton rose considerably in price. In each
of the three years 1865-7 the harvest was deficient.

The next five years, 1869-73, comprised two (1869-70), when trade
was dull and the marriage-rate was low. In 1869 the duty on corn
ceased, but in this and the following four years the harvest was deficient.
In the last three years (1871-3) of this lustre the country revived ; the
year 1871 witnessed a remarkable rise in prices and in the wages of
labour, and commerce and manufactures recovered from the languor of
the previous five years; but a year or two afterwards a reaction set in,
wages were greatly reduced, and these three years of prosperity were
followed by four years (1874-77) of commercial difficulties and stagna-
tion in trade. There was an abundant harvest in 1874, but in 1875-7
the harvests were unsatisfactory, trade was depressed, strikes were
prevalent, and commercial failures were experienced. All this was
expressed in the marriage-rate of the country, which rose from 15:9 in
1869 and 16°1 in 1870 to 16°7 in 1871, 17°5 in 1872, 17°6 in 1878,
and fell to 17:1 in 1874, to 16°8 in 1875, to 16°7 in 1876, and to 15°8
in 1877. The marriages in the last ten years experienced nearly as
great fluctuations as they did in the decade previously to the introduction
of free trade.

The gradual increase in the supply of foreign wheat, a few years after
the duty on corn was reduced, is remarkable. Thus the number of cwts.
of wheat imported into the United Kingdom to every 100 of population
in the five years 1854-8 was 54, whereas in the five years 1859-63 the
proportional number was 94.

In the four years 1863-6 when the price of wheat was low, there was
a considerable reduction in the quantity imported, but in 1867 when
the price rose to 64s. 5d. per quarter, after two or three deficient
harvests, a new impetus was given to the importation of corn, and the
foreign supply still further increased; the average number of ewts.
imported in the five years 1869-73, to every 100 of population, was 121,
and in 1874-7 it was 144.

In 1877 the number of cwts. imported for home consumption was
no less than 53,347,482 or 159 cwts. to every 100 of population,
an enormous increase compared with the quantity in 1846 (8,592,458
cwts.) immediately before free trade was in operation—(40th Annual
Report, pp. xii—xili.)

2.—MaARRIAGES IN SUCCESSIVE GENERATIONS.

It may be of interest to mention that there is a complete series of
Returns of English marriages from the year 1755 down to the present
day ; and it appears (1) that on an average of the 5 years of which
1758 is the middle year, 52,666 men and the same number of women
married annually; (2) that on an average of the 5 years, of which
1791 is the middle year, 72,347 men and as many women married
annually; (3) that in the 5 years of which 1824 is the middle, 104,180
men and the same number of women married; while (4) in the 5 years
1855-9 the marriages rose to 158,868. Taking these intervals of
33 years to represent the intervals between the marriages of successive
generations, it will be noticed, that the numbers run in such prepor-
tions that each couple married in the first generation left two couples
76 [PART II.

of marrying grandchildren and three couples of marrying great-grand-
chillren. Thus 52,666 fathers left to marry 72,317 sons, 104,180
grandsons, and 158,863 great-grandsons, consequently the great-
grandfathers were only equal in number fo one-third part of the number
of their direct male descendants in the third degree. This happens
only in increasing populations, and it is probable that in the four gene-
rations preceding the year 1756 no such inequality existed. An increase
of population implies a profound social modification—(28th Annual
Report, p. v.)

3.—MARRIAGE SEASONS.

Unlike birth and death, marriage is a voluntary act, and if men so
will, all the marriages of a country may be celebrated in any single
month of the year. But human will is influenced by motives, and these
appear to operate all through the seasons of the year with variable
force. In London the close of the season among the higher classes is a
matrimonial epoch; among the working classes the festivals of Whit-
suntide and Christmas, and the season of Lent exert some influence,
so do the terms of service, which vary in different counties. The
geniality of spring is perceptible; but Lincolnshire is the only county
jn which the spring weddings exceed the autumn weddings in number.
The accumulations of autumn supply a store of food and the harvest
wages of the young swains in agricultural districts are often wisely
invested in the furniture of a cottage: it has already been shown that
workpeople are influenced in marriage by economic conditions and
prospects.

It might be supposed that marriages take place indifferently on any
day of the week. But itis not so. Few marriages are celebrated on a
Friday. Now Friday was in former times the day which would be
especially devoted to these celebrations, as is implied by the names
Dies Veneris of the Latins; and Friday, the day of the Saxon goddess
Friga.

This day was chosen by the early church, perhaps partly in opposi-
tion to Paganism, as a day for carnal mortification; it was the day of
the crucifixion of Christ; and hence the festive Friday of the Saxons,
and the day especially under the star which astrologers held was most
fortunate, fell into the category of “unlucky days.” Seamen will not
sail, women will not wed, on a Friday so willingly as on others days of
the week. The Sun, Moon, and Saturn have gained by this silly
superstition. Half the weddings are celebrated on Sunday and
Monday; Saturday has more than its average number, and in the
southern as well as the northern counties the Saturday marriages are
the most numerous. Economy of time is an alleged motive for Sunday
weddings. (27th Annual Report, pp. xiv-v.)

4.— AGEs AT MARRIAGE.

Statement of Ages in the Marriage Register.—The marriage registers
ought in all cases to show the precise age of the parties married, but in
55,098 out of the 190,112 marriages registered in 1871 the age column
was filled in with the words “of full age,” “minor,” or “under age.”
By law the clergy are required to register marriages according to the
form of the Schedule annexed to the Act (6 & 7 W. 4. c. 86), in which
form the example given, instea/l of stating the precise age of one or both
of the parties, describes the man as “of full age” and the woman as
“minor” only. And in the earlier years of registration the clergy
MARRIAGES, ] 97

were perhaps not unnaturally disposed to content themselves with a
bare conformation to the letter of the law without regard to the require-
ments of statistical and legal investigation which needed a more liberal
interpretation of the spirit of that law to satisfy. It is gratifying,
however, to find that whereas in 1451 the proportion of cases in which
the precise ages of the parties married were not stated amounted to
63 per cent. of the total marriages registered, ten years later it had
fallen to 37 per cent., in 1867-70 to 32 per cent., and in 1871 to 29 per
cent. Instances of unwillingness on the part of bride or bridegroom to
divulge their ages must of course be anticipated, but it may be hoped
that gradually they will cease to occnr as common sense gets the better
of a vain wish to hide that which is already probably no secret to the
clergyman or registration officer, whose avocations, moreover, would
most likely predispose them to regard all such matters of detail
from a general point cf view rather than as affecting any particular
individual. Furthermore, if clergymen and registrars made it a rule
to put the question as to age in the form “ What was your age last
“* birthday ?” instead of “ Are you of full age?” the marriage returns
would soon exhibit a diminution in the number of cases of unspecified
age. The importance of complete statistics of the age at marriage in
determining the relative fecundity of population is obvious.—(?4th
Annual Report, p. x.)

If all the ages were returned, it would afford the means of deter-
mining with greater accuracy the mean age at matriage in England,
the probable duration of the joint lives of husband and wife, the annual
rate of marriage at different ages, and many other important social
questions.

The returns are less imperfect now than they were in 1855, when
the ages of both parties were not returned in 42 per cent. of the total
marriages, whereas in 1874, £6 per cent. was the proportional number
of cases of imperfect returns.

Yorkshire supplied the greatest proportional number of perfect
returns, but even in this county the ages of both parties were not
stated in the marriage register in 1] instances out of every 100
marriages. In Wales, and in the Northern counties of Durham,
Northumberland, Cumberland, and Westmorland, ihe proportion per
cent. of imperfect returns was 15, in Lancashire and Cheshire 18 per
cent. The groups of counties furnishing very imperfect returns were
the South Midland, 81 per cent., the South-eastern, Eastern, and South-
western, 28 per cent. But it is in London that the returns were most
imperfect, for there the ages were omitted by the Officiating Minister or
Registrar of marriages to the extent of 53 per cent.—(87th Annual
Report, pp. xi-xii.)

Marriage of Minors.—It is necessary to bear in mind that the mere
fact that the proportion of marriages under age is higher in one
population than in another absolutely proves that the disposition to
early marriage differs only when the proportional numbers of unmarried
women under and above 21 years of age is the same ; for the ‘real
relative tendency to early marriage is measured in two populations, by
dividing the annual marriages of minors in those populations by the
numbers living unmarried at the corresponding ages.—(19th Annual
Report, p. vi.)

The proportion of children to a marriage is, to a great extent,
dependent on the age at which marriage is contracted, and the marriage
registers of a nation furnish the means of determining this age. In
78 [Part IL.

England and Wales of 201,267 marriages registered in 1872 the ages
of both parties were specified in 145,507 instances, about five-
sevenths of the total number. The mean age at marriage of these
145,507, including the re-married, was 27:9 years for men, and 25:7
years for women.

The proportion of young people who marry has never been so high
as it was in 1872, and the proportion has been gradually increasing
since the commencement of registration. In 1851 in every 100
marriages 5:02 men and 15°75 women were under 21 years of age,
while in 1872, 8:00 of the men and 22:32 of the women were
minors, but this increasing tendency to early marriage has not
affected the mean age at marriage to any appreciable extent, for
while the mean age of bachelors in 1851 was 25°8 years, and of spinsters
24°6 years, the ages in 1872 were nearly the same, viz., 25°7 and
24°3 years.

By means of the Census returns relating to the ages and conjugal
condition of the people, I am enabled to show the annual rate of
marriage at each year of age under 21, in each of the three periods
1850-52, 1860-62, and 1870-72.

MARRIAGE-RATES of BacHELORS, WIDOWERS, SPINSTERS, and Wipows,
AGED UNDER 21, in 1850-2, in 1860-2, and in 1870-2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROPORTION MARRIED TO 100 LIVING.
AGES. aes
Bachelors. | Widowers. || Total Men.} Spinsters. | Widows. wot,
ANNUALLY IN THE 3 YEARS 1850-52.
Total aged 15 a= 6, ie 2°
and under 21 ~ 763 2427
ANNUALLY IN THE 8 YEARS 1860-62.

Tee ar “946 4°56 “946 2°959 77452 2°962
es = - “017 — “017
16— 003 — “003 *186 — 136
1i— “031 _ *031 +789 2°94. “790
18— “320 _ *320 3°041 17220 3° 040
19— 1°539 a 1°5389 6°096 5° 714 6° 096

20 and under 21 4°256 7'°273 4°258 9°618 10°204 9°620

ANNUALLY IN TUE 3 YEARS 1870-72.

Total aged 15 : : . “4 se 7
and under 21. 1°177 3390 1°177 3°405 6°710 3°408
16— a = = “018 = “018
16— “002 _ 002 "153 _ °153
li “041 = *041 933 =— 933
18s— 404 = “404 3°640 1'282 3° 639
j9— 2°084 2083 2°034 7° 246 6°857 77246
20 and under 21 5°298 4°698 5*298 10°590 8°333 10°584

 

 

 

 

 

 

 

 

 

Note—The Population at the above Ages has been deduced from the graduated Tables
showing the estimated numbers living at each year of age, published in each of the Census
Reports of 1851, 1861, and 1871. In a certain number of cases the Age at Marriage is not
returned; for example: the average annual number of Minors married in the 3 years 1870-72
was 14,888 Men and 41,978 Women, but an abstract of the instances in which the ages of both
parties were stated only produced 13,681 Men and 35,732 Women ; the ages of one or both of the
couples married in the other cases being distinguished in the marriage registers by the terms
“Minor,” “Under Age, &.” The numbers of Men and Women whose ages were not stated have
been proportionally distributed over the different periods of age.
MARRIAGES, | 79

To ascertain the increased disposition to early marriage more
accurately the number of unmarried women living under 21 years of
age at different periods must be taken into account. This has been
done in the above table, and by dividing the average annual marriages
of minors by the numbers unmarried at corresponding ages, the result
shows that, among men under 21 years of age, marriage was contracted
by 7°6 in 1,000 living in 1850-52, by 9°5 in 1860-62, and by 11°8 in
1870-72; and that early alliances among women under 21 years of age
were contracted by 24°3 in 1,000 in 1850-52, by 29°6 in 1860-62, and
by 84°1 in 1870-72.

There is therefore, beyond doubt, an increasing tendency to early
marriage among the young people of this country.—(3dth Annual
Report, pp. xi-xiii.)

Marriage-rates of Bachelors, Spinsters, Widowers, and Widows.—
A new table is introduced below, in which the number of marriages of
bachelors, of spinsters, of widowers, and of widows respectively is
compared with the numbers of the four classes enumerated at the
Census in 1851. This table supplies a more satisfactory measure of the
rate of marriage than the ordinary comparison of the marriages with
the population, including a variable proportion of children. Thus of
1,000 bachelors in England, 58 married, and the proportions ranged in
the counties from 82 in the Surrey portion of London to 36 in
Herefordshire, and to 32 in Cumberland. Of 1,000 spinsters in England
61 married, and the proportions ranged from 82 in Staffordshire to 36 in
Cumberland. It appears that the marriages in London are in a high
proportion to the marriageable part of the population, and that the
proportion in the surrounding counties of Surrey, Middlesex, and
Essex, is conversely below the average. A certain proportion of the
marriages of the country people are apparently contracted in the towns ;
and in the north of England, it was shown iu the ‘last report, that great
numbers of the population of the northern countries marry, or pretend
to marry, over the borders in Scotland, where the law of marriage is
still in a loose and unsatisfactory state,

ANNUAL MaRRisGE-RATE in 1851 of BacuEtors, SPrINnsTERs,
Wipowers, and Wipows, at Dirrrerent Aczs, to 100 enumerated
in 1851.

 

 

 

 

 

 

Ages. | Bachelors. Spinsters. Widowers. Widows.
1

Total. | 5°773 | 6:085 6°457 2°096
15-19 -| 464 2183 ses 5-000
20-9 3, -|| 11-209 12672 30°766 19-649
25- - 12+209 9°503 385°790 14°906
30- - 7°851 6°025 28°627 11°611
35- is 4°558 3°780 20°313 7°253
40- - - 2°798 2°501 14°075 4°333
45- - 1°448 1:418 8°858 2°672
50- - °705 +599 5°711 1°298
55- - *349 “311 3°201 ‘731
60- i *152 *085 1°745 “241
65— - - *146 *026 *862 * 068
70- - - °031 _— *316 “025
15+ = ie +059 as +100 °O15
80 and upwards - — 044 067 O11

 

 

 

 

 

Note.— Of the 154,206 marriages solemnized in 1851 the ages of both parties were
stated in only 56,347 cases. For this table the marriages in which the ages were
not stated have been distributed to the various ages, in the proportion shown in the
stated cases
80 [PaRT IL,

The accompanying Table shows, for the first time approximately the
rate of marriage at different ages, and will admit of many useful
applications in the solution of questions of population, as well as in the
calculation of rates of insurance under certain contingencies. It will
be noticed that 127 per 1,000 of the spiusters of the age of 20-25
married in the year: and that marriage was contracted by 3 in 1,000
spinsters of the advanced age of 55-60.—(14th Annual Report,

pp. 6-8.)

Widowers are more inclined to marry than bachelors. By the
annexed table, showing the average annual rate of marriage in the
three years 1870-72 at each of 14 periods of age, it will be observed
that this disparity of disposition is most remarkable in old widowers
and old bachelors. At ages 35-40, to every bachelor who xmarried
4 widowers remarried; at ages 40-45, 5 widowers remarried to every
bachelor who married. As age advances this disparity increases, and
at ages 50-55 the relative proportions were 1 bachelor to 7 widowers;
at 66-65, 1 bachelor to 8 widowers ; and at 65-70, to every bachelor
who married 8 widowers remarried. These are marriages out of equal
numbers.

ANNUAL MARRIAGE-RATE of BACHELORS, SPINSTERS, WIDOWERS, and
Wipows at Dirrerent AGes, in the THREE Years 1870-72.

 

 

 

Ages. Bachelors. Spinsters. Widowers. Widows.

Total. 6°175 6°3138 6°575 2-110
15- - - “468 2°252 1:149 4°235
20- - - 12°352 13°785 22°917 17°064
25— 3 13°821 10°418 30-296 15°678
30- - 8°604 argo7 27°943 10°806
35- 7 5°343 3°698 21°872 7°116
40- - 3°051 2°400 15°337 4:459
45— - 1°968 1°581 10°739 2°809
50- - 1:060 "806 7°323 1°5138
55— - *610 °395 4°519 *820
60- - - - * 384 *165 2°735 °393
65- - *146 +057 1°185 *133
70- - 075 "022 538 *047
a5 2 “083 a 190 “013
80 and upwards - — —_ ‘061 “002

 

 

 

 

 

 

 

 

Note.—Of the average annual number of marriages (191,011) in the three years
1870-72 the ages of both parties were stated in 135,854 cases. For this table the
marriages in which the ages were not stuted have been distributed to the various
ages in the proportion shown in the stated cases.

Widows also marry in higher proportions than spinsters ; thus at
ages 15-20, to every spinster who married 2 widows remarried ; at
ages 20-25 and 25-80 the disparity was not so great, but at ages 80-35,
and up to 65, the relative proportions were about the same as at ages
15-20, for to every spinster who married 2 widows remarried.— (35th
Annual Report, pp. xii—xiii.)
MARRIAGES. | 81

5. MARRIAGES AND RELIGIOUS Worsuir.

It will be observed that the marriages in registered places increased
from 2,976 to 15,249, or fivefold in 13 years; within the last 7 years
the marriages in Roman Catholic chapels increased from 2,280 to 5,623,
and in a more rapid ratio than the marriages in other registered places
of worship.

From returns which were procured at the last Census, it was esti-
mated that on Sunday, March 31st, 1851, the total number of persons
who attended places of public worship was 7,261,032.* Upon com-
paring the marriages with the number of attendants at different places
of religious worship, this general result is obtained :—That among the
Roman Catholics the persons who married were in the proportion of one
to every 28 attendants, while among the members of the Church of
England and of other religious denominations, except Jews and Quakers,
there was one marriage to every 25 attendants. ‘The facts stand thus:

 

Attendants at
Persons married | Places of Public | Proportional

in 1850. Worship on Numbers.
March 30th 1851.

 

Church of England and
other Christian bodies

(exclusive of Quakers 281,170 6,913,690 1 to 25
and Roman Catholics)
Roman Catholics - 11,246 305,393 1 to 28

 

 

 

 

 

If we divide the Protestants into two classes a very different result is
obtained :

 

Attendants at

Persons married | Places of Public | Proportional
a in 1850. Worship on Numbers.
March 30th 1851.

 

Church of England 261,918 3,773,474 1 to 14
Other Christian bodies
(exclusive of Quakers i 19,252 3,140,216 1 to 163
and Roman Catholics)

 

 

 

The number of persons married in 1850 at the churches was to the
number of attendants on the Census Sunday as 1 to 14; while the
number of persons married at the chapels was to the number of
attendants as 1 to 164. The whole of this discrepancy can scarcely be
accounted for by the attendance of members of the Church of England
at the chapels, or by the marriage of members of dissenting congrega-
tions according to the rites of the Church of England: but it admits of
no doubt that from the influence of long custom, of opinion, or of a
preference for the judicious, admirable, and well-established marriage
service of the Church of England, vast numbers of the people who
habitually attend other places of worship resort to the churches to
marry.

* Census of Great Britain 1851. Religious Worship, p. elvi.
82 [PARI I.

The dissenters also complain, with justice, that in marrying according
to their own rites they are subject to restrictions and unnecessary
annoyances ; the notices of their marriages are read before boards of
poor law guardians, and their marriages in the register offices have
often to be performed in the workhouses, which, it must be admitted,
as they offer no pleasant associations, open no very inviting avenue to
the temple of Hymen.

The Quakers attended to the number of 18,172 at their 371 places of
worship, containing 91,559 sittings, on the Census Sunday (March 30th,
1851); but in the year 1850 only 138 of the Friends married according
to their own forms, so that there is still an unusual reluctance to marry
among the male or female members of this remarkable sect, which, if it
is neither sustained by hereditary accessions nor proselytes, will
eventually decline in England.

The Jews present quite a different aspect ; they marry in considerable
numbers (520 were married in 1850); but the number who attended
their synagogues on Saturday was only 4,150; so that there was one
Jew married to every 8 who attended. Marriage appears to be common,
but polygamy, though it is allowed by the law of Moses, is, J am
informed, not practised by the Jews in any country of Europe except
Turkey. (13th Annual Report, pp. iii-iv.)

6. CERTIFIED PLacEes oF WORSHIP.

The Toleration Act of 1688 gave Protestants freedom of meetiug for
religious worship at certified places ; in 1791 the same advantages were
extended to Roman Catholics; in 1812 it was enacted that no Protes-
tant congregation of more than 20 persons should meet unless the place
of meeting had been certified to the bishop, archdeacon, or the quarter
sessions ; and in 1852 the certificates were directed to be sent to the
Registrar-General. ‘The Act 18 & 19 Vict. c. 81, only enacts that “ all
“ places of religious worship, not being churches or chapels of the
“ Established Church, should, if the congregation should desire, but not
“ otherwise, be certified to the Registrar-General.” Thus the certifi-
cation is no longer indispensable, and the intolerant restrictions on
religious worship are now entirely abolished in England.

Certain legal advantages attach to the registration of places of
religious worship, for it places them under the especial protection of the
law; and it is indispensable to the solemnization of any marriages,
except those in Established Churches or in Register Offices.

A return was yrocured by this office of all the places that had ever
been certified since the passing of the Toleration Act in 1688 to
20th June 18652, so far as existing documents supplied the information ;
and from that return it appeared that 54,804 places had been certified in
the 164 years. In the first years, down to the end of 1690, 939 places
were certified; 143 as permaneut, 796 as temporary buildivgs. Of
these 289 belonged to Quakers, 108 permanent and 131 temporary
buildings. The places of Wesleyan Methodists first appear in 1741-50
in small numbers and as temporary buildings; but increase rapidly in
1791-1800, and then go on until their numbers in the end amount to
3,901, of which 2,085 were chapels or permanent structures. The
other buildings are registered chiefly as belonging to Protestant
Dissenters, consisting no doubt of Presbyterians (including Unitarians),
Independents, and Baptists. Of 18,950 the particular denomination is
not specified.
MARRIAGES. | 83

The following summary table gives the principal results :—

Praces of Worsurp returned as having been CerTirrED in each
Decenniat Prrtop from 1688 to 30th June 1852.

 

 

 

 

Places described as
Total Number

Houses, Chapels, of eee
Decennial Periods. Dvwelling-houses, Buildings, cere - 1
Rooms, or Meeting-houses, D eat 1

otherwise as or otherwise Period

Temporary as Permanent hes

Buildings, Buildings.

Toran - 39,817 14,987 54,804
1688—1690 796 143 939
1691—1700 1,247 32 1,279
1701—1710 1,219 41 1,260
1711—1720 875 21 896
172i—1730 - 448 27 475
1731—1740 424 24 448
1741—1750 - 502 27 529
1751—1760 703 55 758
1761—1770 701 85 786
1771—1780 978 158 1,136
1781—1790 1,154 316 1,470
1791—1800 3,479 915 4,394
1801—1810 3,975 1,485 5,460
1811—1820 7,497 2,664 10,161
1821—1830 7,675 2,910 10,585
1831 —1840 4,550 2,872 7,422
1841—1850 3,090 2,720 5,810
1851—1852 504 492 996

 

 

 

 

 

 

There appears to have been no means of striking any of the 54,804,
certified places off the record ; but great numbers of them disappeared
in the progress of time ; and at the Census of 1851 returns as to accom-
modation and attendance were obtained from 20,400 places of worship
then existing and not belonging to the Established Church of England ;
17,000 were returned as separate buildings. Of these separate buildings
only 3,228 were on the marriage registers of 31st December of that
year. The number registered for marriages on the last day of the year
1865 was 5,352; and at that date 16,819 places were ou the register of
places for religious worship. The Quakers and Jews are not required
to register their places of worship as such. (28th Annual Report.
pp. vii-viii.)
85

CONTENTS

OF

PART ILI.—BIRTHS.

INTRODUCTION.

1—Birta Reeisrration and Brrtu-rares.—Birth Registration, 1837-76.—
Birth-rates among Married Women, 1851.—Birth-rates among Married
and Unmarried Women, 1841-57.—Birth-rates among Married and
Unmarried Women, 1872.

2.—Fecunpiry oF Marriace.—Births to a Marriage, England and Scotland,
1856-60.-—Births to a Marriage, 1864 and 1874.—Birth-rates and Fecundity
in European States.—Fecundity of Married Women in European States.—
Fecundity in France.— Possibie increase of Fecundity and of the
Birth-rate.

3.—ILLEGITIMATE Birtus.—Registration of [legitimate Births, 1842.—Registration
of Illegitimate Births, 1871.—True Measure of Illegitimacy.—Illegitimacy
and early Marriage.—Proportion of Illegitimate Births, and of Spinsters, to
Females aged 20-40.—Decrease of Illegitimacy.

4+.—Sex Proportion at Birra.
5. DeFEcts of THE Birt Recister: Statistics oF First Born.

6.—STILL BIRTHS.
87

PART II.—BIRTHS.

INTRODUCTION.

Birra statistics are important mainly on account of the influence of
‘the birth-rate upon the increase, and upon the sex and age distribution
-of the population. Population, marriage, birth, and death statistics are,
indeed, so interdependent, that no one of these branches of vital statistics
can be efficiently handled without a full acquaintance with the main
principles and bearings of them all. Birth statistics, including those
of illegitimacy, moreover, possess a social interest apart from their
more purely statistical value arising from the relation they bear to
population. ;

‘Prior to the operation of the Civil Registration Act of 1837, no-
trustworthy birth statistics existed; indeed, they were not possible,
since no machinery for their collection existed, From 1837 we possess,
however, fairly complete national birth statistics, which there is good
ground for believing to be increasingly accurate year by year, In the
earlier years of registration a considerable, but unknown, number of
births were not recorded, and Dr. Farr estimated (see p. 89) that this
‘deficiency averaged five per cent. of the births occurring during the
394 years ending with 1876, on the assumption that the actual mean
annual birth-rate during that period was not lower than 36 per 1,000 of \
‘the population. The Births and Deaths Registration Act of 1874 first ,
made the registration of births compulsory, and, without taking too
sanguine a view ofthe present condition of birth registration, there is no
good reason to doubt that the proportion of unrecorded births is now
not only much smaller than the five per cent. estimated by Dr. Farr prior
to 1876, but absolutely very small,\ It is probable that the births which
now remain unregistered ave for the most part illegitimate. \The recent
steady decline in the proportion of registered births out of wedlock
is, however, probably, due to other causes, and should not be attributed
to increasing deficiency in the registration of such births, as there are
irustworthy grounds for believing that as with legitimate, so with
illegitimate births, the proportion unregistered is considerably smaller
‘than was the case in the early days of civil registration.

The birth-rate calculated by the usual method, that is the proportion
of registered births to the population at all ages, is a sufficient approxi-
mation to a true birth-rate to answer most of the statistical purposes for
which a birth-rate is applied. This crude birth-rate is, indeed, suffi-
ciently trustworthy when the object is to compare the rates prevailing
during a series of years in the same population. When, however, it is
desired to compare the birth-rates in two or more communities, in which
the sex and age distribution of the population may present considerable
differences, it is necessary to calculate the rates by a method which elimi-
nates the disturbing influence of those differences. This may be effected
by calculating the proportion of registered births to the number of
88 [PART TII-

women aged 15 to 45 (the ages at which most children are born)
estimated to be living in the community of which it is desired to
ascertain the birth-rate. The Census Report for 1881 shows the number
of females aged 15 to 45 enumerated in that year in each urban and
rural sanitary district as well as in each registration county, district,
and sub-district. The age and sex proportion of a population changes
very slowly, and, except in those cases where the rate of increase of
population by immigration is very abnormal, it may for all practical
purposes be assumed that those proportions remain constant during a
current intercensal period. On the basis, therefore, of the age and sex
proportions prevailing at the last Census the number of females living
between the ages of 15 and 45 may be estimated for each year between
two enumerations ; and upon this number a birth-rate, trustworthy for
comparative purposes, may be calculated.

If the birth-rate among married and unmarried women, respectively,
be required, it will be necessary to estimate, in a similar manner from
the more recent Census information, the numbers of married and
unmarried females living at these ages in the population to be dealt
with. ‘The proportion of legitimate births to married women, and of
illegitimate births to unmarried women, will thus give true legitimate
and illegitimate birth-rates. It is obvious, however, that such detailed
statistics could not be trusted for comparative purposes unless they
related to a population sufficiently large to avoid the inevitable accidental
fluctuations incidental to all smal! numbers. As a matter of fact, more-
over, the Census Report does not give the necessary information for
estimating the number of married and unmarried women, except for
registration counties, and for all urban sanitary districts having at the
time of the last Census a population exceeding 50,0U0 persons.

The number of births toa marriage affords a fairly trustworthy test
of the fecundity of a nation or community. It is patent, however, that
this test can only be usefully applied when the population to be dealt
with is sufficiently large to yield trustworthy results, and when both
marrige and birth statistics are available for a fairly long series of
years. The law regulating the registration of marriages, moreover, is
unfavourable to the collection of accurate marriage statistics for any
area of which the boundaries do not correspond with those of registra-
tion districts. Practically speaking, therefore, trustworthy statistics of
fecundity cannot be calculated for smaller areas of England and Wales
than registration counties. This, however, is the less to be regretted,
as the main use of fecundity statistics, that is, of the proportion of
children to a marriage, is for international comparison, and for detecting
any change in the degree of prolificness prevailing in a nation in a long
series of years.

Jn the sub-division of this Part dealing specially with illegitimacy
(it was found impossible to exclude all reference to this subject in the
sub-division ‘Birth Registration and Birth-rates”), some valuable
extracts will be found dealing with the influence of early marriages, of
the proportion of spinsters in the population, and of elementary educa-
tion, upon the proportion of illegitimate births. Some of these extracts,
although necessarily fragmentary, are as valuable for what they suggest
as for the information they contain. Extracts bearing upon the mortality
of illegitimate children will be found in the section dealing with infant
and child mortality.

The last three sub-divisions deal briefly with Sex Proportion at Birth,
Defects of the Birth Register, Statistics of First Born, and with Still
Births.—(Eprror).
BIRTHS. | 89

1.—BirtH REGISTRATION AND BinTH-RATES.

Birth Registration, 1837-76.—I propose now to give a brief account
of the registered additions to the population since lst July 1837, when
civil registration began; and to determine as nearly as I am able how
far the number of children registered falls short of the number of children
born alive. The facts prove that the defects were diminishing before
the law was enforced by penalties; and now with due vigilance the
registration of births as well as of deaths will, I believe, be in England
as complete as it is in any other country in Europe.

Looking back from the first complete year of registration to the last,
the annual births were 463,787 in 1838 and 837,968 in 1876; and the
new births actually recorded trom Ist July 1837 on the national registers
were 26,129,906, There were in the first year 30°3 births registered to
every 1,000 inhabitants, in the last year 86°6; and after allowing for
avy naturel increase of the rate in the interval, or any deficiency of
registration in the last year of all, Iam inclined to think the actual
birth-rate of living children was 36 per 1,000 during the 39} years ot
civil registration. At this rate besides the 26,129,906 births registered,
1,441,603 births remained unregistered, or about 5 in 100.

The births were diminished by 17,079,018 deaths, which after sub-
traction left an excess in the numbers added to the population of
10,492,491 ; about 1,200,609 more than the increase of the home popu-
lation determined from the Censuses. The 1,200,609 must have left
England by emigration in excess of immigration. There were in
England and Wales in the middle of 1837 about 15,103,778 people;
and at the end of 1876 more by 9,291,882 new comers, making in the
aggregate 24,395,660 inhabitants on 31st December 1876.

The emigration from Scotland and Ireland has been in proportion to
their population more extensive than the emigration from England ; and
certain numbers of the population of England are of Sectch or Irish
birth or descent. Consequently as the population+in Ireland—not the
Trish people—decreased, the increase of the population in the Unirrp
Kiyepom was less than the increase of the population during the same
time in England and Wales. The increase of population in the UxirEp
Kinapom, exclusive of the islands in the British seas, in the 39°5 years
was 7,619,759. I leave out of account here the numbers of the army,
navy, and merchant seamen abroad, the English, Scotch, and Irish
residing in other countries, as well as the immense number of living
emigrants and their descendants in the Colonies and in the United
States.

The population of the Unirep Kinepom increased in the 39 years
1837-1876 at the rate of 29 per cent. ; and in the last ten years at the
rate of 10 percent. The increase in the last ten years was at the rate of
0:94 per cent. per annum. It was 0°66 per annum during the whole
39 years.—(39th Annual Report, pp. v—vi.)

Birth-rates anong Married Women, 1851.—The mothers of all the
children that are born in the country are between the ages of 15 and
55 ; and the greater part of them are between the ages of 20 and 40.
The English schedule is defective, as it does not show the age of the
father and mother at the birth of the child ; but it may be inferred from
the Swedish returns that not more than 1 in 8 women who bear children
is under the age of 20 or above the age of 40.

It appears that in 1851 there were in England and Wales 2,553,894
married women under the age of 55, and that the children born alive in
wedlock were 573,865 ; so that 22 in 100 bore living children. The

|

I
90 [PART UI.

number of unmarried women,—spinsters and widows inclusive,—of the
same age (15-55) was 2,449,669; and as the number of children born
out of wedlock was 42,000, it would appear that to 100 of them 1-7
children were born. The proportion of children to 100 married women
under the age of 55 ranges between 19'73 in Herefordshire and 25°56
in Durham; the proportion of children to 100 unmarried women
(age 15-55) ranges between 1:12 in Devon and 2°83 in Norfolk.

Bintus in Wep.Lock, registered in 1851 to 100 Married Women,
aged 15-55, in Registration Counties.

 

 

Birth-rate Birth-rate
Counties in order of their to 100 Counties in order of their to 100
Birth-rates. Married Birth-rates. Married
Women. . Women.

Herefordshire 19°7 Monmouthshire 22°4
Shropshire - 20°0
London 20°4 EncGLsanpo AND WALES 22°5
Middlesex 20°4
Norfolk 20°7 Northamptonshire 22°5
Surrey 20°8 North Riding 22°6
Devonshire 20°9 Buckinghamshire 22°6
Gloucestershire - . 21°0 Cheshire - 22°7
East Riding (with York) 21-0 Hertfordshire - 22°7
North Wales Z1*2 Kent 22°8
Somersetshire 21°5 Dorsetshire 22°8
Hampshire 21°5 Warwickshire 22-9
Nottinghamshire 21°5 South Wales 23°1
Berkshire - - 21°7 Huntingdonshire - 23°2
Worcestershire 21°8 Leicestershire - 23°5
Essex 21°9 Cumberland 23°5
Sussex oi Westmorland - 23°5
Suffolk : - 22°0 Northumberland =~ 23°7
Rutland 22°0 Bedfordshire 23°7
Derbyshire 22°1 Cornwall - 24°2
Wiltshire 22°1 Lancashire - 24°3
Oxfordshire 22°2 West Riding 24°4
Lincolnshire 22°3 Staffordshire 25°0
Cambridgeshire - 22°4 || Durham - 25°6

 

 

 

 

 

 

 

The number of women of the age (20-40) in England and Wales at
the time of the Census, was 2,856,398; of whom 1,248,182 were
unmarried, 1,608,216 were married. And if 11°967 per cent. of the
children are deducted, belonging as it may be inferred, to the women
under 20 and above 40, it will follow that to every 100 women of the
age 20-40 about 18°981 children are born annually, to every 100
unmarried women 2°962, and to every 100 married women 31:413
children.

These facts may well calm the apprehensions of those who entertain
any dread of the depopulation of the kingdom ; and they present in an
encouraging aspect the great resources of the English population for
colonization or for war.—(14th Annual Report, p. xiii.)

Birth-rates among Married and Unmarried Women, 1841-57—In
forming an estimate either of the prolificness or of the state of public
morals in a country, the number of children born in wedlock must be
compared with the number of married women at childbearing ages ; and
in like manner the number of children born out of wedlock must be
compared with the number of unmarried women of the same ages.
BIRTHS, | 91

[have hitherto shown the proportion of births in and out of wedlock
to the population of the several counties; and the birth-rate has been
found to differ considerably. But that rate is evidently regulated to a
large extent, firstly by the proportional number of women in the several
counties between the ages of 15 and 55, and secondly by the numbers
living in the marriage state at those ages.

In consequence of the arrangements made at the last Census, the
ratio of legitimate births to married women, and of illegitimate births to
unmarried women, can now be definitely determined for each county,
from the returns of thirteen years, including six years before and six
years after the Census year.

ANNUAL Birtus in WEDLOCK, registered during the 13 Years 1845-57,
to 100 Married Women aged 15-55, in Registration Counties.

 

 

 

Bivth-rate Birth-rate
Counties in order of their to 100 Counties in order of their to 100
Birth-rates. Married Birth-rates. Married
Women. Women.
Norfolk - 19°6 Leicestershire 21°6
Shropshire 20°0 |/ Cambridgeshire - 21°6
Devonshire - 20°2 Oxfordshire 21°6
Herefordshire - 20°2 Derbyshire 21°9
London ie - 20°4 W oreestershire 21°9
Gloucestershire 20°7
Middlesex - - 20°7 ENGLAND AND WALES - 22°0
North Wales - 20°8
Suffolk - 20°9 Kent 921
Sussex - - 20°9 Northamptonshire - 99°]
East Riding (with York) 20°9 Huntingdonshire 22°1
Berkshire - 20°9 Warwickshire 22+4
Somersetshire - 21°0 Cumberland = 22°5
Surrey - 21-0 Bedfordshire 22°5
Hampshire 211 North Riding 22°6
Wiltshire 21°2 Monmouthshire 22°6
Dorsetshire S1*9 Northumberland 22-9
Essex - - 21°3 Westmorland 92°9
Nottinghamshire 21°3 West Riding 23°5
Rutlandshire - 21'3 South Wales 23°5
Hertfordshire 21°4 || Cornwall 23°8
Cheshire - - 21*5 Lancashire 24-0
Buckinghamshire 21°5 Staffordshire 25°2
Lincolnshire 21°6 Durham - 25-2

 

 

 

 

 

 

 

The proportion of women of the puerperal age differs much in the
manufacturing, mining, and agricultural counties; and while the
proportion of women living married at the age of 20-40, to ten
unmarried, is ten in two counties (Middlesex, extra-metropolitan, and
Westmorland), and only eleven in North Wales, Devon, Surrey,
Gloucester, Somerset, Salop, Hereford, Cumberland, the proportion in
four counties, Monmouth, Durham, Stafford, and Huntingdon, is
nineteen married women of the age 20-40 to ¢en unmarried women of
the same age.

The number of unmarried women of the age of 15 and under the age
of 55 may be divided into nearly two equal portions ; the one of women
of the age of 20 and under 40, the other of women above or below that
period; and the Swedish returns show that the mothers of the great
majority of children are 20 and under 40 yearsof age. T have, therefore,
to determine the relative birth-rates, compared the births respectively
(1) with the number of women of the age of 15-55, and (2) with the
92 [PART II.

number of women of the age 20-40. The counties, arranged in the two
orders, stand in nearly the same relative positions.

Thus in Devonshire one child in eighteen born alive is illegitimate ;
while in Norfolk one in every nine children born alive is illegitimate ;
and in Devon eleven unmarricd women out of 1,000 of the age 15-55
bore children annually; while in Norfolk twenty-five out of 1,000
unmarried women of the same age bore living children annually. If the
illegitimate children had been the children exclusively of women of
the age 20-40, then the proportion of such women must have been 21
annually in Devon and 50 in Norfolk out of every 1,000; in nine
counties less than 30; in twenty counties 80 and less than 40; in
fifteen counties 40 and less than 50 women.

The mining counties Stafford and Durham, the border counties,
Hereford, Salop, and Cumberland, the Danish counties, Norfolk,
Suffolk, Nottingham, Derby, Leicester, and the manufacturing counties
in a less degree, Bedford, York, Chester, and Lancaster, have an excess
of women unmarried, yet prolific; while all the Celtic population occupy
an intermediate place; and the population south of the Thames has the
smallest proportion of unmarried women bearing children.

Annuat Brrrus out of WerpLock, registered during the 13 years
1845-57 to 100 Unmarried Women, aged 15-55, in Registration

 

 

 

 

Counties.
Birth-rate Birth-rate
Counties in order of their to 100 Counties in order of their to 100
Birth-rate. Unmarried Birth-rate. Unmarried
Women. Women.

JTondon 0°80 Northamptonshire 1°80
Middlesex Lo? Northumberland 1°82
Devonshire 1°09 Berkshire 1°82
Surrey 1°20 Hertfordshire 1°83
Gloucestershire 1°22 | Lancashire % 1°88
Cornwall 1:24 Buckinghamshire 1°88
Somersetshire 1°85 Oxford - 1°90
Rutlandshire 1°41 Cambridgeshire 1°93
Hampshire 1:45 Westmorland 1°93
Sussex 1°49 Lincolnshire 1°96
Dorsetshire 1°51 Cheshire - 1°99
Kent - 1°52 West Riding 2°60
Warwickshire 1°56 | Durham 2°01
Huntingdonshire 1°60 Bedfordshire 2°01
Monmouthshire 1°61 Derbyshire : “ 2°10
Leicestershire - 2°10

ENGLAND AND WALES 1°64 North Riding 2°14
Shropshire - 2°15

Worcestershire 1:70 | Suffolk  - 2°21
North Wales - 1:73 || Herefordshire 2°23
Essex 1°73 Staffordshire 2°30
Wiltshire - 1:74 Nottinghamshire 5 2°31
East Riding (with York) - 1°75 Cumberland 2°37
South Wales 1°76 Norfolk 2°52

|

 

 

 

 

 

These tables deserve to be studied by persons living in the several
localities in connexion with all the circumstances ; as there can be no
doubt generally of the unhappiness of the children born out of wedlock,
any more than there can of the derangements produced in families by
profligacy.

Why, it may be inquired, do twenty-five in Norfolk, and eleven in
Devon, bear children annually out of the same number of unmarried
women; and what are the consequences to the population of the two
counties, distinguished in such different ways.
BIRTHS. | 93

The proportion of legitimate children borne by women of all ages
annually to 1,000 married women living of the ages under 40 is 392
in Cornwall, 321 in Norfolk, which is thus also in another way
remarkable.

For all England 1,000 married women of the age 15-55 have 220
children annually ; 1,000 unmarried women have 16 children annually,
or one in fourteen of them is exposed to the same chance of bearing
ebildren as married women.—(20th Annual Report, pp. xiv—xvi.)

Birth-rates among married and unmarried Women, 1872.—The
recent Census returns confirm previous deductions, and show that counties
with a high proportion of married women at the child-bearing ages
have the highest birth-rate; thus of every 100 women living at the
ages 15-45 in Durham, 59°9 were married, and in Stafford 56°3, while
in Devon the proportion was only 45°2, in Dorset 47°0, and in
Hereford 47°3. Of every 100 women living in England and Wales, at
the ages 15-45, 49-6, nearly half the number, were married.

The Appendix to the Census Report of 1871 contains some interesting
results bearing upon this point,* and shows that in the counties con-
taining the agricultural districts the birth-rate is generally low, while in
tkose counties where the great mining industries of the country are
carried on the birth-rate is high; thus the proportional number of
legitimate births annually in the ten years 1861-70, to every 100
married women aged 15-55, in the counties of Purham and Stafford,
was 25°3 and 24°8 respectively, while in the counties of Devon, Dorset,
and Hereford, the proportions were only 21°2, 21°7, and 19-7
respectively,

If the ratio of illegitimate births to spinsters and widows aged 15-55
be compared in these counties, the results are nearly equally striking ;
the average annual number of illegitimate births to every 100 unmarried
women being 2°2 in Durham and 2-4 in Stafford, while in Devon,
Dorset, and Hereford, the proportions were 1°38, 1:5, and 2°0 per
cent.—-(85th Annual Report, p. xvi.)

2. Fecunpity or MARRIAGE.

Births to a marriage, England and Scotland, 1856-60.—The
marriages in a calendar year give rise to births which are registered
year after year for 20 years. The births to the 167,723 marriages in
the year 1859 could only be determined by following the families and
counting all the children unto the end. The division of the sum of the
children by the marriages would accurately express the fecundity, as it
has been called, of marriages. If the annual marriages do not increase
or decrease in number through a series of years, the division of the
annual births by the annual marriages of the same years expresses the
fecundity pretty accurately ; but the marriages in England are increasing
rapidly ; consequently the 740,275 births registered in the year 1864
must be divided by the marriages of some earlier year to get an
approximation to the fecundity. As the age of the mothers is unfor-
tunately not recorded, the interval in England is unknown which
intervenes between the mean age of marriage and the mean age of
the mothers when their children are born; otherwise that interval
would indicate the calendar years with which the births of the year
1864 should be compared.

 

* See Vol. IV. Census of England and Wales, 1871.—General Report, Table 81,
p- 68.
9+ [PART II.

But the interval in Sweden between the mean age of mothers at
marriage (25°8 years) and their mean age at the Lirths of their children
(81'7) is six years; and the interval in England cannot differ much
from six years. Hence, if the legitimate births of given years are
divided by the marriages of six years earlier date, the quotient will be
the proportion of children to a marriage within close limits. In
England the births thus determined to a marriage were 4° 256, 4°301,
4°304 in the years 1862, 1862, and 1864. In Scotland the births in
1862 to the average marriages of six years earlier date (1855, 1856, and
1857) were 4°€94. The number of children to a marriage thus appears
to be greater in Scotland than in England, and this is held to be a proof
that married women are more prolific in Scotland than in England.

Proceeding upon another basis the annual number of legitimate
children registered in England was 626,506 in the five years 1856-60 ;
when the average number of wives of the age 15-55, determined directly
from the Census returns of 1851 and 1861, was 2,845,374 ; consequently
100 wives bore 22:0 children annually. In like manner it is found that
100 unmarried women bore on an average 1°7 illegitimate children ;
that is 17 children to 1,000 women. 100 women, including the married
and the unmarried, bear 12°38 children annually on an average.*

In Scotland, during the same years, the following proportions were
found to exist: 100 wives bore 24°8 children annually, 100 spinsters or
widows bore 1°9 illegitimate children ; and 100 women bore 12:0
children legitimate or illegitimate.

The wives of Scotland, as well as the spinsters, are apparently more
prolific than the corresponding classes in England; and yet taken col-
lectively the wcmen of England are more prolific than the women of
Scotland. 1,000 English women (age 15-55) bear 123 registered children
annually ; while 1,000 Scotch women bear 120 children. The difference
is slight, but it is in favour of the English women.

This appears, at first sight, to be contradictory and paradoxical. It is
explained by the circumstance that the proportion of recognized
wives in the population is much lower in propcrtion in Scotland
than it is in England, and as the fecundity of wives is to that of
spinsters as 18 to 1, a slight difference in the proportions alters the
birth-rates of the two populations. The difference in this respect
between England and Scotland is great: in England 52 in 100 women
of the age 15-55 are wives, 48 only are spinsters and widows; in
Scotland the proportions are reversedly 44 recognized wives to
56 spinsters and widows.

1856-60.— Wives and SpinsTERs and Wipows, aged 15-55, in
ENGLAND and ScoTLAND.

 

 

 

 

NUMBER OF MARRIED PROPORTIONAL NUMBER
AND OF OF MARRIED
UNMARRIED WOMEN. AND UNMARRIED WOMEN,
ENGLAND. ScoTLAND. ENGLAND. ScoTLAND.
Women - 5,437,769 867,062 100°00 100°00
Wives - - 2,843,374 383,271 62°29 44°20
Spinsters and Widows 2,594,395 483,791 47°71 55°80

 

 

 

* The proportions are slightly different in the years 1862 and 1864; but the
argument remains unaffected. ‘Ihe same remark applies to the proportions of births
to women of age 20-40.
BIRTHS. | 95
Beto

By altering the proportions in Scotland, for instance, by transferring
57,608 women from the ranks of the unmarried to the married women,
and by transferring 2,130 children from the ranks of the illegitimate to
the legitimate children, the fecundity of women—of the wives and of the
spinsters—of Scotland, becomes the same as the fecundity of the corre-
sponding classes in England, namely, wives having children 22°034 per
cent., spinsters and widows 1°676; instead of 24°790 and 1°916 per
cent.; and when the transfer is made, the proportions remaining still
show a less excess of women living in the state of marriage in Scotland
than in England. Let us push this inquiry a little further.

CoMPARATIVE Fecunpity of Enerisu and Scorcu Women of the

 

 

 

 

 

 

Ages 15-55.
BIRTHS,
YEARS. To 100 Women. | To 100 WIVES. ite Wows.
|
England. | Scotland. | Engl and. | Scotland. England. | Scotland.

|

Average in \
the 5 years 12°321 12°027 22° 034 24°790 1°676 1°916

1856-60 -

1856 12°373 11°851 22°276 24°672 1°670 1°805
1857 12°337 11°982 22°137 24°861 1°671 1°835
1858 12°056 11°997 21° 585 24°700 1°669 1°933
1859 12°543 12°232 22°361 25°073 1°711 2°004
1860 12°295 12°072 21°870 24° 643 1°658 2° 004

 

 

 

 

 

 

 

“There is an important distinction between the law of Scotland and
that of England upon the point of legitimation by marriage, the former
legitimating ail the children of the parties born before the marriage, the
latter legitimating only those who were born after the marriage. * * *

“Tt has been an established rule and principle of the law of Scotland
for some centuries that when a@ mun and a woman are once lawfully
married all the children born of such parents, whether born before the
public celebration or open declaration of such marriage, or after it, are
equally to be esteemed their legitimate children, * * *

“Jt is generally stated in Scotch authorities to rest on a presumption
or fiction, by which it is held thaé there was from the beginning of the
intercourse of the parties, or atthe time when the child was begotten, a
consent to matrimonial union interposed, notwithstanding that the
contract was not formally completed or avowed to the world [at the
Census, for example] wntil a later period.”*

The legitimation of children born out of wedlock by subsequent
marriage is somewhat different in France; it depends on the decision of

 

* Shelford, Law of Marriage, pp. 783-4. In a note he adds . “Legitimation per
subsequens matrimonium is admitted, with different modifications, not only by the law
of Scotland, but in France, Spain, Portugal, Germany, and most other countries in
Europe. It prevails in the Isle of Man (Lex Scripta of the Isle of Man, p. 70-75),
Guernsey, and Jersey, Lower Canada, Saint Lucia, Trinidad, Demerara, Berbice,
the Cape of Good Hope, Ceylon, and the Mauritius. It is not admitted by the law
of England, or of her other possessions in the West Indies and North America, or
by the law of Ireland. It prevails inthe States of Vermont, Maryland, Virginia,
Georgia, Alabama, Mississippi, Louisiana, Kentucky, Missouri, Indiana, and Ohio,
but nof in the other States of America,—1 Burge on Foreign Law, 101.” ,
96 [PART III.

the parents under the Code Napoleon, which nearly expresses the state
of the law on the continent of Europe since the time of the Romans.

“Les enfans nés hors mariage autres que ceux nés d’un commerce
incestueuz ou adultérin pourront étre légitimés par le mariage sub-
séquent de leurs pére et mére, lorsque ceux-ci les auront légalement
reconnus avant leur mariage ou qwils les reconnaitront dans Vacte
méme de celebration.”’—Code Civile, livre i. section 831.

England stands almost alone among the civilized nations of Europe in
refusing legitimation, even at the wish of the parents, to offspring born
out of wedlock: and changes of the law might be demanded not only in
kindness but in justice to the children, if there were no great counter-
vailing advantages on the side of English law. Such advantages are
believed to exist.

Out of 1,000 children whose births are registered in England 65 are
illegitimate; out of 1,000 registered in Scotland 89 are illegitimate
(1856-60) ; the proportion of bastards in an equal number of children
of the two countries is as 3 in England to 4 in Scotland. Is this to be
ascribed to the greater ignorance of Scotch women? By no means.
Is it due to differences of religious belief or zeal? No one pretends
that in this respect the people of Scotland are at all inferior to the
people of England. We are thus driven back for an explanation to
differences of the laws.

It is quite certain that many of the children registered as illegitimate
in Scotland will be legitimated by the subsequent marriage of their
mothers; the number is not always recorded as the mere fact of marriage
regular or irregular legitimates offspring ; but assume the numbers to be
2,180 out of 9,272 illegitimate births, then it follows that an indefinite
number of the women returned at the Census as spinsters in Scotland
are living in a state of quasi-marriage described in the books, and fairly
expecting if they have children to see those children legitimated by
subsequent marriage ; they are kept in an uncertain state, hovering
between concubinage and marriage, to which there is nothing corre-
sponding in England, and they would nearly all, if they lived under the
English law, be explicitly married. If the numbers of these women
are taken at 57,608, as has been before explained, and added to the
wives of Scotland (age 15-55), the numbers of wives de presenti and
wives de futuro will be 440,879, giving birth to 97,143 children annually,
leaving 426,183 spinsters and widows corresponding to the same class in
England, and giving birth to the same proportion of illegitimate children.*

 

*Let the fecundity of wives age 15—55 in England be thus expressed by—
legitimate children in a year
wives living ina year ~~ 73
illegitimate children
spiucterd aud widawa= ©
And for Scotland put / = legitimate births in corresponding year, borne by w wives
of age 15—55; also 7 = illegitimate births by s spinsters and widows of same age.
Then to obtain the proportion (y) of spinsters to be transferred to wives, and of
illegitimate births (x) to be transferred to the legitimate, in order to make the
fecundity of the corresponding classes equal to those of England, we have these
Equations of Condition :

 

and that of unmarried women by

l+ ai
@) wrys

 

= f = +22034

t— at
(2) and rag = ga “01676

of (s + w) — (ol + fi)
pan a —7)
_fwteos—-U+i
a RF)
BIRTHS. | 97

As a class these women in the prenuptial stage have comparatively
few children, for the fruitful marry, and the unfruitful as a rule remain
uninarried.

Other explanations are conceivable, but under this hypothesis it is
not necessary to assume that there is any essential difference in the
organization, the fecundity, or the virtue of the women living north and
south of the Tweed. The laws are different. The result seems to tell
in favour of the English marriage law, and against legitimation by
subsequent marriage, inasmuch as the benefit to existing illegitimate
children is purchased by multiplication of their numbers, uncertain
connexions between the sexes, and extensive disorganization of family
life.—(27th Annual Report, pp. xx—xxiv.)

Births to a marriage, 1864 and 1874.—Assuming that the interval
between the mean age of marriage and the mean age of the mothers in
England is 6 years, then the legitimate births in 1874 divided by the
avevage number of marriages in the three years 1867-9 will give the
average number of births to a marriage—4°57. In the year 1864 the
proportional number was 4°30, so to every 100 marriages in England
there are now 457 births, whereas ten years ago there were 430, or 27
less. This is no doubt owing to some improvement in the registration
of births. The annual number of legitimate births to every 100 married
women aged 15 and under 55, in the 10 years 1861-70, was 22-35,
—(37th Annual Report, p. xiv.)

Birth-rates and Fecundity in European States—The births regis-
tered in England are, in proportion to the population, one-seventh part
more numerous than in France, and one-seventh part less than in
Prussia. To 3,525 inhabitants 100 births are annually registered in
France, 113 in England, 183 in Prussia, 136 in Austria, 151 in Russia.
The small number of births in France is not accounted for by any
difference in the proportion of the persons married, who are in fact
more numerous in France than in any other country from which I have
been able to procure returns. It appears that 100 French wives had
14 children, 100 Prussian wives 21 children yearly; or, in other terms,
717 wives bore annually 100 children in France, 152 children in
Prussia. If the births are divided by the annual marriages that took
place seven years before, there were 3°33 births (in wedlock) to a
marriage in France, 4°05 to a marriage in Prussia, and 4°34 to a
marriage in Austria; 4°26 to a marriage in England, and, if a correction
be made for first marriages, 4°79 to every ¢wo persons married. The
total annual births in England, divided by the persons married seven
years before, give on an average 5°12 children to every two persons
married ; and, as many illegitimate children are the offspring of married
persons before, during, or after marriage, the number of children to
every two persons married in England must be between 4°79 and 5°12,
or litile short of five, about three of which attain the age of marriage
to replace the two parents and those who have no offspring; the surplus
swelling the number of the existing inhabitants of the island, or flowing
off in emigration.—(6th Annual Report, p. xxx.)

Fecundity of married women in European States.—Through the
courtesy of the superintendents presiding over the statistical departments
of the respective European States, I am enabled to publish for the year
1876 some approximate results, showing the comparative fecundity of
married women in the different States.

G
98 [PART It.

T pointed out in the 27th Annual Report,* that to ascertain the number
of births to a marriage (unless the marriage-rate is stationary) the annual
births should be divided by the annual marriages of some previous year.
In the following results it has been assumed, in the absence of more
precise information, that the interval between the mean age of mothers
at marriage, and the mean age at the births of their children, is the same
in England and in other countries, as it is in Sweden, viz., about six
years. The legitimate births in 1876 have therefore been divided by
the marriages of six years earlier date. Thus in Sweden the number
of legitimate births in the year 1876, to the average annual number of
marriages in six years earlier date (1869, 1870, 1871) was 4°84, so the
number of children to a marriage in Sweden appears to be nearly the
same as the number in England, viz., 4°63.

In Italy the proportional number of births to a marriage was
apparently highest, 5°15; but this is probably owing to the fact that
all the marriages are not at present registered. Prussia stands next in
order of greatest fecundity, and the proportional number was 4°92. In
the Netherlands it was 4°83, nearly the same as it was in Sweden.
In Belgium it was 4°48, nearly the same as it was in Spain; in Denmark
it was low (4°24), and in Austria still lower (3°73), while it was
lowest in France, viz., 3°42.

Comparative Fecunpvity in different European STATES.

 

 

|

European Births
a States. | to a Marriage.
|

|
1876 Italy 5°15
45 Prussia - : 4°92
” Sweden i 4°84
a Netherlands \ 4°83
‘3 England | 4°63
i Belgium - | 4°48
1870 Spain ! 4:47
1876 Denmark | 4-24
3 Austria i 2°95
ss France | 3:42

 

 

 

 

(40th Annual Report, p. xxxvii.)
Fecundity in France—In France, according to the last returns of
1863-69, the proportion of children born annually to 100 wives of 15-55
was 165,

 

 

 

AGES 15-55, AGES 20-40.
i
CouNTRY. YEARS. Legitimate Illegitimate Legitimate | Illegitimate
Births to Births to Births to Births to
100 married | 100 unmarried | 100 married | 100 unmarried
Women. Women. Womeu. Women.
ENGLAND AND (1861-70) 22°35 164 85°87 3°34
WALES.
FRANCE - (1863 69) 15°10 162, 26°39 3°33

 

 

 

 

 

 

 

* p, XX.
BIRTBS. | 99

Thus, at the French rate, the English wives would have borne
annually in 1861-70 only 475,948 children, whereas their lawful
children actually registered were 704,309.* 475,948 births would not
have replaced the 479,450 annual English deaths in the period, so the
population, without any emigration, would have declined. In France
more women marry than in England, and though they have fewer
children to a family, the population is not sensibly declining.

This is a question of numbers which are not much swayed either way
by the direct action cf the wealthy, the scientific, or the highly culti-

vated. It involves the sustained systematic policy of two masses of
people,—of the Catholic peasant proprietors and of the artizans of
France, with few settled colonies, on the one hand; of the Protestant
workmen, labourers, miners, artizans, and mariners of England, with
vast colonial possessions, on the other. The social policy in both cases
may perhaps be considered open to censure, and yet may not be without
vindication in the circumstances of the two nations. If the French
parent asks how many of his children have a chance of a livelihood on
a parcel of the dear land he loves so well, and regulates his family
accordingly, he appears to have the sanction of the school of economists
founded by an Englishman: while on the English side we contend,
with the facts revealed by the Census in our hands, that the English
people have instinctively pursued a great and wise policy: they bave
increased at variable rates ; by increasing rapidly since the last century
they have exalted England to a height overtopped by no other power ;
they have peopled colonies ; they have planted wide in perpetuity the
English race ; and they have exercised « great part in the government
of the finest regions of the carth. That they have done under great
discouragements and at great sacrifices. Malthus told them at the
beginning of the century that by the principle of population they were
increasing in geometrical progression ; that they were thus perpetually
pressing upon the means of subsistence, which increased in arithmetical
progression ; that this was the inevitable cause of misery, of which the
only mitigations were destructive diseases cutting down their numbers,
or the diminution of marriages and births by prudence.—(Census Report,
1871, Vol. 4, pp. xvi-vii.)

Possible increase of Fecundity and of the Birth-rate—To 100
married women aged 15-55, 22°47 living children are born annually,
and to 100 unmarried women 1°7 living children are annually born.
Upon the hypothesis that as many unmarried women must ceteris
paribus, be living irregularly to every child born out of wedlock as there
are wives to every child horn in wedlock, then 186,920, or 1 in 13 of the
unmarried women, must be living so as to contribute as much to the
births as an equal number of married women. A certain class of cases
countenances the belief that the numbers and proportions are under-
stated—others, that they are overstated—-by such a hypothesis. But as
the mothers of so many as probably 7 in 8 children are of the second
age (20-40) when 100 married women have 31 children annually, it will
follow that 42,000 children out of wedlock may be borne by about
136,728 women of that age (20-40), or by about 9 (cxactly 9°129) in
every 100 of the 1,248, 182 unmarried women. Nearly 1 in 11 may be
struck off the list of spinsters by this estimate, which appears, on the
whole, to be of the two the nearest approximation to the truth; thus
leaving, out of 1,248,182 unmarried women 1,111,454 living in celibacy

 

*The Average Annual legitimate births in England 1861-70 were 704,309, whilst
at the French birth-rates the English married women agel 15-55 would have borne
475,948 children.

G2
100 [PART III.

in the prime of life (20-40), against 1,744,944 women, namely
1,608,216 wives and 186,728 women who are not wives, who bear
children. Now, some conception of the voluntary control that is exer-
cised over the numbers of the population may be obtained by considering
that the births are proportional to the number of married women, who
at this age may be raised in the proportion of 2 to 3 by the simple
transfer to their ranks of a portion of the 1,111,454 unmarried ; and,
further, that an increase of the actual births by one third part or by one
half would certainly double the rate at which the population has increased
for the last half century. For the sake of simplifying the statement, the
whole of the births have been here referred to the women of the age of
20-40; but it is well known that in America great numbers of women
marry and bear children at the ages under 20, when in Great Britain
only 25,607 are wives, and more than a million young women are
spinsters. (Census Report, 1851; Occupations, vol. 1, p. xliv.)

3. ILLEGITIMATE Birtus.

Registration of Illegitimate Births, 1842.--The Abstracts have
been extended, and present Returns of the first marriages, to which I
have already adverted, and the annual number of illegitimate children
registered,—upon which J proceed to offer a few remarks. The first
attempt to ascertain the number of illegitimate children in England was,
I believe, made at the Census of 1831, when Mr. Rickman obtained,
from the officiating ministers of churches and chapels in England and
Wales, Returns of illegitimate children born in their parishes or
chapelries during the year 1830. ‘The total number returned was
20,089, of whom 10,147 were males, 9,892 females. Mr. Rickman was
of opinion that this return was accurate; but, from want of uniformity
in making the Return, many of the officiating ministers merely stating
the numbers Japtised in their churches and chapels, instead of recording,
as requested, the number orn according to the best information they
could obtain, I think no great reliance can be placed on the correctness
of these Returns. In which opinion I am confirmed, on referring to a
Return of illegitimate children whose baptisms were registered by the
clergymen in the several parishes of Lancashire, the West Riding of
Yorkshire, Norfolk, Surrey, and Herefordshire, during the year 1831,
presented to the House of Commoms in March 1848. No specific
reference is made to illegitimate children in the Registration Act; and,
as it is not stated on the face of the Register of Births whether the
children registered are or arc not born in wedlock, the attempt to deter-
mine this point cannot always be successful ; but great care has been
taken in framing this Abstract, and in every doubtful case the child being
classed as legitimate, I am confident that the Abstract now submitted to
you cannot in any view be conceived to overstate the number of ille-
gitimate children born in England. In the country districts I see no
reason to suppose that illegitimate children escape registration in greater
proportion than children born in wedlock; but, when the facilities in
populous districts for the concealment of births from the registrars,
and the impunity with which a woman may suppose she can assume
a name, or give the name of a father, are considered in connexion
with the relatively small number of illegitimate children registered in
the Metropolis, Liverpool, and some other large cities, I fear that we
must set down the number of illegitimate children in the Abstract
as an under-statement. The attention of the registrars has been
specially directed to these points, and they are required to acquaint every
BIRTHS. | 101

informant that any false statement wilfully made by her respecting any
particular to be recorded in the register, will render her liable to the
pains and penalties of perjury; they are also instructed to discourage
the entry of the names of putative fathers in the Register Books of
Births,

The number of illegitimate children registered in 1842 amounted to
34,796, which is 14,757—or 74 per cent.—more than the numbers in
Mr, Rickman’s Returns of 1830. The population increased only 17 per
cent. in the 12 years. I am disposed to consider Mr. Rickman’s
Returns as deficient to a much greater extent than they were suppose:
to be at the period of their publication; but, with a correction for
the increase of population, the numbers in the Abstract for 1842 would
only have exceeded those in Mr. Rickman’s Returns for 1830 by 11,800
instead of 14,757. This difference may, perhaps, among other causes,
be ascribed to an actual increase in the proportion of illegitimate children
during the operation of that important change in the Poor Law, which
threw the charge of maintaining their illegitimate offspring upon the
mothers. But to whatever cause the increase may be ascribed, the
relative numbers of legitimate and illegitimate births and baptisms
returned in 1830 and 1842, show in the latter year a relative as well
as an absolute excess of illegitimate children. (6th Annual Report,
pp. XXX.-xxxi.)

Registration of Illegitimate Births, 1871.—Illegitimate births to the
number of 14,775 were registered in 1871, amounting to 5°6 per cent.
of the total births registered. Twenty years ago they were close upon
7 per cent. of the total births; in the 10 years 1851-60 they averaged
6°5 per cent.; in the following 10 years 6:1 per cent.; so that from
whatever cause there has been a gradual and uninterrupted falling off in
these evidences of human frailty. I have no grounds for supposing that
the general diminution in the illegitimate birth-rate is caused by any
increase in the omissions to register, on the contrary, I think that as in
those elements of registration which we have the means of accurately
observing, undoubted progress in the direction of greater completeness
has taken place, it is fair to assume with respect to the registration of
illegitimate births that at any rate no more of them are lost sight of now
than in former years, In London little or no variation in the rate of
illegitimate birth has taken place in 20 years; it amounts to about 4 per
cent. of all the births, which is markedly less than the average for the
whole country, partly for reasons, no doubt, which will be sufliciently
obvious to all who are familiar with life in great cities, but which do not
lie within my province to discuss. (84th Annual Report, p. xvi.)

True measure of Illegitimacy.—In seven counties, exclusive of the
metropolitan counties, the proportion of births out of wedlock is less
than 6 in 100 births; namely, 5°3 in Monmouth, 5°4 in Devon, 5°5 in
Cornwall, 5:7 in Durham, 5°'8 in the Extra-metropolitan part of
Middlesex, 5:8 in Huntingdon, 5°9 in Warwick; in six counties the
proportion of illegitimate births exceeds 9 in 100 births, namely, 9-1 in
Westmorland, 9°5 in Nottingham, 9°9 in Shropshire, 10°2 in Hereford.
shire, 10°5 in Cumberland, and 11:1 in Norfolk; so that in Norfolk
1 in 9 of the children, and in Devon 1 in 19, are born out of wedlock.

These returns show that great differences exist in the manners of
different counties ; and they undoubtedly imply varieties in the state of
the family relations, in the social education of children, and in the morals
of the people. But it must not be immediately assumed, as has been
sometimes done, in comparing the counties of England and Wales, any
more than in comparing the results of our returns with those of other

oy selene
102 [PART II.

countries, that the relative morality of the population is expressed hy

these numbers,
The relative proportions of the unmarried women who gave birth to
children in the year 1851 are shown in the annexed Table.

Brrtus out of Weptock, registered in 1851, to 100 Unmarried Women,
aged 15-55, in Registration Counties.

 

 

 

 

 

 

 

 

 

 

 

: Percent- ; Percent-
Birth-| age of Birth- | age of
rate | married rate | married
Covntirs, to 100] women Countirs, to 100 | women
in order of their uh- who in order of their un- who
Birth-rate. mar | signed Birth-rate. mar- | signed
ried by ried by
Wo- | marks, Wo- | matks,
, men. | 1851, men. | 1851.
London 0°82 23 Lancashire - 1°90 63
Devonshire 1°12 36 Northumberland 1°95 38
Middlesex - Lele 30 Essex 1°95 45
Gloucestershire =) 1°37 37 Bedfordshire 1°97 59
Surrey 1°35 29 Westmorland 1:97 i)
Cornwall 1°36 52 Cambridgeshire 20) 46
Hampshire - 1°46 34 Durham 2°02 48
Somersetshire 1°51 43 Lincolnshire 2°04 39
Dorsetshire - 1°52 38 Buckinghamshire 2°06 50
Sussex ~ 1:54 29° |) West Riding 2*09 59
Rutlandshire - | 1°59 32 | North Riding 2°09 36
East Riding (with | 1°62 39 ' Cheshire 2212 55
York) | Oxfordshire - 2°13 39
Warwickshire 1°65 43 | Derbyshire - 214 42
Kent - 1°62 34. || Northamptonshire 2°15 45
Monmouthshire 1°68 61 | Hertfordshire 2°15 51
eas ee e Shropshire QF 47
England and Wales - | 1°72 45 | Herefordshire 2:90 41
Worcestershire 1:79 48 Leicestershire 2°32 43
South Wales 1-80 67 | Staffordshire 2-40 60
Berkshire 1-80 35 |, Cumberland 2°44 30
North Wales 1°82 66 | Suffolk - 2°45 46
Wiltshire - 1°85 47 | Nottinghamshire 2°46 48
Huntingdonshire 1°89 47 | Norfolk 2°83 44

 

Excluding London from view, as the returns are probably imperfect,
it may be inferred that generally the unmarried women in the counties
south of the Thames, comprising the descendants of the old Saxon
population, have few illegitimate children: Wales stands next in the
scale: the West Midland, the North Western, and the South Midland
counties, covering the area of the ancient Mercia, present less favourable
results ; while in Yorkshire, the Northern counties, the North Midland
counties, and particularly the Eastern counties, covering the area of
the ancient Danish population, the number of illegitimate children is
excessively great.

The women of the counties in which there are fewest illegitimate
children appear to be the best mothers and housewives, as, other things
being equal, they lose fewer of their children in infancy than the women
of counties where many children ave born out of wedlock.

With the facts in these tables before them, it will be for the clergy and
for other moral inquirers in each county to investigate the causes of the
discrepancies which they disclose, and to ascertain how the existing evils
can be most eflicaciously and successfully treated, To facilitate such
BIRTHS. | 103

inquiries, which should be elaborate and not be confined to a single class
of causes, the counties are arranged in the above Table in the order
that the proportion of mothers of illegitimate children of the age 20-40
bear to 100 unmarried women of the same age; commencing with the
counties in which the proportion is lowest. A column is added showing
the state of elementary education among the women who married, these
throwing indirect light on the state of education of the unmarried women
in each county. (14th Annual Report, pp. xiii—xiv.)

“Illegitimacy and Early Marriage——The average annual number of
children born out of wedlock in the 10 years 1846-55, to every
100 spinsters aged 15 and under 45, was 1:89. In the 10 years 1866-75
the proportional number fell to 1-79, showing a decrease of 5°3 per cent.

-The increasing number of early marriages does not appear to account
for the decreasing rate of illegitimacy in England.

As an illustration in confirmation of this, take the four counties of
Cumberland, Norfolk, Salop, and Westmorland, which had the highest
proportions per cent. of children born out of wedlock in the 10 years
1865-74; the mean annual rate of illegitimacy in these four counties
was 9°6, and the mean proportional number who married under age
to 100 marriages in 1865-74 was 5'7 for men, and 17°5 for women;
whereas in the counties or parts of counties of Middlesex (extra-metro-
politan), Surrey (extra-metropolitan), London, and Monmouth, where
the proportion per cent. of children born out of wedlock was lowest—
4:1 per cent., the proportional number who married under age to
100 marriages in 1865-74 was 5:0 for men, and 18-2 for women.
(38th Annual Report, p. xxvii.)

Proportion of Illegitimate Births and of Spinsters to Females aged
20-40.—The relation between the illegitimate births and the propor-
tional number of xpinsters in different counties is strikingly exhibited if
the counties are arranged in groups in the order of the rate of
illegitimacy.

 

Children born Proportion of
out of Wedlock | Spinsters aged

 

Grours or to every 100 20-40 to every

Births. 100 Women

REGISTRATION COUNTIES. living at the

same Age in
1876. 1871.
lst Group of Ten - 3°9 36°1
2nd Group of Ten 4°6 37°9
3rd Group of Ten - 2 5:0 39°1
4th Group of Ten - 5:9 38-6
5th Group of Six - 8°0 41°3

 

 

 

 

 

[A useful table in the 39th Report (on page xxv) shows the propor-
tion of illegitimacy in each English county in the ten years 1856-65, in
the ten years 1866-75, and in the year 1876, also the decrease per cent.
in 1876 compared with the mean proportion in 1866-75; and the pro-
portion of spinsters aged 20-40 to females of the same ages in 1871.]
(39th Annual Report, p. xxvi.)

Decrease of Illegitimacy.—A great reduction in the rate of illegitimacy
has taken place during the last 164 years (reckoning from the middle of
each of the periods 1855-64 and 1875-7): the reduction per cent.
reached 39 in Leicestershire, 35 in Cheshire and Nottinghamshire, 34 in
104 [PART 11.

Derbyshire and the North Riding of York, 33 in Essex and Lancashire,
32 in South Wales and Wiltshire, 31 in Berkshire, and 30 in Durham.
Indeed, in the whole of England and Wales the fall in the 16} years
was not less than 27 per cent. (40th Annual Report, p. xxiii.)

4. Sex Proportion at Birtn.

Sex proportion at Birth, 1841.—I showed in the Fourth Annual
Report that the proportion of boys to girls born in England was 10,486
to 10,000. The mathematical questions connected with the proportion
of the sexes born have been investigated by Laplace, Poisson, Babbage,
and other distinguished philosophers; and one of the results which has
attracted most attention and created most speculation is, that the pro-
portion of boys is greatest among legitimate children. {n France, for
instance, the boys are to the girls born as 106°4 to 100°0; but among
illegitimate children the proportion is 104°4 to 100°0. The present
Return gives a result exactly the reverse ; of the legitimate births the
boys are to to the girls as 105°4 to 100°0; of illegitimate births the
boys are 108° to 100°; and, small as the numbers are, the ratio differs
little in the two quarters. It is, I believe, assumed in the French
Returns that foundling children are illegitimate. If it be true, as is
stated by those acquainted with the matter, that many of the children
sent to the foundling hospitals in France are the offspring of married
people, who probably abandon a greater proportion of girls than boys,
it will follow (1), that the proportion of children born out of wedlock
is nearly the same in England as in France ; and (2), that the inference
from the Returns of Continental States having foundling hospitals as to
the relative predominance of females among natural children is fallacious.
(5th Annual Report, pp. 10-11.)

Sex Proportion at Birth, 1838-83.—More hoys than girls are born
every year in England and Wales. In 1877 the boys were in the
proportion of 103-6 to every 100 girls. The proportions of the sexes
are perhaps regulated by some natural law in operation immediately
preceding, or at some early stage of, intra-uterine life ; probably several
other causes also exert their influence, such as the social status and
relative ages of the parents at marriage. The excess in the births of
males over those of females is believed to be greater among first-born
children than it is among those born afterwards.

To whatever influences the relative proportion of the sexes at birth is
due, it is well known that an excess in the number of boys born prevails
not only in England but among all European races.

Dr. Bertillon and others have collected facets which throw some light
on this interesting subject. In the meantime I wish to draw attention to
the remarkable fact that this exccss in the proportional number of boys
born to girls born in England and Wales is less than it was, as will be
seen by the subjoined table.

ProportronaL NuMBER or MALES BORN TO FEMALES Born.

 

a Males born
Years. to every 100 Females born.
Ino the 10 Years 1838-47 - 105°0
i » «1848-57 104°6
is 9 1858-67 104°4
a » 186877 103°9
a 6 Years 1878-83 103°8

 

 

(40th Annual Report, p. xxi.)
BIRTHS. | 105

5.—Derects oF Birta Reaister; Sraristics or Frrst Born.

Two grave defects in the registers of the United Kingdom deprive
them of much of their utility as pedigrees, and as records of facts for the
solution of the great problems of population. Neither the age of mothers
at the births of each of their children, nor the order of birth, is recorded ;
so that the number of children borne by women at different ages, and in
the course of their lives, cannot be ascertained. This defect was supplied
in the first schedule of the Scotch Act, but the important parts of the
schedule were unfortunately discontinued after 1855. Dr. Stark turned
some of the precious results of that year’s registration to account ; and
so has Dr. Duncan in his valuable work on Fecundity. Dr. Duncan
proves from various sources that the mortality in the first pregnancy is
to that in subsequent pregnancies nearly as two to one; and from the
data he has collected it may be assumed, until further observations are
made, that about 1 wife in 8 or 10 is sterile.

How can we determine the number of firstborn children in England
annually ? It must evidently bear some relation to the marriages. Now
the annual number of legitimate children in the six years 1&62-67 was
695,597, and the annual marriages in the six years 1856-61, with which
they may be fairly compared, were 162,681, of which 147,804 were
marriages of spinsters: so that the births to a marriage are 4°276; the
births to each woman married are 4°706. The births to each procreant
wife—if only 138,024, or nine in ten wives, have living children—
must be 5°229. Consequently as families consist of one, two, three,
four, up to ten or more children, and every family has one first-born
child, it is evident that the first-born children in wedlock will be to the
total children so born as 133,024 to 695,597 ; or as 1 to 5°229, We
can from these proportions infer that about 19 per cent. of the children
in wedlock are first-born, but to get the number of women bearing first
children, the mothers of the children born out of wedlock must be
brought into account, and some corrections must be made. This being
done, it will be found that the 3,600 annual deaths in childbirth during
the six years 1862-67 imply about 48 deaths to 10,000 delivered; and
if, as is found by other observations, the mortality in first deliveries is
proportionally to the mortality in subsequent deliveries as 2 to 1, the
mortality among English mothers will be 80 in 10,000 for first children
and 40 for subsequent deliveries, taken in the aggregate.

STATISTICS OF FIRSTBORN.

To get the number of firstborn children by mother from the total
number of children ¢ born in wedlock to w wives: let 0:9 or
any fraction s be the co-efficient of fertility, then it is evident that
sw = w' = number of procreant wives out of w wives. = = e

695,597
= = "138 0a4
mother, made up of families compounded variously of one, two, three

. n children; unless the wife has before marriage borne children
every family thus constituted has necessarily one firstborn child to
mother: and the number of firstborns in the legitimate births of a year

c
are thus determinable, as they = w’ = ¥

 

= average number of children in the family of a fertile
106 [PART LT.

Let d include the mothers either married or single dying in child-
birth. Then to complete the estimate of the firstborn the children
born out of wedlock must be brought into account; their average
numbers in the six years were 46,181. What numbers of children in
the aggregate do these mothers bear out of wedlock? Not éwo probably
on an average; and if the proportion of the firstborn among the
children is taken at ¢wo in three it will imply that two such women bear
on an ayerage three illegitimate children; that two-thirds of the
illegitimate are firstborn.

 

 

 

ENGLAND.

Annual marriages in the 6 years 1856-61 162,682
Husbands marrying for first time 139,930
Widowers 22,752
Wives marrying for first time 147,805
Widows re - 14,877

Children born annually, 1862-67 741,778

In wedlock - 695,597

Out of wedlock - 46,181

(d) Annual deaths of mothers by childbearing in
the 6 years 1862-67 3,600

AnnuaL Birrus IN ENGLAND IN THE Srx Years 1862-67.

 

 

 

 

 

 

 

 

 

Total 6 : Second -born
Children born. First-born. and others.
See (a + b) (a) (b)
Children born 741,778 163,812 577,966
|
Legitimate 695,597 133,024 562,573
Illegitimate 46,181 30,788 ? 15,393 ?
I

 

To determine from the English returns the mortality from child-
birth, on the assumption that the first child-bearing is twice as fatal ag
those following, we have this equation :

2va + xb = d= deaths by childbirth

d 3,600
+ os a ¥ — 2
Sy rs 003975 = 905,590

where 2. represents the rate of mortality in the first pregnancy, a
represents the number of such childbirths in the given year, and 6
= the childbirths of all other orders from second to last inclusive.
BIRTHS. | 107

The above reasoning supplies us with the means of answering this
question approximately : What is the proportion of firstborn to mothers
in the population? Among the portion of the population born in
wedlock nearly 1 in 5, or 19 in 100, are firstborn. This proportion
could only be disturbed to any extent by emigration or by a difference
between the rate of mortality among the firstborn and the subsequent
born children of families. The proportions among the children not
born in wedlock would be very different ; and there is reason to believe
that the casualties of infancy cut down their numbers.

The number of men exceeds the number of women who marry more
than once; hence the proportion of firstborn children to total children
of fathers is less than the proportion of firstborn children to mothers.
Thus the mean annual number of children born in wedlock in England
(1862-67) was 695,597 ; the mean annual number of marriages (1856-61)
was 162,682; that is 162,682 men married 162,682 women in those
years ; now if we divide 695,597 by the annual number of husbands
marrying one or more times in their lives, namely, about 139,930, the
mean number of legitimate children by one wife or more to each
husband is 4:°971.

Thus, if the fathers marrying at 28, aged 34 when their children are
born, divide their property equally among their legitimate children, and
nine in ten fathers have children, the nine fathers will have on an
average 5°52 children, and will leave at death, taken at the age of 64,
about 3 children, so the property will be divided into 3 parcels on an
average. This is exclusive of the sub-divisions of the property of
childless fathers.

In France the proportions of children are much lower; to each
husband only 3°637 children are born to his one or more marriages ;
and, taking nine in ten as fertile, the average family will consist of
4°04] children; so, taking the proportions to survive as the same, the
property will only be divided into ¢wo parcels.

The firstborn to fathers in 100 of the population will be 18 in
England, 25 in France; one in jive or sia in England, one in four in
France, is a firstborn child.

Second-born children are fewer in number than firstborn: and first-
born = last-born children. (80th Annual Report, pp. 222-6.)

6. Struu Brrens.

In the case of children born alive—or who breathe—both the birth
and death are registered, but stili-born children are not registered in
England.

Under ithe provisions of the new Registration Act no still-born
children, however, should be buried without a certificate, stating that
they were still-born, signed either by the registered medical practitioner
who was in attendance at the birth, or by one who had examined the
body. In the absence of a registered medical practitioner a declaration
has to be made by the midwife or some other person qualified to give
such information, stating that the child was not born alive.

Still-born children, therefore, are by the new law certified as such,
although they are not registered. In England the proportion of still-
born children to total births is supposed to be about 4 per cent., but this
is uncertain. /

In France, under the provisions of the Code Napoleon, children who
die (either after or before birth) before registration, are recorded as
still-born. Dr. Bertillon estimates that 22 in 100 of the children
108 [PART III.

registered in France as still-born breathed, and such children in England
would be registered among the births and deaths.

The number of deaths registered in France in the year 1875,
exclusive of so-called still-born, was 845,062, and the death-rate was
23:1 per 1000 of population.

The number of still-born children registered under the provisions of
the Code in the same year was 43,834, a deduction of 22 per cent.
(9643) from which, represents the corrected number of still-born children
in France in 1875, viz., 34,191.

Including the estimated number of live-born children (9643) the
deaths in France in 1875 were 854,705, instead of 845,062, and the
corrected death-rate, therefore, was 23°4 instead of 23:1 per 1000.

In France in 1875, the corrected proportion of still-born children to
every 100 live-born children was 3°6. In Belgium the proportion in
the years 1860-65 was 3°7. (38th Annual Report, pp. xxv—vi.)
109

CONTENTS

OF

PART IV.—DEATHS.

INTRODUCTION.

1.—DeatH-RATES, THEIR CONSTITUTION, AND THEIR SIGNIFICANCE AS TESTS OF
Hearth anp Huattu Procress.—Life and Death in England.—
Decennial Mortality Reports.—Local Death-rates.—Ilistory of Death-rates.
—The Law of Mortality and Death-rates at all ages.—Significance of
Death-rates.—Relation between Birth-rates and Death-rates.—True Death-
rates and Probability of Dying.—Method for comparing Local with
Standard Death-rates.—Progress of Public Health possible.—Probable
decrease of Mortality.—Possibilities and Difficulties of extending Human
Life.—Progress of Mankind in Health.—Sanitary Work, and Decline of
Mortality.—Mortality and High Prices of Wheat.—Cotton Famine and
Mortality in Lancashire, 1862.—Mortality and Water Supply, London.
—Area, Elevation, and Water Supply —Male and Female Mortality in
London, 1862..—Relative Mortality of Males and Females at seven Age-
periods, in Hight Groups of Districts, 1861-70.

2.—RuraL anp Ursan Morrariry.—Low Death-rates and Healthy Jiistricts,
1841-50.—Healthy District Mortality—Exceptionally Healthy Districts,
1841-70.—Healthy and Unhealthy Districts, 1838-44.—Ixcessive
Mortality in Towns.—Excessive Urban Mortality, London, 1838-44.— Area,
Elevation, and Density of London, 1868.—Excessive Urban Mortality ;
Manchester compared with Surrey, 1838-44.—Loss of Life in large Towns,
1851-60.—Causes of Excessive Urban Mortality.—Diseases of Town and
Country.—Relation between Density of Population and Death-rate.—
Effects of Density of Population on Health.—Improvement of Health in
Towns.

8.—Mortanty at Dirrerent Acrs.—Census Ages, and Ages in Death
Registers —Age Constitution of the Population—Mortality at Groups of
Ages in England, Carlisle, Belgium, and Sweden.— Mortality of Males and of
Females, at Groups of Ages, 1838-44.—Mortality of Males and of Females
at various Age-periods, 1838-62.—Mortality of Males and of Females at
Groups of Ages, 1838-71.—Proportional Mortality at different Age-
periods,—Mortality of Males and of Females at various Age-periods
1861-70.

4.—Inraxt axp Cutty Morrazity.—Mortality of Children.—Mortality of
Infants.—Mortality of Infants under one year, and its causes.—Child
Mortality in London, 1730-1830.—Mortality of Illegitimate Infants.—
Mortality of Infints in each month of the First Year of Age; England,
Healthy Districts, and Liverpool—Mortality of Children (0-5), in
Registration Districts, 1851-60.—Mortality of Children (0-5), 1861-70.
—Mortality of Children in European States.—Infant Mortality and Census
enumeration of Children,
116

5.—Causes or Duaru, (GENERAL): THEIR NOMENCLATURE, CLASSIFICATION,
AND Morrtatiry.—Importance of Registration of Causes of Death.—
Registration of Causes of Death : Explanatory Statement.—Practical utility
of Registered Causes of Death.—Analysis of Causes of Death.—Registra-
tion of Causes of Death ; Defects and Imperfections.—Statistical Nosology.
—Analysis of Morbid Phenomena ; Nomenclature.—Report on the Nomen-
clature and Statistical Classification of Diseases.—Statistical Classification
of Registered Causes of Death.—What are causes of Death ?—History of
Registration and Classification of Causes of Death, 1837-75.—Medlical
Certification of Causes of Death.—Compulsory Medical Certification of
Causes of Death—Causes of Death in Inquest Cases.—Mortality from
Phthisis, and from Diseases of the Respiratory Organs.—Puerperal Mortality,
1847-54,—Registered Puerperal Mortality, and Mortality in Lying-~in
Hospitals.—Puerperal Mortality, and Mortality in Maternity Charities.—
—Mortality from Alcoholism.—Violent Deaths in London, England, and
Foreign Countries, prior to 1839.—Coroners’ Returns of Violent Deaths,
1852-6.—Violent Deaths in Mines and on Railways, 1863-72.—Inter-
national Statistics of Violent Deaths, i873-6.—Statistics of Suicides,
1838.—Manner of Suicides, 1858-63.—Causes of Death in the Metro-
polis, 1629-1835,—Causes of Death at Different Ages.— Ages at Death from
Different Diseases.—Effect of the Extinction of any Disease on the Duration
of Life-—Kconomie Effect of Deaths by Different Diseases —Particulars
given in the Registrar General's Annual Reports concerning Causes of
Death in England and in London, 1837-75.

6.—Causes or Deatru: Ervipemic, Inrecrious, Aanp Zymorte Diswases.—
Laws of Epidemics.—Cause and Jiffect of Zymotic Disease.—Effect of
Epidemies on Mortality in subsequent Years.—Influenza Epidemic, 1847.—
—Cholera Epidemic, 1848-$.—Sex Mortality from Cholera, 1848-9.—
Cholera Mortality at Different Ages, 1848-9.—Duration of Cases of
Cholera, 1848-9.—Cholera Mpidemics of 1831-2 and 1848-9 compared.—
The Thames, the Water Supply, and the Cholera Epidemic, 1848-9.—
Elevation and Cholera Mortality in London, 1848-9.—Conditions under
which Cholera is most Fatal.—Rise and Progress of the Cholera Epidemic,
1853-4.—Local Fatality of Cholera, 1853-4.—Sex and Age Mortality from
Cholera, 1853-4.—Elevation and Cholera Mortality, 1853-4.—Water
Supply and Cholera Mortality, 1853-4.—Four Cholera Epidemics in
England.—Cholera in London, 1866.—QOrigin and Causes of Cholera.
Localisation of Cholera in East London, 1866.—Cholera in the several
Waterfields of London, 1866.—Scientific Elements of Cholera; Epidemic
of 1866.—Iever Mortality at Different Ages.

7.—Crass anp OccuvationaL Morraviry.—Class Mortality ; Kings and Peers.
~-Mortality of Males engaged in Different Occupations, 1851.—Mortality
of Males engaged in Different Occupations, 1861-2 and 1871.—Mortality
of Miners, 1848-53 and 1860-2.—Mortality in the Royal Navy and in the
Mercantile Marine.

8.—Mzrrorotocy snp Morrariry.—Influence of Climate.—Influence of Seasons.
—Weather and Mortality; Summer Quarter, 1860.—Meteorology and
Health.—Low Winter Temperature and Public Health, London, 1855 and
1874.

9.—Morvarity in Pusiic Insrirertons.—Mortality in Metropolitan Work
houses, 1837.—Prison Mortality—Mortality in Public Institutions.—
Hospital Treatment of Infectious Diseases.—Mortality of Lunatics in
Asylums.—Correction of Local Death-rates for Deaths in Public Insti-
tutions.

10.—Marriice axp Morrariry.—Influerce of Marriage on the Mortality of the
Freuch People.

 
lil

PART IV.—DEATHS.

INTRODUCTION.

It may confidently be assumed that the most important branch of
vital statistics is that which deals with deaths and rates of mortality.
This is not only the most complex branch of the subject, therefore
demanding the more careful study, but the influence. of health on the
human race is so powerful for good or evil that statistics of deaths and
rates of mortality acquire their greatest value from their acceptation as
trustworthy indications of public health.

The public confidence in the use of death-rates as a test of health or
sanitary condition may be fairly attributed to the educational influence
of Dr. Farr’s statistical work, published during a long series of years
in the Registrar-General’s Weekly, Quarterly, and Annual Reports.
By the death-rate here alluded to is meant the proportion of annual
deaths (at all ages and from all causes) io the population at all ages.
Attempts have, it is true, been made at various times during the past
15 years to decry or depreciate the value of what has been called the
“national system” of death-rates. The opposition to this system may
be said to have culminated when the late Dr. Letheby, then President
of the Metropolitan Health Officers’ Association, made, in one of his
Presidential Addresses, his notorious attack on the system of mortality
statistics initiated by Dr. Farr, and adopted by the Registrar-General
in his reports. Dr. Letheby, with more or less justification, claimed
as his supporters in this attack on Dr. Farr’s system, Dr. Rumsey,
Dr. Ransome, Dr. E. J. Wilson, Dr. Syson, Mr. W. Royston, and
Mr. Andrew Watt. In this Presidential Address, Dr. Letheby went so
far as to deny that a high death-rate was necessarily an evil, and
said that “an increase in the rate of mortality is often a sign of
“ prosperity, for a high death-rate means a high birth-raie, and a
“ high birth-rate is the invariable concomitant of prosperity.’ The
main ground of Dr. Letheby’s attack was an entire misconception of
the relations between birth-rates and death-rates. It is well known
that the recorded death-rates in populations having high birth-rates
are almost invariably higher than those prevailing in populations in
which the birth-rates are low. From this observed fact Dr, Letheby
and others assumed that the high death-rates were due to the high birth-
rates, by causing an undue proportion of young children in the popula-

‘tion ; young children being inevitably liable to a high rate of mortality.
Dr. Farr had again and again pointed out the fallacy of this assumption,
and shown that populations having high birth-rates should, sanitary
conditions being equal, have lower death-rates than populations having
low birth-rates. An apology is now almost necessary for re-stating
that this is due to the following facts. A high birth-rate implies an
exceptionally large proportion of young adults in a population, and
consequently an unduly small proportion of elderly persons ; it there-
fore implies an age distribution of the population which is exceedingly

PK yg
112 [PART IY.

favourable to the death-rate. A low birth-rate, on the other hand,
implies an unduly small proportion of young adults, and necessarily a
large proportion of adult persons; the age distribution of such a
population is, therefore, very unfavourable to the death-rate. In
explication of the fact that high birth-rates are generally found co-
existent with high death-rates, it is only necessary to point out that
the aggregation of young adults which produces high birth-rates only
takes place in urban districts; and that it is the urban aggregation,
and not the high birth-rate that results from it, which causes the high
death-rate. The fallacy involved in the assumption that high birth-
rates cause high death-rates appears still to have lingering attractions
for some medical officers of health, anxious to account for excessive
mortality in urban districts, but it has never been authoritatively put
forward since the discomfiture of Dr. Letheby’s attack. The contro-
versy is now matter of history, but those interested in the subject will
find Dr. Letheby’s paper in the ‘Transactions of the Metropolitan
Health Officers Association, and a reply thereto, in a paper read by
the Editor of this volume before the Statistical Society, in Vol. 37 of
the Journal of that Society.

In the first sub-division of this Part will be found a selection from
Dr. Farr’s writings bearing upon the significance of death-rates, and
upon the various disturbing influences that militate against the value of
the crude death-rate as an accurate test either of mortality or of health
condition. From what has been written ahove it may be assumed that
rural death-rates, by the national system, are somewhat over-stated, and
that urban rates by the same system are under-stated. Consequently, a
comparison of rural and urban death-rates, unless the rates be corrected
for the differences of age-constitution in the two populations, considerably
understates the excess of mortality due to urban aggregation and
insanitary condition.

The necessity for such corrections and some of the methods by which
they may be made, are dealt with in many of the extracts in the
following pages. Before proceeding to correct death-rates for differences
of sex and age proportions it is necessary to fix upon some standard
with which useful comparison may be made. The Life Table is the
only method that gives true rates of mortality, from which all dis-
turbing influences of sex and age proportions have been_eliminated.
Ti therefore appears desirable to use life table death-rates as the
standard for comparison. The rates of mortality given by Dr. Farr’s
English Life Table, No. 3, and by his Healthy District Life Table,
supplies two such standards; the former if the mean death-rate in
England and Wales during the 17 years 1838-54 be the desired
standard ; and the latter if the higher standard, based on the mortality
in 68 selected healthy districts, should recommend itself for adoption.
The application of these standard life table death-rates of males and of
females at the several age-periods to the proportional numbers living at the
same age-periods of each sex will show the number of deaths that would
occur in any given population if such life table rates prevailed at the
several age-periods. The aggregate number of deaths calculated by
this method, divided by the population at all ages, would give what may
be called the normal death-rate, in accordance with any standard
adopted for the purpose of comparison. The difference between such
normal rates and the recorded death-rates showshow much the recorded
death-rates differ from the standard of comparison, after due allowance
has been made for variations of sex and age proportions. This method
was adopted in the paper, referred to above, which was read
before the Statistical Society in answer to Dr. Letheby’s attack upon

 
DEATHS. | 113

Dr. Farr’s system of mortality statistics in December 1874.* In the
more recent paper, read before the same Society in April 1883*, will be
found the outline of another Life Table based upon the mortality
experience in England and Wales during the five years 1876-80, when,
under the influence of improved sanitary organization, and increased
public interest in health matters, due in great measure to the Public
Health Acts of 1872 and 1875, a well-marked decline in the national
death-rate had fully set in. This affords yet another standard for the
calculation of corrected rates. In the Registrar-General’s Decennial
Supplement to the 45th Annual Report, dealing with the mortality
statistics of the ten years 1871-80, yet another standard for comparison
is adopted by Dr. Ogle, the successor of Dr. Farr. This standard is based
upon the mean death-rates in England and Wales, at 12 groups of ages,
during the 10 years 1871-80, these rates being used in this report for the
construction of a Life Table, the results of which are there compared
with those of Dr. Farr’s English Life Table, No. 8, based upon the
mortality in the 17 years 1838-54.

The second sub-division of this Part is devoted to those selections
dealing specially with rural and urban mortality, and with the excess
of urban rates due to aggregation or density of population in towns.
Dr. Farr was probably the first vital statistician to discover and precisely
to point out the remarkably constant relation between density of popu-
lation and mortality. Indeed, he found the relation so constant that
he styled it a law of mortality, a term, however, open to some
objection, since it may easily be proved that it is possible for a high
degree of density of population to prevail, without its producing the
excess of mortality which the word “ law ” suggests is the inevitable result
of such density. One of the main objections urged by the opponents
of the “ national system ” to the “ use of death-rates as a test of sanitary
“ condition is that they take no cognisance of varying density of
“ population, of the quality of house accommodation, of occupation, of
social condition, &c., in different populations. As if, forsooth, these
were not the main causes of the varying health- conditions of popu-
lations, of which the cdeath-rate has been so generally accepted as
a trustworthy test. Sanitary authorities of towns in which the
density of population is great, the streets und courts narrow, crowded,
and ill-ventilated, and in which large proportions of the population
follow unhealthy occupations und belong to the poorcst classes of society,
are heavily handicapped in their health responsibilities, but the
death-rate of such towns do not on that account afford less accurate
numerical tests of thcir health condition.” t
The effect of density upon the death-rate is, however, beyond dispute,
and the prevention of such aggregation and over-crowding in towns as
is detrimental to health is at the same time one of the most important
and most dithcult problems, the solution of which is being diligently sought
by the development of sanitary science and organisation. It should always
be borne in mind that the death-rates in urban populations at all ages,
as has been explained above, unless corrected for differences of age
distribution, invariably understate their real mortality, while for the
same reasons the death-rates in rural districts, unless corrected, over-
state their true mortality.

‘

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a

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a

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* The Value of Death-rates as a Test of Sanitary Condition, Journal of Statistical
Society, Vol. xxxvii., p. 437-71 ; and the Recent Decline in the English Death-rate,
and its effect upon the Duration of Life, Journal of the Statistical Society,
Vol. xlvi., pp. 189-213. Both these papers were contributed by the Editor of this
volume.

f See paper read, by the Editor of this volume, at the Birmingham Congress of
the National Association for the Promotiou of Social Science, September 1884.

H
114 [PART Iv.

While, however, the uncorrected death-rate at all ages is, for com-
parative purposes, open to objections, some of which have been above
referred to, death-rates at groups of ages are practically free from such
objections. The proportions of deaths under five years of age, to persons
living at those ages, or, as they are usually and correctly called, the
death-rates of children under five years of age, whether in urban or in
rural districts, are trustworthy for comparative purposes, as are the
death-rates at other groups of ages. Several of the extracts in the
following pages deal with this subject, and point out the importance of
supplementing the death-rate at all ages by death-rates at groups of
ages. No health officer’s report should be deemed complete without
rates of mortality at groups of ages, namely, the proportions of deaths
at such groups of ages to the estimated numbers living at the same
groups of ages. Here it may be noticed that there are two false
methods by which many health officers seck to show the varying rates
of mortality in their districts at different age-periods. The first of
these false methods is the calculation of the proportion of deaths at
various age-pericds to the deaths at all ages. The second is the caleu-
lation of the proportion of the deaths at various age-periods to the
population at all ages. The results of both these false methods are
liable in a still greater degree to all the disturbing influences of variations
of age-distribution, which depreciate the value of uncorrected death-
rates at all ages for comparative purposes. The results by these two
methods depend tar more upon the proportions of persons living at the
various age-periods than upon the rate of mortality prevailing at such
age-periods, and are therefore valueless as tests of true mortality. The
number of age-periods which it is desirable to adopt in health reports,
with a view to throw light upon the sanitary condition of any population,
must mainly depend upon the amount of population to be dealt with.
If the population be small, five age-periods would be sufficient, as too
great « subdivision of the population would affect the value of the rates
for comparative purposes. ‘These age-periods might, therefore, vary
from five to the twelve adopted by the Registrar-General for all England,
and its several counties, according to the population of the district to be
dealt with. As has previously been stated, the Census Report for 1881
gives, in vol. 3, the ages of the enumerated population of each urban
and rural sanitary district, as constituted in 1881, in twenty quinquennial
periods. As, for all practical purposes, it may be assumed that the
proportional age distribution that prevailed at the last Census has since
been maintained, no real difficulty stands in the way of estimating the
number of persons living at any age-period in any sanitary district in
any year, or of calculating the annual rate of mortality at uny age-period.
This method of analysing a death-rate at all ages is absolutely necessary
in order that true and indisputable inferences may be drawn therefrom
as to the sanitary condition of the population.

As tests of sanitary condition the death-rates of infants under one
year, and of children under five years of age, are more important than
the rates at any other groups of ages. The rate of mortality of infants
under one year of age may be measured cither by the proportion of
recorded deaths at this age to the estimated number of infants living at
the same age, or by the proportion of deaths under one year to the
registercd births. Investigation has shown, beyond doubt, that the ages
of young children are very incorrectly returned at the Census enumera-
tion, owing to the general and indiscriminate use of two methods for
describing age. At the Census cnumerations the numbers of infants
under one year of age ave certainly under-stated, for there is good
ground for believing that many infants in their first year of age are
DEATHS. | 115

returned as aged one year; that a smaller number in their second year
of age are returned as aged two years, and so on. Some pane sought
to explain the deficiency of infants returned at the Census fo omissions
in the enumeration; but Dr. Farr, on grounds which are fully described
in the extracts on pp. 206-9, attributed the deficiency to confusion
between the current year of age and the completed years of life rather
than to actual omissions. The probability of the truth of this assumption
is supported by the fact that, so far as can be ascertained by investi-
gation, the deficiency under one year is practically balanced by the
excess of the numbers enumerated at the succeeding agex, two, three,
and four years, inasmuch as there appear to be no good grounds for
supposing that the total number of children enumerated under five years
of age is. deficient. On account of this deficiency in the Census numbers
of infants under one year of age, the mortality of those infants is
measured in a more trustworthy manner by the proportion of deaths
under one year to registered births than by the method of estimating the
numbers living at this age from the enumerated numbers. The correct
application of this method is to divide the deaths under one year of age
in a given year by the mean number cf births registered in that and
the preceding year. As, however, the numbers of births in a population
do not vary very considerably from year to year, the simpler and very
usually adopted method is to use the proportion of deaths under one
year to registered births in the same year as a measure of infant
mortality; and for all practical purposes this simple method gives
results which are sufficiently trustworthy.

The death-rate of children under five years of age should invariably
be calculated upon the estimated number of children living at these
ages, This death-rate of children affords an invaluable test of the
sanitary condition of a population, and is for this purpose more important
than the death-rate at any subsequent age-period. As has already been
pointed out, all attempts to judge of the mortality of children by the
proportion of deaths of children to total deaths, or even by the proportion
of deaths of children to the population at all ages, can only tend to
fallacious inferences.

In all cases in which the population dealt with is sufficiently large
to yield trustworthy results, the death-rates of males and of females
should be calculated separately, not only at all ages (which rates should
be given in all reports), but at five or more groups of ages. The relative
mortality of the two sexes often throws light upon the causes of,
fluctuations in rates of mortality, and whenever the relative mortality
of the two sexes shows abnormal proportions it ix desirable further to
analyse the mortality by calculating rates for males and for females at
various age-periods. Several of the extracts in the third section of this
Part (see pp. 179-88) afford valuable information bearing upon the
mortality of males and of females at different ages.

The fifth and sixth sections of this Part deals with causes of death, as
returned for the purposes of the national death register, by medical
practitioners and by coroners. Causes of death in the death register
are necessarily little more than the more or less trustworthy guesses
of a large body of more or less skilled observers, except in the small
proportion of cases in which these guesses are corroborated (or
modified by post mortem examinations. Statistics of causes of death
should therefore be compiled with caution, and without any attempt at
over elaboration of detail. Still greater caution should be used in
drawing inferences and deductions from a comparison of the results for
a series of years. Changes of nomenclature and of classification add
materially to the difficulties in the way of useful comparison of such

H 2
116 [PART Iv.

statistics for different periods of years. There is uo reason to doubt
that the quality of the material placed at the disposal of the Registrar
General year by year by medical practitioners and coroners for national
statistical purposes is steadily improving, and if due caution be observed
in the use of the statistics compiled from this material they may be
made to vender valuable service in facilitating the solution of the many
important problems bearing upon the fluctuations of mortality that still
await solution. One of the most necessary qualifications for successful
statistical work is a correct and strictly impartial estimation of the value
of the materials available as the basis of calculation. The rejection of
all materials that arc not beyond all suspicion would fatally restrict the
field of statistical research, while, on the other hand, the progress of
statistical service is hindered rather than advanced by the too confident
use of materials inherently and fatally defective. Much valuable work
may be done with defective materials if their defects be kept steadily in
view, both in the calculation of results and in making deductions there-
from. The materials with which Dr. Farr had to work nearly fifty
years ago were defective enough to have discouraged a less sanguine
and indefatigable statistician; but while he was able from time to time
to improve the quality of his materials, few will venture to deny the
value of the results he derived from such defective materials, even in
the early years of his service in the Statistical Department of the General
Register Office, which dated from 1838. In vital statistics all students
must learn to use imperfect materials and yet to guard, as far as possible,
against fallacious results. It is at all times important not to conceal
the imperfections of materials dealt with, but rather to draw attention
to them in such manner as to promote the acceleration of their removal.

The extracts in this section range over a wide ficld, and necessarily
include a considerable number that, after the lapse of years, are more
valuable for their suggestiveness than for the actual facts they set forth.
The statistics of mortality from the several zymotic and epidemic diseases
are valuable, however, for reference purposes, The sclections from
Dr. Farv’s Cholera Reports form important contributions to the history
of epidemic disease in England, and could not have been omitted from
this volume, although they are not all strictly statistical.

The concluding pages of this Part are devoted to selections bearing
upon class and occupational mortality, meteorology and mortality,
mortality in institutions, and the influence of marriage on mortality.

(Ep1ror.)

1. DEATH-RATES, THEIR CONSTITUTION, AND THEIR SIGNIFICANCE
AS Tests or Huatra anp Heatra PRoGRess.

Life and Death in England—How the people of England live is
one of the most important questions that can be considered; and how—
of what causes, and at what ages—they die is scarcely of less account ;
for it is the complement of the primary question teaching men how to
live a longer, healthier, and happier life.

The vital units to be specially dealt with are persons living and
persons dying in the ten years 1861-70, only distinguishing them into
units representing males and females of different ages and occupations,
losing life year after year by various causes, in about 627 districts
extending from the borders of Scotland to the English Channel and
from the Irish Sea to the German Occan. ‘The deaths in the several
classes have to be compared with the population enumerated at three.
decennial censuses, in corresponding groups.
DEATHS. | 117

The long series of Tables offers a retrospect extending over the ten
years, and is in continuation of a series embracing the previous ten
years, with which it is compared.

The primary object is to determine what the death-toll* is at the
several ages, and what the causes of the loss of life are, under different
circumstances. The importance of this determination will become
apparent by enumerating some of the relations the mortality bears to
other orders of facts. There is a relation betwixt death and sickness ;
and to every death from every cause there is an average number of
attacks of sickness, and a specific number of persons incapacitated for
work. Death is the extinction of pain. There is a relation betwixt
death, health, and energy of body and mind. Thereis a relation betwixt
death, birth, and marriage. There is a relation betwixt death and
national primacy: numbers turn the tide in the struggle of populations,
and the most mortal die out. There is a relation betwixt the forms of
death and moral excellence or infamy ; men destroy themselves directly
or their fellows under the most varied mental conditions; they may die
by indulgence in excesses, by idleness, or by improvidence. Death is
met especially in primeval races not only in conflicts with each other,
but in conflicts with other races of animals—-directly with great carnivorous
quadrupeds or creeping poisonous serpents, and indirectly with four-
footed animals, winged birds, and multitudinous insects, blighting or
consuming food. Death is also wrought by low but organised parasites
in the body. It is still more frequently the result of elementary mole-
cules (zymads) which, though of no recognised form, evidently thrive,
propagate, die in the bodies of men, disintegrating or devitalizing their
tissues.

There is finally a relation betwixt death and the mean lifetime of
man; if alife passing through a given time is represented by a line,
death is the point of termination as birth is the point of origin. Anda
generation of men born together is represented by an indefinite number
of such lines of life. The natural lifetime of man is a century; that age
under ordinary conditions is, as the Etruscans remarked, attained by at
least one in every considerable generation, and they made it their
seeculum ; as in that time are passed through all the phases of childhood,
youth, manhood, maturity, and monumental age.t The mean lifetime
in the healthiest districts of England—and in the healthiest ranks—is
49 years; and we have no evidence that under the most favourable con-
ditions it exceeds 50 years. Actually individual life varies in duration
from a second toa century. And the relation to be shown here is
between the dying by different causes and the living at every stage of
the march of a generation through time. The mean lifetime of a gene-
ration may be the same, and yet the several lifetimes of the individuals
of which it is composed may vary infinitely ; under the actual laws of
mortality, great numbers die in infancy, few in adolescence, more in
manhood, and, after infancy, the greatest number by the English Table
at the age of seventy-three, the numbers born having fallen in the pro-
portion of ten born alive to two then surviving. Ji is evident that an
entire revolution in the life of the human race would follow if every
person born lived the average lifetime of fifty years, or if half the deaths
happened in infancy and the other half at the end of 100 years or at any
very advanced age. What we observe actually is that in certain con-
ditions the mean lifetime sinks to half its standard length; and that

 

* This compound of Saxon words appears to be preferable to “death-rate” or
“ death-tax ;”’ it is equivalent to “ rate of mortality.”

+ See Census Report of 1851, Vol. L, p. xv.
118 [PART Iv.

this is the result of the high mortality in the first five years, of the
reduced mortality in adolescence, and of the increasing mortality in man-
hood up to the ultinate term of life; few old people surviving and few
dying therefore after four score years, especially in such unfavourable
conditions as exist in Liverpool.

Under the existing state of things, of the constituent lives of every

, generation a certain number dies at every age of causes to be inves-

tigated under two heads :—direct and organical, including’ diseases and
injuries; and remote and indirect, namely, the causes of those diseases
and injuries. Before entering upon the investigation two preliminary
questions have to be discussed. (Supplement to 35th Annual Report,

pp. 3-4.)

Decennial Mortality Reports.—The determination of the law of
mortality requires an extensive area of observation, both in space and
time, to eliminate accidental perturbations. Aud the causes affecting
the life of children, of adults, and of old peopie,—of males and females,—
of persons in different occupations, are so various that we can only hope
to unravel their influence by a general analysis of the phenomena in
different places through a series of years,

As helps towards this analysis several series of Tables have appeared
in the Appendices to the Annual Reports.

The division of the country for registration purposes is based upon
the Poor Law Unions which have towns in their centre, and our cal-
culations have gone generally to show the mortality in the districts of
England and Wales. The Ninth Report showed the rates of mortality
of males and females at each of seventeen periods of life, and at all ages,
in the eleven Divisions, in 40 counties of England; the three ridings of
Yorkshire; in North and South Wales ; and in 824 groups of districts,
The calculations were founded upon the living at ages enumerated at
the Census of 1841, and upon the deaths at the same ages in the seven
years 1838-44.

Again, the Sixteenth Report contains Tabies of the density of the
population, and of the annual mortality, during the ten years 1841-1851.
The rates of mortality are deduced from the registered deaths in the
ten years 1841-50, and from the populations enumerated at the Cen-
suses of 1841 and 1851. The facts are printed in detail in the
Thirteenth Report. The corresponding facts for the years 1851-60
will be found in the Twenty-third Report.

The present volume shows the annnal rate of mortality per 1000 in
all the districts, counties, and divisions of England during each of the
decenniads 1841-50 and 1851-60. It also exhihits in an elaborate
series of Tables the deaths and the rate of mortality among males and
females of the age under 5 years, 5-10, 10-15, 15-20, 20-25, 25-35,
35-45, 45-55, 55-65, 65-75, 75-85, 85 and upwards; as well as the
causes of death at all ages.

It is shown in the Introduction to the English Life Table that the
mean of the populations at the beginning and end of a period is some-~
what above the mean numbers living through the period, when the
population of a district increases in geometrical progression, and that
consequently when the deaths of such a district are divided by the living
thus determined the quotient is rather too small; so the rate of mortality
in the present series of Tables is slightly understated in the districts
increasing in a geometrical ratio. The labour of obtaining the years of
life by integration would have been beyond the compass of the force at
our disposal; and such errors as have been mentioned are of' little
practical import:nee in dealing with the limited numbers of even large
DEATHS. | 119

districts, subject to various local disturbances from migration and other
causes, and only yielding results approximating more or less to settled
averages. Some inaccuracies in the statement of the ages also interfere
with the results, but toa less extent than might at first be supposed ;
and they will not interfere essentially with the comparisons to be drawn
between the rates of mortality in the various town and country districts
of the kingdom. (Supplement to 25th Annual Report.)

Locul Death-rates.—The death-rate for England (in 1864), as has
been stated, was 2°386 per cent. ; but while this is shown by the Tables
to be the rate for the whole kingdom, it may not be precisely that which
ruled in any assignable part of it. Density of population, purity and
impurity of earth, water, and air, wealth and poverty, the geological
structure of a district,—these and other elements of health and sickness,
in their manifold combinations, depressed the mortality in one place,
raised it in another. The following rates in different counties may be
selected, though these, as must be obvious, are derived from populations
living each in circumstances almost as diversified as those of the
country in its whole extent, and therefore do not furnish the extreme
examples that distinguish the busy town from the hamlet. But the
differences are nevertheless very considerable in some instances :
Westmorland supplied, amongst all the English counties, the best
example of healthy condition, the rate of mortality in it having been
1:°820; for in the Table, it should be mentioned, the Welsh counties
are not distinguished, but are formed in two groups, North and South
Wales. The next lowest rate was 1°902, which prevailed in the extra-
metropolitan portion of Surrey.—(27th Annual Report, pp. xxx-i.)

History of Death-rates——The history of death-rates in the various
towns and districts of England has been recorded in the annual reports
for a period extending over 36 years, and from time to time it has been
pointed out that the variations from such disturbing causes as sex and
age are confined within comparatively narrow limits—especially the
elements of sex, and do not affect the general mortality of persons at all
ages to such an extent as to interfere with its value as a sure
indicator of the prevalence of conditions prejudicial to life; and
recent investigations have confirmed this, and shown that the ratio of
deaths to population at all ages may be taken, as a fair indication of
the sanitary condition of the population. Wherever the general
mortality is high, agencies are to be found at work unfavorable to
health, and the town or district requires the attention of the medical
officer of health, but statists have long considered the general death-rate
as only a preliminary test, to be followed up by further research relating
to the mortality of children and adults at different ages, and by different
diseases.—(36th Annual Report, pp. xiii—xiv.)

The Law of Mortality and Death-rates at all Ages.—In a popula-
tion rapidly increasing, disturbed by immigration or emigration, and
liable to fluctuations in the rate of mortality, the law of mortality, and
consequently the duration of life, or the expectation of life at different
ages, can only be deduced with any approach to accuracy from two
series of facts ; (1), the population existing at annual, quinquennial, or
decennial periods of life, and (2), the deaths at the corresponding ages.
—(4th Annual Report, p. 17.)

The mortality of the various populations of the world is generally
stated as one in so many, or as so many per cent. or per 1,000 per
annum. The latter result is the ratio of the deaths at all ages io the
living at all ages.
120 [PART Iv.

Now it is evident that the proportion of deaths 1o a given number
living varies to a great extent with the ages of the living; in the first
five years of age the mortality is at the rate of 7°243 per ceut. for boys,
at the age of 10-15 it is 0°488, at 55-65 it is 3°085, at 75-85 it -is
14°667 per cent. The mortality of the two sexes also varies, so that,
independently of other canses of variation, the mortality of different
populations will differ according as they consist of numbers in various
proportions at the ages at which the mortality is high or low.

When the population is sustained by an uniform annual number of
births, the number living at each age is regulated solely by the law of
mortality, reducing the numbers year by year, until each annual
generation is extinguished.

The laws of mortality may vary infinitely, it is conceivable, so as to
yield the same mean lifetime, and the same rate of mortality. Thus by
the English Life Table 1,000,000 children born alive die off so as to
leave survivors in every year of age up to the 109th, when the last of
the generation dies off; the mean lifetime is 40°858, and 1 in 40°858, or
2-447 per cent. of the population so constituted die annually. If every
one of the 1,000,000 children lived 40°858 years, and died at the end of
the term, the mean lifetime would be 40-858 years, and it will be
evident that the mortality would be at the rate of 1 in 40°858, or 2°447
per cent. per annum. Yet how different are all the circumstances ?
How different are the conditions of existence ? How different is the
law of mortality ?

The rate of mortality in England was not 2'447, but 2°2+45 per cent.
per annum, during the period when the facts were collected upon which
the Table is based. Thus 1 in 44°54 died ; while the mean lifetime was
40° 858.

Assuming the prevalence of the same law of mortality, the rate caleu-
lated on the mean population, and the deaths at all ages, is lower in a
rapidly increasing population than it is ina stationary population, because
the mortality at all ages from about + to 54 is lower than the mean
mortality of the whole normal population; and while a regular increase
of population has the effect of increasing the proportion of children under
4 years of age, who die off quickly, it has also the effect of still further
increasing the proportion of the living at the ages 4 to 54, and of
diminishing the proportions of the old people, whose rate of mortality is
high.

a the healthy districts of England the normal mortality is 2-059 for
males, and 2°022 for females by the Life Table; while it is 1-772 for
males and 1°733 for females, as deduced from the ratio of deaths at all
ages to the living at all ages. ‘This is the rate of 17 deaths per 1,000 of
the population, which is so often and so fairly quoted, as a standard of
comparison applicable to increasing populations.

There is another disturbance of the proportions living at ages more or
less mortal, by immigration and by emigration. Thus the general effect
of immigration into towns is to reduce their rates of mortality, by
increasing the proportion of the living at ages of less than the mean
mortality of the people of the place. The bulk of the emigrants to
towns from the country are probably in good health, but a certain
number of sick resort to the town hospitals ; upon the other hand, of the
emigrants, some are comsumptive, seeking health in the country and
abroad, or returning home to die; but the emigrants are less numerous
in the aggregate than immigrants, and so far have less effect on the
mortality—(Supplement to 25th Annual Report, p. xxv.)

Significance of Death-rates—The rates of mortality published in
the Weekly Returns having been misunderstood in some quarters, it
DEATHS. | 121

may be useful once more to explain what the general death-rates of a
population imply.

The rate of mortality differs in a generation as it passes through
different ages, It is in infancy very high, in boyhood very low, through
manhood it increases, and as men descend into the vale of years is
rapidly accelerated by the wearing away of vital force. The mean rate
in England has been for some years 22 annual deaths to 1,000 living of
all ages. The rate for males is 183 in 1,000 im the first year of life ;
only {8 in the fifth, 6 in the tenth, 5 in the sixteenth, § in the twenty-
first year of life; 13 in the forty-first year, 19 in the fifty-first year ;
33 in the sixty-first, 70 in the seventy-first, 153 in the eighty-first year,
307 in the ninety-first year of life. Infants and boys under 4 years of
age experince a mortality above the average rate, and so do men of the
age of 54 and upwards ; while boys and men of 5 years of age and
below 54, die at less than the average rate. In the country and in
cities, under the same sanitary conditions this universal law prevails ;
infants and old people die off more rapidly; boys and girls as well as
men and women in the prime of life, less rapidly than the average rates
imply.

The general rates of mortality, as they are usually given, may differ
therefore in two populations, merely because the one contains more of
the population under 5 and above 55 than the other. When the births
exceed the deaths, the effect is to increase the number of children
under 5 years of age; and it is conceivable that a novice in these
inquiries may rush to the conclusion, that the effect of an excess of
births is to increase the general rate of mortality ; whereas it is found
by observation to have the contrary effect. The mortality of a popula-
tion with an excess of births over deaths is lower than the mortality of
a stationary population where the births and deaths are equal. And
the reason on reflection is obvious. The births take place steadily year
by year in acity; and if they are in excess of the deaths, they throw
into it not only additional children under 5 years of age, but also
children and adults above that age; and hence there is less than the due
proportion of old people in the whole population; hence also the
mortality appears below what it would be in the same population, under
the same sanitary conditions, if the births and deaths were equal. In
all England the births are to the deaths as 3 to 2; and this has the
effect of reducing the rate of mortality to 22 in 1,000. By the English
Life Table, in which the people of different ages are distributed as they
would be if the births and deaths were constantly equal, the correct rate
is found to be 24 in 1,000. In Liverpool when the rate of mortality
was 34, the corrected rate was 39; in the same year the rate for London
was 24, the corrected rate 27.

Immigration has the effect of reducing the general rate of mortality ;
as it swells the excess of persons at ages of low mortality.

The rates of mortality as they are generally cited, when the popula-
tion is accurately determined, are for all the cities in the weekly tables
below the true rates; and when the differences in the rate in two cities
are great, it is certain that this cannot be explained by any differences
of the ages of the two populations.

A sustained rate of mortality above 17 in 1,000 always implies
unfavourable sanitary conditions: the London rate of 24 is moderately
good ; any rate above 30 implies sanitary conditions highly destructive
to human life.

When any city experiences a higher rate than the average, it
should always be a matter of serious inquiry and concern to its
citizens.
122 [PART ly.

As to the significance of weekly rates of mortality the following

propositions may be laid down :

1. These rates calculated in the usual way express facts; and higher
rates than usual in a town show that from some cause or other
the deaths are frequent, and vice versd.

. These rates are below the true rates in all the towns of the
United Kingdom, in consequence of the great excess of births
over deaths ; which has the effvet of increasing the proportion
of the population living at ages when the mortality is below the

nN

average,

3. The excess of immigration over emigration operates in the same
direction.

4. An excess of females in a town reduces its general rate of
mortality.

5. There is an influx of patients into Hospitals in towns, but
this is probably more than counterbalanced by the retirement of
consumptive immigrants into the counties of their birth to die.

6. A sudden and large addition of births in a singie year would
have the effect of slightly raising the general mortality in that
year ; but the supposition of such an addition in English cities
is baseless: the law here is a constant excess of births over
deaths, which keeps up a constant excess of young and middle-
aged lives.

7. A. Life Table constructed in the usual way shows the true average
rate of mortality, and the mean duration of life; the two facts
being indissolubly connected. The correct mortality of our
worst cities was 1 in 25, in our healthiest districts it was 1 in
50; the duration of life was 25 and 50 years under the same
circumstances.

8. A comparison of the true rates with the rates calculated in the
usual way will show that the latter rates exhibit the relative
fatality of different cities with sufficient accuracy for all ordinary
purposes. They have no fallacious meaning.

9. Instead of reducing the death-rate of towns, on the ground that
their birth-rate is high, the reverse should be done to get the
correcied death-rate,

10. The true death-rate in all England lies between the death-rate and
the birth-rate calculated in the usual way; a sixth of the
difference added to the death-rate is nearly its proper correction,

11. The causes of the differences of the rates of mortality are various,
and in every case demand careful investigation on the spot by
the town authorities—(Weekly Return, No. 12, 1870.)

The significance of the death-rate has been frequently explained, but
as it is not yet apparently understood by all who employ it, a few words
on the subject may be of use.

The parish clerks of London, at the instance probably of Elizabeth’s
government, began the weekly bills of christenings and burials in 1593,
and the series was continued uninterruptedly from the year 1603. At
first the plague was distinguished, and then other diseases and casualties.
The average deaths being known the mere rise or fall of the weekly
numbers gave a good indication of the varying mortality of the people,
without any reference whatever to the population.

The Registrar General in the year 1840 took up the traditional
London Weekly Bill, extended it, and has since made it complete by
including with London 20 more great towns of the United Kingdom,
the whole inhabited by nearly eight million people. By persevering
DEATHS, | 123

applications the returns have at length been procured weekly from the
principal cities of Europe, India, and America. As the cities and towns
vary in population, to make comparison possible it was necessary tc
show not only the number of deaths, but the proportion the deaths bore
to a fixed number of the living, for convenience made 1,000; and,
further, as in the calculation of simple interest, to show not what the
rate is per week, but per annum. This is the death-rate as it, appear:
in the present publication.

It is evident in the first place that if the weekly deaths are correctly
recorded, their fluctuations in a town will show its varying states 0:
mortality ; and if the populations of towns, which seldom fluctuate
much, can be calculated approximately as the rates of increase vary
little, the death-rate will show as a matter of fact how much the mortality
of a town varies from the mortality of other towns in any particulai
week, The Census is only taken every ten years; but the loca
authorities have it always in their power to determine whether the towr
is increasing or decreasing at the usual rate, so that no error of any
magnitude need be committed in the estimate of the population, especially
where the population is large. Thus in London before the Census o
1871 was taken, the population was estimated hy the Registrar Genera
at 3,247,631, and it was found by enumeration at the Census to be
actually 3,254,260.

The death-rate is a fact; anything beyond this is an inference. Ih
deciding whether the mortality is much greater than it should be, anc
whether the average mortality of one town is greater than the mortalit;
of another town differing from it but little, all the resources of statistica
science have to be brought into requisition. The distribution of th
population according to age and sex may be different, and this has to bi
taken into account. The deaths of males and females have to be com
pared with the corresponding mean- population living at different period
of life; and from the death-rates varying in each period, the variation
of the law of mortality with age can be determined. ‘This being done
a Life Table for the population of the place can be constructed, showin;
the mean lifetime from which the normal mortality of the people can b
determined. The same table shows the population living at each year o
age io a given number born, and the mean age of the living.

Poputation, Dearns, and Mortarity per 1,000 at Twetv:
DIFFERENT Prriops of AGr, in Lonpon and in EN@nanr

 

 

 

 

 

 

 

1861-70.
\

| LONDON. LONDON. LONDON. | ENGLAND.

AGES "MEAN PopULATION,|| ANNUAL DEATHS || ANNUAL Morratiry per 1,000 living
5 1861-1871. in 10 Years 1861-70- during the Years 1861-70.

Males. | Females, || Males. | Females.|| Males. | Females.| Males. | Females
All Ages -/1,415,466 |1,613,659 37,581 36,053 | 96°55 22°34 23°61 21°28
0- 195,963 196,500 17,032 14,997 || 86°91 76°32 73°16 63°43,
5— 161,161 163,821 1,509 1,449 | 9°37 8°85 8°15 7°76
10— 141,969 145,035 603 590 4°24 4°07 4°46 4°48
15— 181,585 151,530 766 773 | 5°82 5°10 6°16 6°62
20— 133,185 166,302 1,096 1,084 |; 8°23 6°22 8°45 7°96
25—- 233,714 | 280,674 2,538 2,470 10°86 8°80 9°90 9°69
35— 178,860 206,826 3,066 2,656 17°14 12°84 13°46 12°03
45— 124,417 144,530 3,195 2,676 25°68 18°52 19°17 15°56
55— 71,145 90,739 3,120 3,035, 43°85 33°45 33°00 27°77
65— 38,097 49,021 2,741 3,296 82°83 67°23 66°90 58°80
T—- 9,325 16,338 1,576 2,394 169° 02 146° 54 146°58 13-4743
35 & upds. 1,055 2,343, 339 683 321° 42 291° 42 318°57 283° 64

 

 

 

 

 

 

 

 

 

 
124 [PART IV.

The preceding table shows the mean mortality of the population of
London at 12 ages, in the ten years 1861-70, compared with the rate in
England and Wales.

Disturbing elements have to be considered : thus a certain number of
patients sent from the country to London for medical advice die either in
private houses, workhouses, or hospitals, and a certain number of un-
married young consumptive people return home to the country to die;
these two currents probably neutralize each other, and it would be unsafe
to attempt a correction either way on this account.

The chief disturbing clement in the country is the exccss of births over
deaths, which has the effect of increasing the mass of young people living
at ages when the mortality is low ; and in addition to excess of births
in towns, the immigrants at early ages have the same effect. The death-
rate true in itself is below what the death-rate would be in the same
population normally constituted as regards age.

But the disturbances from these and from all other intrinsic causes
acting on the death-rate, so far as is yet known, are not great; thus in
all England the crude annual death-rate for 35 years is 22°4 per 1,000,
while the corrected rate by the Life Table is 24°5. The crude death-
rate in towns understates the mortality. But as far as we know the
underrating does not exceed 3 or 4 per 1,000; and this is not con-
siderable when we find the average death-rates of 30 years (1841-70)
varying from 15 in Glendale (Northumberland), to 24 in London, 27 in
Birmingham district, and 86 in Liverpool. Add 2 to Glendale, 3 to
London, 3 to Birmingham, and 8 to Liverpool, and the mortality,
corrected approximatively so as to make it the mortality of a population
normally constituted as to age and sex, becomes 17, 27, 30, and 39.

It will be observed that the correction alters the relative less than the
absolute mortality, and that for immediate practical purposes the relative
crude mortality is a satisfactory guide.

In deciding on the exact relative mortality of these towns the
observations should extend over about ten years, so as to get an average
not much disturbed by epidemics. The rates of mortality and the
causes of death at convenient intervals of age should also be determined,
and be made the basis of the Life Tables.

And if it is desirable to investigate the causes of any differences in the
mortality, the density of population, the water-supply, the drainage, and
the occupations will naturally be taken into account.

A volume is now in preparation showing for the males and females of
622 districts of England and Wales the rates of mortality, at the same
ages as are shown for London.

It may thus be summarily stated that :

1. The crude rate of mortality, which is the proportion the deaths
bear to the population, is a definite fact, and shows the variations
in the mortality of London or of any other town, from week to
week, year to year.

2. The true rate of mortality and the mean lifetime of a people living
in a town or a country can only be determined by means, of a
Life Table, such as that which has been constructed for England
and Wales.

3. As the population of England is increasing by the excess of births
over deaths (3 births to 2 deaths), and the increase is still greater
in towns by the excess of their immigration over emigration, the
number of people is in excess at ages when the mortality is low,
so the death-rate is below what it would be if the numbers of
population at different periods of life were in the same proportion
as they would be if the births equalled the deaths in number.
DEATHS. | 125

4. The absolute mortality, as derived from a Life Table properly
constructed, is higher in England, where the population is
increasing, than the crude death rate, to which 2, 3, or 4 per 1,000
should be added in the several districts to get the absolute
mortality.

5. The death-rate, which is a safe guide in judging of the varying
mortality of the same place, is also a safe guide in judging of the
relative mortality of towns. Wherever the mortality exceeds 17
in 1,000 there is much sanitary work to be done.

(Weekly Return, No. 43, 187+.)

Relation between Birth-rates and Death-rates.—The natural term of
human life appears to be a hundred years; and out of the annual
gencrations successively born in England and Wales a few solitary
individuals attain that limiting age, the rest dropping off year by year
as age advances ; so that the mean lifetime is at present only 41 years.

If every person born lived 100 years, and the annual births were equal
year after year, the mortality would be at the annual rate of 1 in 100, or
of 10 in 1,000 ; and if every person lived 41 years, it is obvious that, the
births being equal, the mortality would be at the rate of 1 death annually
in 41 living, or rather more than 24 deaths in 1,000 living.

If the births constantly exceed the deaths in number, upon this
hypothesis, the mortality remaining the same, although the ~ mean
duration of life remains 41 years, the mean mortality will be below 1 in
4+1—below 24 in 1,000. And the same proportion is true, though the
lifetimes of individuals vary from 0 to 100 years : thus though the mean
lifetime is 41, the births exceeding the deaths and increasing, the
mortality in England and Wales is 1 in 45, or rather more than 22
annual deaths in 1,000 living.

The rate of mortality among children and among men and women of
different ages, varies; so that the mortality (73 in 1,000) of children
under 5 years of age is at nearly three times the average rate of the whole
population, while among boys and girls of the age (10-15), the mortality
is at the rate of 5 in 1,000, or only one-fourth or one-fifth of the general
rate ; and the mortality remains below the average until the age of 55,
but becomes after that age much above the average. The population in
which the annual number of births increases, contains an undue propor-
tion of children, of youths, and of persons of middle age ; and the result
is, that the rate of mortality is less than it would be if the population
was in the proportions that would arise from an equal number of annual
births.

The deaths to 1,000 living in different districts will, therefore, vary
to some extent, according as the population is constituted of more or
less of the children or adults at the ages that experience a relatively high
or a low rate of mortality.

But allowing for the circumstance that the annual deaths to 1,000
living in England should be less than they would be if the births did not
increase, the mortality of different districts varies with the different
degrees of health in the population. (16th Annual Report, p. xiv.)

Arranging the districts of England in the order of their mortality, it
is found that the annual mortality in the various groups ranges from the
rate of 15 to 39 per 1,000; the birth-rate from 29 to 40 per 1000; and
it is seen that, in the next Table, as the death-rate increases, the birth-
rate increases, so that in all the districts with a mortality under 25 per
1,000 the natural increase of population is very constant. The mortality
increases with the density of the population ; and thus every additional
death is met by an additional bir
126 [part Iv:

tensity of Poputation, Deatu-RAtE, BirTH-RATE, Excuss of BixtHs
over Drarus, and Increase of Porutarion per 1,000 Persons
LIVING, in Seven Groups of Districts arranged in the Order of
Mortality.

 

 

 

 

 

 

 

 

 

 

 

 

| | 4
; 1861-70.
eee
‘Range of Persons | To 1,000 PERSONS LIVING.
ae Mortality : tou ree oo a a = eae a4
a 1
Rates per Square Average
oP tiie : ; Average
Destrects, , 1,000 Living. Mile. Average | Average ‘Annual aoe of
| Annual Annual Excess of Population
i Deaths. Births. Births over | 3) middle of
Deaths. A
' | <i period.
ers
ENGLAND !
& Wares | 15-39 367 Dee 35°1 12°6 : Int
619
as eed '
| | |
3k : 15-17 | 171 16°7* ' | 15'8
|
349 | 18-20 195 19°2 13°0 8°8
1t2 ! 21-23 447 22/0 13°6 16°2
56 226 | 2,185 25°1 38°1 13°0 15°3
16 27-30 6,871 27°8 39°1 11°3 89
1 32 12,172 82°56 37°3 48 32
1 39 65,834 38°6 37°68 -1'0 —12°3
\ .
|

 

 

* These rates are obtained by dividing the aggregate deaths and births in the districts having
1 average annual mortality ranging from 15 to 17 per 1,000, by the aggregate population of those
stricts (P): Each group is treated in the same manner,

In the first stage of the scale, that is in the 54 healthy districts, the
eath-rate is 16°7, the birth-rate 30°1; in the second stage the death-
ute is 19°2, the birth-rate 32°2; in the third stage the death-rate is
2:0, the birth-rate 35°6 ; in the fourth stage the death-rate is 25-1,
ie birth-rate is 38°1. The natural increase of population in each of
iese four stages ranges from 13°0 to 13°6, or is severally 13:4, 13°0,
3°6, 13°0. When the mortality reaches the jifth stage the death-rate
; 27°8, the birth-rate 39°1; and after that point, while the death-rate
rereases to 32°5 in Manchester and 38°6 in Liverpool, the birth-rate
scedes to 87°3 and 37°6, and there is a decrease of indigenous
opulation, which if it should go on might end in a decrease of
opulation in geometrical progression.

Should the deaths in the districts where the mortality is 22-0 per 1000
e reduced by sanitary measures to the same level as in the districts where
ae mortality is 19°2, the births might be reduced in the same or a
veater degree, namely, from 35°6 to 82°2; and should the death-rate
e brought down to 16°7, the birth-rate might be reduced, us in the
ealthiest districts, to 80°1; the deaths falling 5°3, the births actually
5°55 per 1,000, as shown in the table. The fall of the birth rate is
bserved in the existing circumstances of this country ; it maintains an
niform increase in districts under different laws of mortality, but it is
ot anecessary consequence of a reduced death-rate, and if, in the opinion
f the parties concerned, their prospects are good, they marry and
rocreate children at the same rate as before; in that case the population
DEATHS. | 127

inercases faster ; whereas in a depressed condition the births fall off until
the population becomes stationary, or declines.

‘Thus there is no inevitable connection between the gradual reduction
of the mortality of the whole kingdom to the rate of 17 per 1,000 and
the more rapid increase of population; because the birth-rate may of
itself tall to the level of that now prevailing in the healthiest districts
and leave the increase of population as it was. Statesmen are not then,
by alarming cries of increase of population in a faster geometrical
progression, to be deterred from the noblest work in which they can
engage; for it ix certain that population as it improves in England will
not increase faster than the requirements of industry in all its
forms at home or the new openings of colonial enterprise abroad.
(Supplement to 35th Annual Report, pp. xii-xiv.)

True Death-rates and the Probability of Dying —Il on an average
of years ont of 1,000 children born simultaneously, 149 die in the twelve
months following the date of birth, the probability of dying is expressed
by the fraction 0°149: that is the death-chance of a new-born infant
under the given law of mortality. As 851 of them survive, 0°851 is the
fraction to express the probability of living; it is the défe-chance.
Now *851-+-° 149=1=life-chance+death-chance.

This probability is often expressed thus: the chances are $51 to 149
that a new-born child will live a year. The value of £1 payable if the
child should live a year is 17s. (£°851); the value of £1 payable on the
death of the child is 3s. (£°149) ; the chances in favour of life being
greater than the chances in favour of death.

The lives may be looked at with a view to determine the persistency
of the life-force; which is such in the present case, that 851 live out
of 1,000 during one revolution of the earth; at the age of 20 it is
such that 992 out of 1,000 men live a year. The proportions vary
under varying conditions, but these variations do not accurately denote the
vital force, which is only correctly measured on the seale of mortality.

The mortality is determined by the ratio which the deaths bear_to the
years of life. “The men living, and the time expressed in years,
““jaultiplied into each other, produce the years of life with which the
“deaths are compared. A year of life is the lifetime unit.”* It is
represented by one person living through a year; or by two persons
living through half a year. A regimeut of an average strength of 1,000
men during three years represents 8,000 years of life; and if the
deaths in the three years are 60, the rate of mortality is thus expressed :
n= . = ‘02; or the mortality is said to be at the rate of 2 per
cent. per annum. ‘The 100 years of life are a tixed quantity; and as it
is found that under various circumstances, and at different aves, the
rate varies from 1 to 2, 3, 4, 5 up to 50, this scale serves to measure
the life-force, or the complementary death-force, in the same way as the
centigrade scale of the thermometer serves to measure heat.

A. thermometer is not a convenient measure of heat unless at all
temperatures it contains the same quantity of mercury, and unless each
degree measures equal expansions of the mercury. If the mercury
escapes, a correction is required to give the expansion of equal quantities
cf mercury at every degree of temperature. In observing with the
barometer, the measure is adjusted at both ends, so as to give the exact
height of the column above the mercury in its well.

 

* See Introduction to English Life Table, pp. xiv to xx; extracts from which will
be found on pp. 485-8.
128 [PART Iv.

So, to determine the rate of mortality on a strength of 1,000 men
joined by no recruits, it is necessary to take their mean strength during
the whole period of observation; for if one man dies at the end of a
week, 999 only remain afterwards exposed to risk, and if the numbers
are reduced at variable intervals to 990, to 9865, to 911, tc 700, to 600,
and so on, it is evident that the years of life in the same time will be
less than the years of life in a regiment which obtains a recruit for every
casualty. All that is required in such cases is to take the observations
so us to give the true years of life; and the ratio which these years of
life bear to the deaths is the exact measure of the mortality. It is
evident, on the other hand, that such a measure is not supplied by a
comparison of the deaths in a year, for example, to the living at. the
beginning of that year. The results by this method are only strictly
comparable when the deaths ave in the same proportion and occur in the
same periods of the year.

By the English Life Table 1,000 infants followed through their first
year of age yield nearly 903 years of life; and the mortality is at the

- or, more correctly, sas = °16,559. It is 16°559 per cent.
per annum. The probability of dying is *149,493; and upon the
erroneous assumption that this is the rate of mortality it would be
14°949 per cent. per annum; less by 1°610 than the true rate, with
which it should never be confounded.

At other ages than the first year the rate of mortality serves to give
the probability of living a year, and thus supplies the fundamental
elements of a Life Table. The difference between the rate of mortality
(m), and the probability of dying (p), becomes less in proportion as the
two fractions diminish ; for upon the hypothesis that the deaths in a
year occur at equal intervals in the year, the relation of p and m is thus
expressed :

 

rate of

l—tm _ 2-—m.
P = eH, SO
ltitm  2+m.

(Supplement to 25th Annual Report, pp. iv-v.)

Method for comparing Local with Standard Death-rates—We have
no means of ascertaining what the rate of mortality would be among
men living in the most favourable sanitary conditions; otherwise
observations for a term of years on a considerable number of such
persons would supply a standard rate with which other rates could be
compared.

In the absence of such a standard, the districts of England in which
the mortality rate did not exceed 17 annual deaths in 1,000 living, have
been selected as the basis of « new life table which will shortly be
published, as the nearest approximation we can obtain to a_ table
representing the human race in the normal state.

The 5th column in the annexed table shows the rates of mortality at
12 different ages in the districts of England which we call, for the sake
of distinction, healthy. The sanitary conditions are often defective, but
the defects are counterbalanced; so that the districts being much less
unhealthy than the average, may be so designated.

Tt will be observed that if the population (2,373,983) be multiplied
by 17, and the product be divided by 1,000, the resulting number
(40,358) will represent the annual deaths that would take place in
London if the mortality were at the rate of 17 in 1,000 annually. The
actual rate of mortality in those districts was 17°72 in 1,000 males,
and 17°33 in 1,000 females.
DEATHS. |

129

Metuop for comparing the Rares of Morratiry in the HeaLtuy
Districts of Eneianp, with the Rates prevailing in other Districts ;
Lonpon given as an example.

 

 

 

 

 

 

 

 

Lonpoyn.
|
ae e atte
ths whic’
Average ce
Population Average Aewant Bete of} Annual Mor- Ree if the
AGES estimated to | Annual Deaths |" yy oytality i tality in Mortality had
F i i y in ortality
z the middle of | in the 5 Years the 5 Years Healthy Deen the sare
1851. 1849-58. 1849-53. Uaogs) | asin Healthy
< Districts.
1 2 3 4 5 6
MALES.
0—- 147390 12156 08247 “04348 6367
5 121977 1274 01045 “00674 817
10— 107745 569 *00528 00384 412
15— 208028 1669 “00802 00691 1432
25— 195983 2178 ‘01111 *00818 1598
35— 145165 2504 01725 *00928 1341
45— 96559 2542 * 02632 *01273 1223
55— 54479 2396 04398 * 02294 1243
65— 26514 2299 08670 "05486 1446
T5— 7387 1294 17522 °12817 942,
85— 794 272 34247 °28350 225
95 and up-
wards - 48 19 *40047 *40000 19
All Ages - 1112069 29172 *02623 *°01534 17063
FEMALES.
0—- 147969 10635 07187 “03720 5473
5— 123082 1220 *00991 *00702 859
10— 109701 540 “00492 00480 524
15— 248763 1619 *00651 00765 1896
25— 233846 2213 "00947 “00894 2082
35— 165265 2345 “01419 “00998 1642
45— 113007 2241 “01983 “01192 1338
55— 69308 2460 03549 02162 1487
65— 36496, 2645 07247 "04992 1809
T5— 12582 1936 15384 “11866 1483
85— 1793 514 28635 26711 477
95 and up-
wards. 102 42 41611 °45000 46
All Ages - 1261914 28410 02251 *-01615 19116
Persons - 2,373,983 57,582 02425 *°01524 36,179

 

 

 

 

 

 

 

* This is the rate of mortality that would prevail in the healthy districts at all ages if the
distribution of the ages were the same as they were in London in 1851.

 

But the population experienced very different rates of mortality at
different ages, and the proportional numbers living in London at the
various periods of life is not the same as it isin the country districts,

which send out emigrants.

and partly by births.

the prime of life.

London is supported partly by immigrants
It has hence an excessive number of people in
Accordingly, it is found that with the population as

it was distributed in 1851 the annual deaths in London would not exceed
36,179, or the annual mortality would be 15 in 1,000 if the rates of
mortality at each of the 12 periods of life were the same as those
prevailing in the healthy districts.

Example: The number of boys under 5 years of age was 147,390 ;
the annual rate of mortality in the healthy districts was ‘04348; and
multiplying these two fractions together, 147,390 x *04348=6367 deaths

T
130 [paid 16

vhich would have happened in London had the mortality been at the
ame rate as it was in the healthy districts.

By continuing the process, the numbers in column 6 are obtained,
mounting in the aggregate to 36,179; the mortality in London should

36,179 os
2,373,983 ='0152 or 15 in 1,000.

All towns like Liverpool, Glasgow, and Manchester, have an excess
f£ that part of the population which experiences, on account of age, less
han the average rate of mortality. A part of the mortality of the towns
s therefore marked by this circumstance.

And the effect of a correction for age such as has been employed in
he Registrar General’s reports shows that the number of wrnratural
leaths is always understated by comparing the total deaths with the
leaths which would take place at the rate of 17 in 1,000.

It is shown in the table that, on an average, 57,582 persons died in
yondon annually during the five years 1849-53, whereas the deaths
hould not, at rates of mortality then prevailing in certain districts of
ingland, have exceeded 36,179; consequently 21,403 unnatural deaths
ook place every year in London. It will be the office of the Boards
£ Works to reduce this dreadful sacrifice of life to the lowest point,
nd thus to deserve well of their country.

In Liverpool, by the same method, it is found that 6,418 lives were
ost in the year 1857, in excess of the deaths at the healthy rates. In
Aanchester the sickness and mortality are also excessive. (20th Annual
teport, pp. 174-6.)

herefore have been

Progress of Public Health possible—Malthus maintained at one
ime that attempts to prevent the ravages of epidemical diseases are
iopeless, inasmuch as the population always presses on the means of
ubsistence. Now population is dependent on two factors, the yearly
virths of children and the number of years the children live ; and if
ubsistence is limited, population is also limited. The population of
ingland may be less, but can never be greater, than the subsistence it
‘an command. It is not, however, necessary that the subsistence itself
hould be produced in England ; other products of the same exchangeable
‘alue can in the present state of transport in the world always be
converted into subsistence. Manchester lives as well as a county
consisting of farmers and agricultural labourers. A nation then is not
‘cabined, cribbed, confined,” by its acres ; it can create on one acre of
and produce worth the agricultural products of a thousand acres.
Subsistence is a limited but not a fixed quantity. Its extension may
ceep pace with the extension of population. Then the births of the
wesent day suffice to sustain a population much larger than the popu-
ation existing; and yet the births might be increased by one-third, as
vill be evident when it is considered that more than 2,000,000 women
f the age of 15-55 are unmarried, and that the 3,000,000 women of
hat age married, “ or otherwise to the same extent as married women
‘ bearing children,” bear on an average only 22 children annually to
‘very 100 women. The reproductive power of the nation is thus under
‘restraint,” as Mr. Malthus called it, and the experience of France implies
hat without diminishing the number of persons in the married ‘state the
mnual births may here fall very considerably below the present
umbers. Then there is the great opening of emigration. Vast regions
ff America, Australia, Asia, and Atrica, are unpeopled, or are peopled
'y unsettled unproductive savages. Colonial settlements, plantations as
3acon calls them, are the glory of England. Other races have tran-
iently conquered the nations of the earth; England has planted
DEATIIS. ] 13].

Englishmen on continents from which time cannot dislodge them
These plantations call perpetually for recruits.

To dread, therefore, any ill consequences from arresting epidemics,
or to argue on @ priori grounds that it is impossible in opposition to
nature to save life, to prolong life, to strengthen, and in every respect
to improve the English race, is illogical; for give them health, and if
the increased numbers cannot be sustained on subsistence by their
industry within the shores of those islands, the births will naturally
decline; but the natural remedies are increased industry to command
produce from abroad, and emigration to seek after subsistence on the
vast trans-oceanic territories.

Then the very conditions which diminish the numbers killed in the
battle of life diminish the numbers of wounded ; and as every single death
by violence implies the injury or mutilation of survivors, so nearly all
the zymotic diseases leave irreparable traces in the blind, the deaf, the
weak in body or brain. By removing the discovered causes of death
you at the same time remove conditions which prevent the progress
towards perfection of the English race. We have, therefore, everything
to hope, and nothing to dread from measures of public health and of
public safety. (80th Annual Report, pp. 210-11.)

Probable Decrease of Mortality.—There are many obstacles to the
sanitary progress of a nation, and it is evident that at present they can
only be overcome in part; but there is no ground for despair. There
bas been progress. The mean lifetime of sovereigns and peers is
prolonged; it was in past ages much shorter than the lifetime of the
unhealthy labourers in the cities of te-day. The mortality of the city
of London was at the rate of 80 per 1,000 in the latter half of the
seventeenth century, 50 in the eighteenth, against 24 in the present day.
The mortality in the liberties of the city of London within and without
the walls was in the four plague years 1593, 1625, 1636, 1665, at the
rate of 24, 31, 13, and 43 per cent. In the city alone 90,472 persons
died of plague in the four epidemics, and 55,604 of other diseases. The
enumerated population of the city was 130,178 in 1631. In the cholera
epidemic year of 1€49 the mortality from all causes in the metropolis
was only 3 per cent. And in the last two epidemics there was a further
decline. Thus it is as certain that the high mortality can be reduced
by hygienic appliances down toa certain limit as it is that human life
can be sacrificed. »

The analysis of the causes of the mortality renders it still further
certain that the actual mortality of the country can be reduced. Many
of the destroyers are visible, and can be controlled by individuals, by
companies, and by corporate bodies, such as explosions in coal mines,
drowning in crazy ships, railway collisions, poisonings, impurities of
water, pernicious dirts, floating dusts, zymotic contagions, crowdings
in lodgings, mismanagements of children, neglects of the sick, and
abandonments of the helpless or of the aged poor.

Furthermore, including the London district of Hampstead, there are
fifty-four large tracts of England and Wales which actually experience
a mortality at the rate of only seventeen per 1,000—less by ve than the
average mortality per 1,000 of the whcle country, less by ¢en than in nine
districts, and less by twenty-two than the mortality reigning for ten years
in Liverpool. Now the healthy districts have a salubrious soil, and
supply the inhabitants with waters generally free from organic im-
purities. The people are by no means wealthy ; the great mass of them
are labourers and workpeople on low wages, whose familics get few
luxuries, and very rarely taste animal food. Their cottages ure clean,

T2
132 [part Iv.

but are sometimes crowded, and impurities abound; the sanitary
shortcomings are palpable. ;

It will not, therefore, be pitching the standard of health too high to
assert that any excess of mortality in English districts over 77 annual
deaths to every 1,000 living is an excess not due to the mortality incident
to human nature, but to foreign causes to be repelled, and by hygienic
expedients conquered.

It is right to state that the real is greater than the apparent mortality
of these districts ; they are increasing, and contain an undue proportion
of population at the younger healthicst ages, so that a correction for this
makes the mortality 20 instead of 77. That is the rate of their stationary
mortality if the population were stationary, if births equalled deaths, and
there were no migration.

The mean annual deaths at the rate of 22°4 in the ten years 1861-70
were 479,450 in England; and had the rate of mortality been 17 the
annual deaths would not have exceeded 363,617 ; so the overplus due to
the operation of causes existing, but less destructive in the healthier
districts was 115,833. The hope of saving any number of these 115,833
lives annually by hygienic measures is enough to ‘fire the ambition of
every good man who believes in human progress. (Supplement to
35th Annual Report, pp. viii-ix.)

Possibilities and Difficulties of extending Human Life.-—The laws
of life are of the highest possible interest, even if the knowledge of
those laws gave men no more power over the course of human existence
than the meteorologist wields over the storms of the atmosphere, or the
astronomer over the revolutions of the heavens. But all human laws
proceed on the belief that the lives of individuals and of communities
can, witbin certain limits, be regulated for good or for evil; and as
latterly this has been questioned, it becomes necessary to discuss the
problem—can lifetime be prolonged by a knowledge of the causes that
cut it short, or by any means within a nation’s power ?

To live long is a natural aspiration, and in the early years of the
marvellous science of chemistry the alchemists sought with as much
ardour as they sought the philosopher’s stone for an elixir vite to confer
on man perpetual prime; they promised him, by its discovery, immor-
tality upon earth. The possibility of this seems to have been an ancient
belief, for in one of the oldest legends man had been told that he should
not die—that he should live for ever. And it had in it some grounds,
or it could never have led the first Bacon, Descartes, Franklin, and
Condorcet to intimate that human life might be prolonged indefinitely.
The forces, as well as the constituents of the body, are in truth indestruc-
tible; but they are fugitive, and are perpetually passing out of the men
of existing generations into other forms: the flame of consciousness
shines in one life only for a while. But the alchemists were right when
they saw virtues in minerals and trees to prolong as well as to shorten
life; to check disease and to set the body free; for if mercury, arsenic,
antimony, iron, potash, soda, magnesia, phosphorus, chlorine, iodine,
sulphur, in their various salts and acids; if stryehnia, quinine, opium,
chloroform, «ther, ipecacuanha, camphor, and alcohol, will kill, they
will also cure in the hands of the skilful. Surgery too has its great
triumphs. Therapeutics is not a delusion, the Healer is a reality. But
no drug can do more than prolong life for a time ; the man raised from
the grave dies in the end. Life can be lengthened by regimen—by
dietetics, which Celsus says engaged in his day the most eminent
professors of medicine in Rome, because it is the most potent and
philosophical, dealing in regimen of mind and body, and medicinally

 
DEATHS. | 133

controlling aliment, air, sleep, and exercise. ‘The influence of the external
world of air, water, soil, and climate on health and length of life was
placed beyond doubt by the great treatise of Hippocrates. And Moses
had before inculeated the exclusion of the sick by zymotic diseases from
the Congregation. In these latter days science has gone further, and
shown under what conditions the lifetime is long or short; and the
science of life, yet only in its infancy, wili make further progress, and
solve many problems hitherto held to be insoluble, when hygiene is
cultivated in all the medical schools. The genius of agriculture, of
engineering, of industry, and of commerce is growing every year, and
handling new power in new machines, is supplying new means of
existence, and banishing fatal impurities.

Descent is easy, and onward motion over a level road is not difficult ;
but every step upwards toa higher state encounters obstacles ; and so itis
in the improvements of the human race. Of this 1 few examples are
instructive :—small-pox is a fatal disease, and after it had been learnt
that a milder type could be induced artificially, fatal to few of the
inoculated, the practice was introduced in London, and was publicly per-
formed in the years 1746-63 on 3434 persons at the small-pox hospital ;
only 60 of whom it is said died of the disease.* The mortality varied in
different places, but it was nowhere considerable. What appeared so
well fitted to justify Lady Mary Wortley Montague’s exultation when
she learnt in Turkey that “ingrafting’” rendered small-pox harmless 2
“JT am patriot enough,” she wrote in 1718, “to take pains to bring this
“ useful invention into fashion in England.” But it was found after it
was brought that the deaths from small-pox in London, compared with
the deaths from all other causes, and also the absolute mortality, increased
considerably when inoculation became common. Large numbers of
children and adults remained unprotected, and inoculation kept the
vartolads alive in an artificial nursery. Inoculation is now made illegal.
Again, hospitals were opened to receive people attacked by this dreadful
disease, and to afford them the advantages of watchful attendance and

skilful advice. This was carried out in London; but the mortality of

the patients in the hospital was double the mortality by the disease
outside.t Here was another apparent failure. But vaccination was
a great advance on inoculation ; the danger of the operation was quite
inconsiderable, and cowpox, unlike small-pox, never scattered abroad
the seeds of disease. In 1771-80 small-pox in London was the cause of
100 in every 1000 deaths, in 1831-5 of 27, in 1861-70 of 11, and in
the absolute mortality by this disease there was a large reduction. In
the last two decenniads, 1851-70, the mortality per 100,000 by small-pox
remained stationary in London at 28. In all England the mortality per
100,000 by small-pox declined from 22 to 16, or to the extent of 6; but
population growing denser the mortality by scarlet fever rose from 88 to
97, thus increasing 9, or one and half times as much as the mortality by
small-pox decreased. The mortality by measles, diphtheria, and
whooping-cough also increased. Vaccination diminished the chances of
taking small-pox, and though it did not afford absolute security, it
reduced the danger of its attacks. But, density of population increasing,
other zymotic principles appeared to find in its absence freer scope for

 

* Duvillard cites Dr. Jurin, who prepared a table showing that out of 447
inoculated with effect 9 died ; Dr. Monro inoculated 5554 persons, of whom 72 died;
Dr. Gregory set down the mortality at 3 in 1000. By natural small-pox the
mortality per 1000 attacked ranges from 150 to 300.

t The mortality in the Small-pox Hospital was at the rate of 25 per cent.
in 1746-63, for 1634 of 6456 patients died. For later returns see Letter to the
Registrar General in Appendix to 34th Annual Report.

ihe ao is se Ne
134 [ParRT Iv.

their destructive operations. In quenching the flames at one point the
good work is begun but it is not ended. Can zymotic diseases of all
kinds never be quenched ?

Out of pity for poor children Foundling hospitals were erected, but
the babies nearly all perished, and a greater number than ever were
abandoned. Had these hospitals succeeded the race of child-abandoning
men must have been multiplied.

Another example is offered by the drainage of towns. In London the
fatal refuse which had been retained in-the houses was conveyed by
water into the drains and into the Thames; and this was an advance on
the previous state of things; but the sewers were charged with im-
purities ; they put houses by their efflavia in communication with each
other, and poured zymotie elements into the waters which were dis-
tributed by companies to the houses of both the wealthy and the indigent.
And even at the present hour the sewage is pumped into the Thames,
which it pollutes and obstructs, instead of being distributed over the
land to which it belongs. The same difficulty in disposing of sewage is
encountered in all English towns.

Tn the early ages the English population was scattered in slight dwell-
ings over woods, meads, and undrained marshland, where they suffered
from agues, rheumatisms, and famine fevers ; as the people multiplied
they assembled in cities and partook of a few of the advantages of
civilization; but the increase of density brought new dangers, and, as
the proximity of houses exposed towns to conflagrations, it laid their
inhabitants open to devastating maladies, and to destructive pestilences.
The people flocked in numbers to London in the reigns of Henry VIL,
of Elizabeth, and of James, and the sweating sickness and fevers and the
oriental plague decimated the population. The Restoration brought
country families to the metropolis, and the plague made its ever-
memorable swoop. The manufactures, the mines, and the great works
that create subsistence for thousands, collect workmen in towns as ill-
provided with sanitary appliances as ill-organised camps ; and thus
Lancashire, Yorkshire, Durham, South Wales, are still in a high degree
insalubrious. Until the Legislature, led by Lord Shaftesbury, intervened,
the lives of young children and mothers were barbarously sacrified in
the factories and mines.. Here is seen again the success with ahich
evil poisons the healing springs of industry.

The low wages of large numbers of artisans in towns deprived them
of the means of healthy life; latterly wages have risen, and they had the
command of those means to a larger extent, but unfortunately the con-
sumption of spirits and other stimulants absorbed their wages to the no
small detriment of health. To sweep out the dusty and close workshops
they are apt to be made draughty, so difficult is it to improve the health
of artisans.

In the last twenty years the towns of England have increased from
five hundred and eighty to nine hundred and thirty-eight; their popula-
tion from nine ‘to fourteen millions; and the health of the whole
population of the country has remained stationary.

Breeders reject weakly animals from their stock, and thus achieve
success, By the care now taken of the humblest member of the human
race the weakly, it is said, survive ; they marry and propagate, and thus,
ws some contend, the proportion of inferior organizations is raised.
The imbecile, the drunkard, the lunatic, the criminal, the idle, and all
‘ainted natures were once allowed to perish in fields, asylums, or gaols,
f they were not directly put to death, but these classes and their
offspring now figure in large numbers in the population. (Supplement
‘0 85th Annual Report, pp. v—-vili.)
-

DEATHS. | 135

Progress of Mankind in Health—Turgot, Price, Priestley, Godwin,
had written on the perfectibility of man, but Condorcet put this doctrine
forward with new force in the remarkable work he wrote while be was
under the ban of proscription in the last bloody days of the French
Revolution.* Any Secretary of the French Academy of Sciences is not
only distinguished by eminence in one branch of learning, but by a
general acquaintance with the whole circle of the sciences; in writing
on human perfectibility, Condorcet, therefore, did not write in ignorance.
He knew the greatness of the conception; and had sounded all its
depths. His argument is an induction drawn from the progress of
nations through nine historical epochs in science, art, literature and
civilisation ; and from the gradual rise to heights higher and higher,
as well as from the intrinsic energy of their animating principle, he
predicts in the last chapter not only an indefinite development of the
sciences, of the arts, and of institutions, but of man himself in all his
faculties. He foresees new discoveries in all the sciences, and in the
arts, reacting on each other; improvements in the theory and practice
of life; completing the faculties by placing more powerful instruments
at their disposal ; and by their own development. All classes by educa-
tion, by free trade, by cheap law, by simpler manners, will be raised
to a higher level; the classes dependent on labour, and men having a
little capital, by insurance, and by co-operation, will enjoy advantages
now only possessed by great capitalists. Progress will be accelerated
by new methods in the sciences; by new notations; by the application
of calculation to all branches of human affairs ; and by simplifications of
processes in the arts. Teaching both the sciences and the arts will be
facilitated; men and women will alike cultivate the fields of nature. At-
present not a fiftieth part of the people endowed with talents obtain the
education required for their development.

What Condorcet in 1794 sketched of the progress of the arts and
sciences has already been fulfilled. The sketch was a prophecy. But
he is equally confident that as plants and animals have been developed,
so man, already richly endowed, is susceptible of organic perfectibility.
The English and French are as much in advance of the Saxons and
Franks as the cattle and horses of to-day are ahead of theirs. The
senses will grow finer, the forces more vigorous, the intellectual faculties
inconceivably superior to what is seen in the present average of the
race ; man may be indeed a “little lower than the angels.” Who can
doubt, he asks, that the progress of conservative medicine,t the use of
healthy aliment and lodging, a regimen which will develope energy by
exercise without wasting it by excesses; the removal of the most potent
causes of degradation, abject poverty and superfluous wealth; will
prolong the lifetime of men, insure more constant health, and more
robust constitutions. It is clear that conservative medicine, rendered
more efficacious by reason and social institutions, must in the long run
banish transmissible and contagious diseases, as well as maladies due
to climate, diet, occupation ; nay, the hope of relief may be extended to
all other diseases whose remote causes may probably be recognised.
Now, is it absurd to assume that this perfectibility of man will go on

 

* Esquisse d’un Tableau Historique des Progrés de l’Esprit Humain. Ouvrage
Posthume de Condorcet ; 3rd edition, 1797. Condorcet, born 17th September 1743,
died on 8th April 1794. In early life he co-operated with Turgot; and was for
many years the Perpetual Secretary of the French Academy of Sciences. He wrote
in favour of free trade and against the slave trade when prohibition and slavery
were recognised institutions.

{ Médicine conservatrice is the expression of Corvisart ; it will bear transplanta-
tion into English. He also uses the term médicine préservatrice. Hither is better
than “ preventive medicine.”
136 [PART IV.

ndefinitely through endless ages? So argued Condorcet. Malthus, to
confute his doctrine, advanced the principle of population under which
nankind multiplies, he contends, so fast in geometrical, while subsistence:
ncreases in arithmetical progression, that the numbers are necessarily
cept down by “misery.” This principle of population—the ‘“ wedded
‘ love” that Milton hailed—is the inexhaustible source of human
vretchedness! The irony is terrible.

Condorcet, one of the eminent band of mathematicians then existing
n France, would have smiled at the hypothesis that men increased in
‘eometrical and subsistence in arithmetical progression, when it happens
hat the plants and animals on which men feed can all increase or
lecrease in geometrical progression at faster rates than man. The law
sthe same. He anticipated tke objection from an indefinite increase,
nd suggested how it may be overcome.*

Mr. Darwin, accepting the law of the increase of animals in geometrical
rrogression, instead of viewing it as a reason for an eternal stand-still of
aisery, traces to the consequent struggle for existence, and the survival
f the fittest, the progressive development of creation from its lowest to
ts highest forms. He contends that living matter in the past was
erfectible; and this is an argument for the indefinite perfectibility cf
ae through future ages.

The great source of the misery of mankind is not their numbers, but
heir imperfections, and the want of control over the conditions in which
hey live. Without embarrassing ourselves with the difficulties the vast
heories of life present, there is a definite task before us—to determine,
rom observation, the sources of health, and the direct causes of death in
he two sexes at different ages and under different conditions. The
xact determination of evils is the first step towards their remedies,—
Supplement to 85th Annual Report, pp. xix—xx.)

Sanitary Work, and Decline of Mortality.—There are many districts
a England where the good effects of the sanitary administration of the
ist 20 or 380 years can be distinctly traced. Those in the annexed table
aay be cited as examples of such improvement.

Jistricts of Exe@ranp and Waxes showing some IMPROVEMENT in the
Annual Rate of Mortarity in the “TAREE DecapeEs 1841-50,
1851-60, and 1861-70.

 

 

 

 

 

 

 

 

Enumerated Avene ie nual
Nunibee : Population. aby
See lnc pai Registration ios
of Name of District. Gounty Deaths to 1,000 Living.
District. ‘
1861. | 1871. | 1341-50, | 1851-60.| 1861-70.
* 182 North Witchford- | Cambridge - 14,791 15,585. 27 21 20
183 Whittlesey - -| Cambridge - 6,966 7,002 25 23 21
184 Wisbech - - | Cambridge -| 38,309 | 34,209 25 22 20
189 Orsett = - Essex - -| 11,595! 18,172 24 21 18
254 Salisbury* - - | Wilts - - 9,039 9,212 238 24 20
279 Stoke Damerel -| Devon - -| 50,440] 49,449 26 23 21
372 Wolverhampton - | Stafford - | 126,902 | 136,053 27 28 24
393 Coventry - | Warwick -| 41,647 | 40,118 27 25 21
446 Macclesfield - | Chester - | 61,543 | 59,339 26 25 23
520 Hull » - | York - - 56,888 68,316 31 25 26
582 Newport -  -| Monmouth -| 51,412 | 61,252 24 22 21
585 Merthyr Tydfil - | Glamorgan - 93,008 | 104,239 28 29 25
605 Cricknowell - | Brecknock -| 22,457 | 20,147 27 25 23

 

 

 

 

 

 

* The District. of Salisbury was abolished, and the sub- -district of Salisbury transferred to
1e District of Alderbury, in the year 1869.

 

* Condorcet, Esquisse, pp. 362-4.
DEATHS, | 137

The district of North Witchford affords a striking instance of the
important results that can be attained through health administration.
The average annual mortality fell from 27 per 1,000 in 1841-50, to 21
in 1851-60, and to 20 in 1861-70: in the four years 1871-4, the results
are still more remarkable, the mortality being reduced to 17 per 1,000.

In Whittlesey, a steady improvement in the mortality is also discernable
from 25 to 1,000 in 1841-50, and 23 per 1,000 in 1851-60, to 21 per
1,000 in 1861-70; in 1871-4 the rate fell to 19 per 1,000.

In Wisbech sanitary supervision commenced soon after the cholera
epidemic of 1854. In 1866 the town was supplied with pure water, and
extensive sewerage works are now completed. The annual death-rate
of this district has been reduced from 25 per 1,000 in 1841-50 to 19 per
1,000 in 1871-4.

The great land drainage works have had great influence in improving
the health of the inhabitants of the Isle of Ely. By their means the
atmosphere has been purified and dried, and the returns for Wisbech
show a marked diminution in the death-rate from phthisis, the average
annual mortality per 1,000 living in the 10 years 1851-60, being 2:0,
whereas in the ten years 1861-70 it was reduced to 1°6.

In Orsett the remarkable reduction in the death-rate during the 30
years 1841-70 is partly due to sanitary improvements, but mainly to the
drainage of the land and consequent dryness of the soil. In the four
years 1871-4 the mortality was only 17 per 1,000. The annual rate of
mortality from phthisis decreased from 2°8 per 1,000 in 1851-60, to 1:9
per 1,000 in 1861-70.

Reference has already been made in some of my previous reports to
the good effects of drainage and water supply in the district of Salisbury.
Before any improvements were made, the annual death-rate in 1841-50
was 28 per 1,000, but by the year 1855 an excellent system of drainage
was in operation, and the district was supplied with pure water, so the
annual rate was reduced in 1851-60 to 24 per 1,000, and in the
following decade it was still further reduced to 20 per 1,000. The city
of Salisbury, with a population in 1871 of 12,903, appears to be in a
good sanitary condition, the annual mortality in the four years 1871-4
being at the rate of 21 per 1,000.

In Wolverhampton the annual mortality has fallen from 28 per 1,000
in the 10 years 1851-60 to 24 in the four years 1871-4. Dr. Love,
the Medical Officer of Health, attributes this reduction to various
sanitary improvements carried out since 1858. In 1865 the town was
entirely re-sewered, and a more wholesome water supply obtained, but
much still remains to be done to put Wolverhampton in a good hygienic
state.

The cause of the great improvement in the health of Coventry is
attributed by Dr. Fenton to the progress of sanitary works. Such
improvements have been the means of reducing the annual death-rate
from 27 per 1,000 in the 10 years 1841-50, to 25 per 1,000 in the 10
years 1851-60, and to 21 per 1,000 in the 10 years 1861-70. In the
four years 1871-4 the mortality rose to 24 per 1,000. This was owing
to an epidemic of small-pox in 1871-2, and of scarlet fever among
children in 1873-4.

Previously to any sanitary improvements in Macclesfield the mortality
of this district, in 1841-50, was at the annual rate of 26 per 1,000. In
1853-6, sewerage works were executed ; in 1851-2, the town was
provided with an improved water supply, and various other sanitary
measures were adopted, ‘but the condition of Macclesfield was far from
satisfactory, for the mortality of the district, in 1851-60, was 25 per
138 [PART Iv.

1,000. In the following decade, however, 1861-70, it fell to 23 per
1,000.

Kingston-upon-Hull presents another example of the good effects of
sanitary measures. Mr. Holden, the Medical Officer of Health, states
that cholera was appallingly fatal in 1849; in proportion to population,
it suffered more from cholera than any district in the kingdom. The
annual rate of mortality, from all causes, in the 10 years 1841-50, was
31 per 1,000. An investigation showed that the drainage was bad, and
the water—derived entirely from the river Hull—received the sewage
of such places as Driffield and Beverley. The Local Board of Health,
incorporated in 1851, began to carry out sanitary improvements, and in
the 10 years 1851-60, the mortality was reduced to 25 per 1,000. In
1864 the river water was abandoned, and the town received a constant
supply of pure water from the springs rising out of the chalk wolds at
Derringham. What has been effected is encouraging, but the mortality
of Hull may be still further diminished, for in the 10 years 1861-70 the
mortality was 26 per 1,000, and during the four years 1871-4 it was
25 per 1,000.

The improvement in the health of Newport is attributed by Dr. Davies
to the extensive and complete system of drainage executed chiefly
between 1851 and 1860, by means of which the sewage was swept into
a tidal river about three miles from its mouth. The effect of the drainage
has also been attended with the beneficial result of lowering the subsoil
water. The town now receives a constant supply of good water. The
mortality declined from 24 in 1841-50, and 22 in 1851-60, to 21 in
1861-70.

The mortality of the district of Merthyr Tydfil—the great centre of
the iron manufactures of South Wales—in 1841-50, and in 1851-60,
was at the high average annual rates of 28 and 29 per 1,000 respectively.
This was attributed by Mr. Dyke, the medical officer of health, to
deficient drainage, to the absence of any system of scavenging, and to a
scanty and impure water supply. In the year 1866 the drainage was
completed, and a plentiful supply of pure water obtained, so that the
annual rate in 1861-70 averaged only 25 per 1,000. The sanitary state
of the town, however, was not satisfactory, for the mortality in the
four years 1871-4 rose to 27 per 1,000, owing to the prevalence of
small-pox in 1872, of enteric fever in 1873, and of contagious fevers in
1874.

The improvement in Crickhowell is mainly due to sanitary arrange-
ments in the urban district of Brynmaur, which has been thoroughly
drained and provided with an ample supply of pure water. Sanitar
improvements are in progress, however, in various parts of Crickhowell.
The mortality in the 10 years 1841-50 was at the annual rate of 27 per
1,000; in the following decade, 1851-60, it fell to 25 per 1,000, and in
1861-70 there was a further reduction to 23 per 1,000, at which rate
it continued during the four years 1871-4.—(37th Annual Report,
pp. ix-xxi.)

Mortality and High prices of Wheat—The close of the 16th century
was marked by the commencement of two important series of statistical
observations, —the Record of the prices of Wheat in the Eton Books,
and the London Bills of Mortality,—which were continued, with
scarcely any interruption, through the 17th and 18th centuries. The
character and nature of these returns are well known. The London
Bills did not include all the deaths,—parishes were gradually added,
and the population of the metropolis at any time before 1801 is un-
known, so that the absolute mortality cannot be determined. The
DEATHS. | 139

Windsor prices, taken only twice a year, do not give the real average
prices of wheat all the year through in London. A comparison with
the averages drawn up by the Receiver of Corn Returns, however,
exhibits a general agreement, which places them beyond the reach of
the disparaging criticism in the Report of one of the Parliamentary
Committees.

In comparing the two series of observations, with a view of ascer-
taining whether there is any connexion between the prices of wheat
and the mortality, I bave taken periods of 10 years, from 1601 to 1610,
1611 to 1620, &c., up to 1800, and have arranged the years in the
order of the prices, beginning with the highest, as in the annexed
example.

 
    
 

EXAMPLE.
Burials in Burials in
i London, : London,
Year. i nee according to Year. eo Hat aba according to
SF : the London a the London
Bills. s. d. Bills.
LOA. cas saisieies 32,169 TF 5 Ob sesieiansie 23,727
1746 .....08. roe BSIEF D742 cision wave 27, ASS
1748 ... weve 23,869, 1745 ... seve 21,296
DIAG ccisrivcrnva . 25,516 BIAS ssercieae . 25,200
TTAT scousuess 25,494 L744 cecscesee 20,606

  

The deaths in the & years of highest prices are then compared with
the deaths in the 5 years of lowest prices in the Table, and the general
result is, that in the tweaty decennial periods, the deaths were 1,971,076
in the 98 years of highest prices, and 1,830,835 in the 98 years of
lowest prices. The excess of deaths in the years of highest prices was
140,241. The method, by taking several short equal periods, contains
in itself corrections of all the errors arising from the increase of popu-
lation, or progressive improvements in the metropolis, and resting only
on the relative number of deaths, yields results entirely independent of
the absolute mortality.

The causes of a high mortality are various; but the greater number
of known causes may be referred to five heads: 1, excessive cold or
heat ; 2, privation of food; 3, effluvial poisons generated in marshes,
foul prisons, camps, cities ; and epidemic diseases, such as typhus, plague,
small pox, and other zymotic diseases; 4, mechanical and chemical
injuries ; 5, spontaneous disorders to which the structure of the human
organization renders it liable. The three first classes of independent
causes vary in intensity from year to year; and as each will separately
produce the effect which we are investigating, namely, an increase of
deaths, it must be evident that this effect will not always vary as priva-
tion or as any one of the class of causes. For instance, the sweating
sickness, said to have broken out in Richmond’s camp, spread through
England, and destroyed great numbers. It was a poison in the air,
and like other poisons, its fatal action was not stopped by abundance of
food, although its ravages, if aided by famine, might have been rendered
more deadly. So of the black death in 1348, the plague in 1665, the
cholera in 1832.

Then, low prices do not always denote plenty, nor high prices
searcity. And if high prices increase the mortality, any great mortality
has a tendency to reduce the price of provisions. Thus in 1349 “the
price of every kind of cattle was much reduced; they wandered about
in herds without herdsmen. Corn of all kinds was so abundant that
no one cared to gather it.” Workmen were scarce, a “great part” of
them having been destroyed, and demanded high wages.—See against
140 [PART IV.

he years 1848-9, Henry de Knyghton, Rymer’s Feedera, Walsingham,
*. Barnes, Holinshed.

Those great disturbing causes and the imperfections of the returns
equire for the elimination of their effects a series of observations ex-
ending through a century. The concurrent evidence of the 17th and
8th centuries appears to me to justify the inference that high prices of
vheat—I mean relatively high—irrespective of the other necessaries
f life, had then a tendeucy to increase the mortality in London.

Mr. Tooke, in his valuable work on Prices, has reviewed all the years
f scarcity and high prices ia the 18th and 19th centuries. Mr. Tooke
ad no theory to support on this subject which did not fall within the
cope of his work. I therefore take the periods upon which he has
xed to test the effects of dearth. He mentions seven periods of various
egrees of dearth in the 18th century, exclusive of 1800, which is con-
ected by 1801 with the 19th century: 1709 and 1710 were years of
great dearth ;” in 1727, 1728, 1729, ‘some degree of dearth” was
alt; 1740 was “felt as a year of dearth;” “thousands of acres
emained unsown in 1756”—there was “a scarcity of corn and a high
ice of provisions ;” in 1766 there was “ dearness of provisions ;” the
uartern loaf in London was at one time as high as 18d. ; [at Windsor
rices were highest in 1767 ;] the five years 1770-4 are said to have had

unproductive harvests*.” A table presents a comparative view of
he deaths reported in the London bills before and after the years
ientioned by Mr. Tooke. The correspondence, as might be excepted,
etween the high and low prices, and high and low rates of mortality
; only general,

Mr. Rickman procured from the clergy, returns of the burials at the
dstablished Churches for each year from 1780 to 1830. The returns
re incomplete, but they serve to show the relative mortality all over the
ountry in consecutive years. Thus we find that the ‘“ partial defi-
iency ” of the harvest of 1794 was followed by scarcity and an increase
f deaths in 1795. The harvest was favourable in 1793. The prices
a 1794 were 58s. 4d. per imperial quarter; the burials, 197,740. In
794 there was a partial deficiency. Prices in 1795 were 76s. 6d. per
mperial quarter ; burials rose to 210,339.

In 1799 and 1800 the seasons were “bad,” and the dearth of 1800
nd 1801 produced great distress. Committees of both Houses of
-arliament were appointed to inquire into the means of supplying the
reople with food ; and with the scarcity a typhus epidemic took its rise
oncurrently, which was inquired into by a Committee of the House of
Yommons. The prices and burials returned during the five years
798-1802 were—

Average Prices of the Winchester

    

Quarter of Wheat. Corn Burials

‘Windsor Prices. Returns. in England.
d, s. d.
DM aeons 50? 8) sara 187,531
BP ce siocas 67 6... «+» 189,586
DY scaieny 11387. sees 208,063
6 acca TIS> Bese vee 204,434
Bete BU si ast reeineteey ae: 199,889

 

* «The King’s Speeches,” “Corn ‘Tracts,” and other original authorities, are

ited by Mr. Tooke. A little confusion in the dates is apparently caused by the
ar lier writers making their year terminate in March. Thus the winter of 1709, new
ty le, is the winter of 1708, old style.
DEATHS. | 141

Up to 1837 the registers of deaths were imperfect, The rate of
mortality could only be obtained approximately. The registration
under the new system is complete ; and with the Censuses of 1831
and 1841, enables us to calculate the proportion of deaths to the
increasing population of each year. Taking the three first and the
three last years, which are the years of highest and lowest prices, it will
be found that the mortality in Yorkshire, Cheshire, Lancashire, and all
England, was highest when the prices of wheat were highest.

Average annual Deaths to 100,000 of the Population in the
three years when the prices of Wheat were

Highest. Lowest.
Yorkshire . 2239 - 2147
Lancashire and Cheshire 2789 2468
England 2270 2110

The difference in these rates implies a difference of many thousands
in the deaths of the whole country. Out of the same population in
Lancashire and Cheshire, for every seven deaths in the years of low
prices eight persons died in the years of high prices. The mortality
was higher in the agricultural counties in the three years when the
average price of wheat was high, than in the years when the price of
wheat was allowed to fall nearer the natural average which prevailed
through the two preceding centuries. For all England, out of the
same population, the funerals in the three years of high prices, were
14 to every 18 in the three years of lower prices, approaching the
natural standard. (Journal of Statistical Society, Vol. IX., pp. 163-7.)

Cotton Famine and mortality in Lancashire 1862. A few of the
registrars witnessing a reduction of the mortality with the distress that
prevailed in their districts at the same time have been tempted to
speculate on the facts, and as those officers in the course of their duties
are in frequent communication with the labouring classes their opinions
may be quoted. The registrar of Wigan states that more freedom to
breathe the fresh air, inability to indulge in spirituous liquors, and
better nursing of children, are believed to have improved the public
health. The registrar of Little Bolton holds that the decrease of deaths
is mainly due to a greater amount of domestic superintendence. The
registrar of Hulme thinks that the even temperature of the weather and
increased attention paid to young children have caused the decrease.
The registrar of Knott Lanes (Ashton) attributes the result to absence
of epidemics, mildness of the weather, out-door exercise, maternal care ;
also to parish relief and charitable contributions, by means of which
food has been obtained not sufficient for health but enough to mitigate
distress and prevent hitherto an increase of mortality. The registrar of
Preston sub-district also refers to the good effect of fresh air, nursing,
and mildness of the weather, and he adds: “In the weeks ending
“ Aueust 2nd, 9th, 16th, 28rd, and 80th, I registered 30, 25, 29, 24,
“ and 87 deaths, but in the corresponding weeks of 1861 when work
was more plentiful and people in better circumstances they were 50,
“© 40, 50, #2, and 57. The peaceful and dignified conduct of the
“ operatives entitles them to the warmest sympathy and support of all
“ classes.” The registrar of Ancoats (Manchester) is convinced that the
low rate of mortality in his sub-district was due to the coldness of the
summer, in consequence of which diarrhcea did not prevail.

It has been recently asked whether starvation is good for the health,
and attempts have been made with indifferent success to solve a difficulty
which has not arisen. Nobody will seriously contend that inadequat

6
142 [PART Iv-

upplices of food are conducive too health ; it is too well known that famine
ias often slain its thousands ; but it is right at the present time to
‘uard against deductions from the returns of mortality which they do
iot justify. It has been assumed as obvious that if the death-rate in the
stressed districts does not exceed or falls below that which has prevailed
n times of prosperity, the relief obtained by the unemployed from
rublic and private sources has sufficed to maintain them in health. The
llowances may or may not have been sufficient in amount, but the
eturns of mortality furnish no evidence of the fact; they only show
hat extreme consequences of famine have not yet been manifested.
%ecreation in the open air, moderation in meat and drink, and the due
ministration of domestic offices are beneficial to health, but if they
lave been compensation for the loss of wages the tables above quoted
re silent on the point. These tables prove that under circumstances
avourable {o human life the mortality in England was reduced last
juarter, and that the districts of the cotton manufacture were not pre-
‘ented by the distress from participating in the benefit, they cannot show
hat if Lancashire had been prosperous the health of its people would
ot have been still better and a further reduction of mortality obtained.
tis amatter not of speculation but fact that winter approaches, and
hat the cold of winter swells the bills of mortality by attacking the
Id, the young, and the infirm of middle age, and it needs not the gift of
rophecy to predict that if cold and want, prolonged and embittered,
ttack a population with combined force, it must fall as if under an
rmed host. To avert or mitigate such a result, food, clothing, bedding,
wd firing must be dispensed by a public or private charity that can rise

o the greatness of the occasion. (25th Annual Report, pp. xxxii-iii.

Mortality and Water Supply: London.—No observations exist
mbracing the whole of the phenomena of the life of these numbers of
oth sexes and of different agvs extending over a century, and severally
arying in strength, in morality, in intellect, in industry, in health, in
recupation, in effectual production and consumption.

But we have now before us the results of observations on a certain
lass of phenomena. The births, the deaths, and the causes of death are
ecorded shortly after they occur, and an analysis of the registers has
een published weekly for twenty-one years.

The results are as valuable as an experimental philosopher could have
leduced from his experiments if he had had the power to expose the
opulation to great vicissitudes of heat and cold, of dampness and
lryness; to the changes incidental to differences in the prices of food;
o air and water of different degrees of impurity; and to destructive
pidemics.

Some of these results were pointed out at the time when the facts
vere first observed, or in the annual reports, and others will undoubtedly
e elicited by future investigations.

Thus we learn that in the same circumstances the same number of
reople die at the same ages of the same diseases, year after year;
rganized hodies being governed by laws as fixed as those which govern
be stars in their courses.

Certain changes of condition, within given limits, produce no
ppreciable effects ; but beyond those limits the effects are in some regu-
ated proportion to the intensity of the causes; varying, however, also
vith the state of the bodies submitted to their action, as is evident by
tudying the effects on the two sexes at different ages.

Thus excessive heat and cold injure health, and increase the mortality
no the former case, by giving rise to diarrhoea, in the latter to diseases
DEATHS. | 143

of the respiratory organs ; the effect generally being greatest in infancy
and old age, and varying with age at rates regulated by laws.

The human body consists principally of water, in combination with
some organic compounds and salts; and this compound of oxygen and
hydrogen is in constant use for drink, ablution, and daily use, so that
water is the life-blcod of cities. Without water they cannot exist, and
on its quality their salubrity depends to an extent which the observations
of twenty-one years have determined.

The supply of water in London is derived from shallow wells, from
deep wells, from the New River, and from the River Thames, or its
tributaries the Lea and the Ravensbourne. The well waters are foul,
and nearly all of them have in solution organic matter derived from
cesspools. The Thames has during this period been the great sewer of
London, and in the years of the cholera epidemic was found charged
with organic matter of unquestionable origin. The Lambeth Water
Company, the Southwark, and the Chelsea, in the first epidemic (1849),
supplied the South and West Districts of London with Thames water,
from the part of the river extending from Hungerford to some distance
above Vauxhall Bridge, and the cholera was then fatal, as the table
shows, to 14,125 persons in London, and it was equally fatal in the
houses of the same districts and streets that were indiscriminately
supplied by the Lambeth Company, which pumped its water from the
foulest part of the Thames at Hungerford, and by the Southwark and
Vauxhall Company, which took its water higher up the river, but
within the tidal range.

It was shown in the Cholera report (1849), that, in 10,000 inhabitants
living in the districts supplied with water taken from the Thames at
Kew and Hammersmith, 15 died of cholera; that 48 died of cholera in
districts supplied with the waters of the Amwell, the Lea, and the Ravens-
bourne ; and that 123 out of the same number died of cholera in the
districts supplied with waters taken from the foul part of the Thames
between Battersea and Waterloo Bridge. “ One, three, and eight,” it
was added in the report, “express the relative virulence of the epidemic
“* in the three conditions.”*

The Lambeth Company, in January 1852, wisely removed its source
of supply at once up to a part of the Thames above Teddington Lock ;
another company lingered on its old site; and the epidemic cholera of
1854, therefore, found parts of the population of London on the south
side of the river in very different conditions; the one supplied with
very impure water by the Southwark Company; the other supplied
with water much less impure provided by the Lambeth Company, The
companies had been in competition, and they often supplied the same
streets and districts, so their customers were nearly in all respects in the
same sanitary conditions, with one exception; a gallon of the Southwark
water contained 3°5 grains, of the Lambeth water 1:4 grains of organic
matter. The dejections of the cholera patients of London were in the
Southwark water in small quantities, but in quantities sufficient to
augment the mortality week after week in every district; and in five
weeks 2,284 persons died of cholera in 40,046 houses supplied with the
Southwark water, while 294 had died in 26,107 houses supplied with
the water taken higher up the Thames. +

The previous deduction was thus confirmed, and the subsequent. in-
vestigation by a committee appointed by the Board of Health, to inquire
into the deaths in every house supplied by the two companies, placed it

 

* Report to Registrar General on Cholera in England 1848-9; see Extracts on
pp. 833-51.

ft Appendix to Registrar General’s 17th Report ; see Extracts on pp. 357-63.
144 [PART Iv.

youd a doubt that the mortality of cholera in London was augmented
y the impure water with which the population. was supplied.

It will be remarked that the guantity of organic matter which was so
vidently deleterious in the Southwark water amounted, according to
he best existing methods of chemical analysis, to ¢wo grains in a gallon
a excess of that in the Lambeth water; that is, 2 grains in 70,000
rains, or one part in 35,000. A person’who drank a quart of the water
rould take only a grain of organic matter, and still less of the fatal
erment.

Animaleules and muscular fibre have been found in water containing
1inute quantities of organic matter; it is evident, therefore, that this
uid in rivers, which receive the sewage of towns, must often contain
he elements of zymotic diseases, and can never be circulated through a
opulation for any length of time with entire impunity. And water
ompanies may be assured that the purest water is the most salubrious,
nd that which is likely to retain the firmest hold on the market.

It is therefore of the utmost importance to keep strict watch and
rard over the quality of this fluid, which is now supplied to the in-
abitants of London by companies enjoying a virtual monopoly under
n Act of Parliament, which bound them to alter the sources of supply,
r to improve the quality of the water, after the following dates :—

Grand Junction - 1855, August 31.
Southwark and Vauxhall 1855, August 31.
West Middlesex - - 1855, August 31.
Chelsea - - - 1856, August 31.
East London - 1856, August 31.
New River - - - 1857, June 80.

ind this is done much more effectually than it could be by any vexatious
aspection of their works, through a careful perivdical analysis of the
rater as it is delivered, by one of the most eminent chemical analysts of
he day. The publication of the results of the analysis in the Weekly
‘ables is perhaps of more utility than the publication of meteorological
henomena, over whick public companies have no control.

The improvement in the water supply of London within the period is
reat and decisive; and it coincides with the reduction of the mortality.
ifter the Census the data will exist for comparing the rates of mortality
1 the several districts of London supplied by wells and by the several
rater companies, with the mortality in towns where the waters are
ofter and purer.

From the twelve monthly analyses of the waters of each company by
yr. R. D. Thomson in 1860, it will be observed that the quantities of
rganic matter in the waters supplied by the Chelsea, Lambeth, West
Tiddlesex, and New River Companies are nearly equal (1°67 to 1-69) ;
ae Grand Junction and the Southwark waters contain a little more
upurity (1°74); the East London still more (1:90): the Kent water
, however, the worst, and contained 1-99 grains. A marked improve-
rent will be observed in all since 1851, when their fatal effects in
ggravaling the mortality of cholera were first disclosed. (23rd Annual
teport, pp. XXXiv-vli.

Area, Elevation, and Water Supply : London.—Kight companies sup-
lied the population with water, the life-blood of cities, from the Thames,
nd from its tributary the Lea, supplemented by wells. Their supply to
ondon and its environs, according to the returns of the companies,
mounted to 458,857 cubic metres daily, making a ton to every house
ihabited or uninhabited : correcting for the supplies to factories and to
DEATHS. | 145

streets, the domestic supply is equivalent to 12 decalitres (26 gallons)
daily to each person. The water drawn from the wells of London is
now inconsiderable in quantity. Dr. Frankland’s careful analyses show
the composition of the waters. The Thames, unlike the yellow Tiber
and the turbid Arno rushing down from the Appenines, is justly called
“clear ” in ordinary seasons, but it overflows, and its basin was heavily
flooded during winter all down its lowest levels. Drought followed in
summer, hence the composition of its waters varied largely.

The manure of fields, with the sewage of cities, was washed into the
waters. On 60 trials, #ve in each month, the water was clear in 35
instances, slightly turbid in 10, turbid in 8, and very turbid in 7 instances,
when drawn from the pipes of the five Thames companies. It deserves
note, that the waters of the West Middlesex company were in all the
12 trials found clear and transparent; and that the New River water
was only twice found slightly turbid. The matters rendering the waters
turbid are in suspension. Dr. Frankland’s analyses deal with the matter
in solution. He found the solid impurity dissolved in the Thames water
ranged from 23 to 89 parts in 100,000, in the Lea water from 21 to 36
parts. In the summer months the waters attained an unusual degree of
purity. Upon Dr. Frankland’s scale the sewage contamination was
much less in 1868 than in 1867; the West Middlesex and the East
London companies both stood well. (85th Annual Report, p. lxv.)

Male and Female Mortality in London, 1862.—Not only the births
of males are in excess of those of females, but also the deaths of males
almost invariably exceed those of females, and last year the proportion
in London showed 104 deaths of males to 100 of females, which is
nearly the average proportion in England. Maitland, who published
his History of London in 1739, speculated on this twofold result, which
he was enabled to deduce from the christenings and burials of the
seventeenth and eighteenth centuries; and he drew the conclusion,
which undoubtedly was erroneous in those times, as it would be in the
present day, that the population within the bills of mortality contained
a majority of males. He writes: “Having the bills of mortality now
“ before me, I think it will not be amiss to undeceive the public in these
particulars: 1, Much the greatest part of mankind are of opinion that
there are two females to one male of the human species, but that this
is a palpable error is manifest from the accounts of christenings and
“ burials from the year 1657 to that of 1738, during which time of
“ eighty years there appears to have been christened 619,187 males and
* 585,334 females, and buried 994,656 males and 965,298 females, which
“ in the christenings amount to 33,853 more males than females, which
is 55 per cent. in favour of the former, and in the burials, 29,358,
which is likewise 3 per cent. in favour of the males. This is a double
demonstration that there are considerably more males than females.”
He adds, that “the majority in favour of the males is by our naturalists
“said to be designed by nature for the support of that part of the
*“ human species which is more liable to be destroyed by war than the

other. But as war is only casual, and not perpetual, Iam of opinion
that this supernumerary supply is designed by nature as a constant
remedy against incessant contingencies which the males are more
“ obnoxious to both by land and water than the females.” The second
prevailing opinion which he undertakes to refute is, that “not one
‘“ person in a thousand lives to the age of seventy or eighty.” (25th
Annual Report, pp. xliii-iv.)

6
“
66

“
“

“cc

be
oe

““

Relative Mortality of Males and Females at Seven Age Periods, in
Eight Groups of Districts, 1861-70.—The following Table affords
K
146 [PART Iv.

aluable evidence of the varying incidence of the effect of density of
opulation and of insanitary conditions upon males and females living
t seven age periods, in various groups of districts in which the annual
ate of mortality, during the 10 years, 1861-70, ranged from 15 to 39
er 1,000. The rates prevailing at each age period, in each sex, are
ompared with the rates that ruled in the 53 healthy districts in order
) show the relative excess at each age period, and of each sex, in the
ore unhealthy districts.

 

Mortality Range - - | 15-17 18-20 | 21-23 24 24-26 | 27-80 32 39

 

Persons to one square

 

 

 

 

 

 

mile 166 186 379 25,671 1,718 4,499 | 12,357 | 65,823
DEATHS OF MALES AND FEMALES, out of Numbers living.
Nun- I I
\ozs.| Sex, bers < n In
living. Healthy ue ee In oy 2 Man- | Liver-
Dis-"| Dis- | Dis- | LOM | pis. | pig. [Chester| pool
tricts. | tricts. | tricts. * | tricts. | tricts. | 45 ce trict:
ALL Males - 5,692 100 112 130 151 149 172 201 233
AGES (Females) 6,151 100 114 128 137 Litt 158 187 223

 

5 Males - 2,411 100 124 164 210 212 244 284 349
OF Females 2,931 100 128 170 224 223 260 310 394
5-19 § Males - 17,825 100 109 141 167 168 196 250 294,
Females | 18,416 100 111 189 163 164 183 212 279
925-35 Males - | 12,063 100 106 118 131 117 159 177 241
Females | 11,919 100 a 123 105 123 125 156 208
35-45 Males - | 10,030 100 103 123 172 137 181 233 802
Females} 10,081 100 105 119 129 127 142 194 24.3,

45-55 Males - 7,386 100 104 127 190 152 199 255 323
Females | 8,432 100 4 119 156 139 167 22 312
55-65 Males - 4,211 100 106 130 185 161 186 253 299
Females} 4,662 100 103 120 156 146 167 285 269
65-75 {Roles : Ls8k 100 103 122 162 144 163 199 219
Females} 1,975 100 101 114 | 183 182 148 186 189

 

 

 

 

 

 

 

 

 

 

 

 

Out of 2411 Male Children living under 5 years of age 100 die annually in the Healthy
districts,...... 284in the Manchester District, and 349 in the District of Liverpool.

(Supplement to 85th Annual Report, p. clxii.)

2. RuraL AND UrBan Morratiry.

Low Death-rates and Healthy Districts, 1841-50.—Upon examining
he tables it was found that in three districts (Rothbury and Glendale
u Northumberland, Lastbourne in Sussex,) the annual mortality was at
he rate of 15 deaths in 1,000 living.

The annual rate of mertality was 16 in 1,000 living in the fourteen
ollowing districts; Holsworthy (Devon), Battle, Cuckfield (Sussex),
Reigate (Surrey), Haltwhistle, Easthampstead, Guisborough, Bootle,
Shristchurch, Hambledon, Okehampton, Garstang, Builth, and Steyning.

The annual mortality was at the rate of 17 in 1,000 in Hendon
comprising Harrow), Belford, Southwell, Dorking; and in all forty-
even districts.

Upon going over these districts it will be found that the health and
he circumstances of the population by no means approach any ideal
standard of perfection. Nature, however, does much for the inhabitants.
The fresh air dilutes the emanations from their nuisances; and infectious
liseases are not easily transmitted from person to person in detached
iouses. Still the health of the people in those districts admits of
mprovement ; and it may be assumed with certainty, that the mortality
of the English people, in very variable but generally favourable
sonditions, dces not exceed 17 in 1,000 deaths.
DEATHS. | 147

The deaths of 17 persons in 1,000 may therefore be considered, in our
present imperfect state, natural deaths; and all the deaths above that
number may be referred to artificial causes.

Tt will greatly facilitate sanitary inquiry if a convenient scale can be
framed for measuring the degrees of damage, and the loss of life, which
each district sustains from the various causes of insalubrity. The most
accurate scale is supplied by the Life Table; which can only be con-
structed by expending a considerable amount of labour on the returns
of each district. A much simpler scale is derived from the rates of
mortality. Thus the mortality in the districts of England ranged from
15, 16, and 17 to 36 in 1,000.

If, as has been proposed, 17 is taken as the point above which all the
mortality is excessive, 17 will be the zero of this new scale; and in
England the scale will range up to 19 or 20 degrees. There are 87
districts experiencing ove death in excess of 17 annually; 96 have ¢wo
deaths, and 111 have three deaths; and 18 have eleven or more deaths
in excess annually. It may be observed that the mortality increases as
the density of the population, or the nearness of the people to each other.
—(16th Annual Report, pp. xv—-xvi.)

Healthy District Mortality—The proportion of the deaths in a
given time to a given population is not an exact measure of its vitality ;
the mortality being very different at ditferent ages, and the proportional
numbers of young and old being disturbed by excesses of births over
deaths, and by emigration, the deaths in two equal populations may vary
from differences in their composition as to age, without implying any
real differences in the vitality. A disturbance may also be produced
from dispropertions in the sexes. Under ordinary circumstances the
annual rate of mortality, however, at all ages, serves as a sufliciently
accurate measure of the relative sanitary condition of the population ;
and where this is insufficient, the mortality at quinquennial or decennial
periods of life may be separately determined.

The mortality of England and Wales in 1857 has been compared with
the wortality of England and Wales in the ten previous years, and it
may be compared with the mortality (22°36 per 1,000) in the 19 years
1838-56. It is below that average. But is that average itself, it may
be asked, the true standard? What is the natural rate of mortality
among Englishmen, under favourable sanitary conditions? Under such
conditions how long do they live? How many of them die annually ?
No direct answer can be given to these questions. No large body of
Englishmen is breathing pure air, living on a perfectly sound diet, free
from all defilement, and free from vice, exercising duly the mind and
body generation after generation. We can point to no model city—to
no model caste ; we can discover no model parish in the country. In
the matter of health we are all very ignorant or desperately negligent.
What courses then remain open to the inquirer? One ouly. The
mortality of the districts of England in which the sanitary conditions
are the least unfavourable, can be employed as the standard measure
until happier times supply the real standard of vitality. Sixty-four
districts in various parts of the country are found where the mortality
of the people ranged on an average extending over ten years from
Jifteen to seventeen deaths in 1,000 living. This is not an accidental
event; the mortality only fluctuates in such places slightly from year tc
year, and the death rate under the same circumstances will not be
exceeded. The people dwell in sixty-four districts extending ovei
4,797,315 acres, and their number at the last Census w:s 973,070
Undoubtedly the sanitary conditions in which they live are in many

K 3
148 [PART IY.

espects favourable. They generally follow agricultural pursuits ; and
aey are scattered thinly over an open country, often on high ground, so
aat the imputities which they produce are dispersed and diluted in the
ir and water. They do not breathe each other’s exhalations in theatres
nd churches. They do not drink water sullied by impurities. They

o not drink poison in gin palaces. Their minds are not overwrought
y dissipation, passion, intellectuai effort. But visit their dwellings,
nd amidst much that is most commendable you will discover many
ources of insalubrity. The bed-rooms are often small, close, crowded ;
ersonal cleanliness is not much studied; the dirty pig and the filth of
arious kinds lie here in close proximity to the house; the land there
3 imperfectly drained; in the winter, clothing, fuel, and food are
cantily enjoyed in all large or improvident families ; ignorance yields
ts baneful fruits ; medical advice is ill supplied or unskilful, Yet the
mnual mortality per 1,000 of this million men, wemen, and children,
ear after year, does not exceed 17. Is it not evident that under more
avourable auspices the death rate would be still lighter? Under such
anitary conditions as are known, and with all the mechanical appliances
xisting, can we not imagine a community living a healthier life than
hese isolated people ?

Without affirming on physiological grounds that man was ereated to
ive a destined number of years, or go through a series of changes
vhich are only completed in eighty, ninety, or a hundred years,
xperience furnishes us with a standard which can only be said to
re too high. 17 in 1,000 is supplied as a standard by experience.
tere we stand upon the actual. Any deaths in a people exceeding 17
o 1,000 annually are unnatural deaths.. If the people were shot,
rowned, burnt, poisoned by strychnine, their deaths would not be
acre unnatural than the deaths wrought clandestinely by disease in
xcess of the quota of natural death; that is, in excess of seventeen
ieaths in 1,000 living.

But it may be said that this standard cannot fairly we applied to
ietermine the excessive mortality of large towns, which can never
recome so healthy as the country. How healthy towns may become
ve do not know. It is only proved that the population of parts of
nany towns experiences a mortality little above the natural standard;
nd that the prevalent diseases are referable to causes which evidently
rom their nature admit of removal. The question, however, is not, Does
he excessive mortality admit of removal ? but, does it exist >—and these
wo questions have no logical connection. The existence of the excess is
‘stablished by comparing the actual mortality with the standard. Then
he chief causes of the excessive mortality are now ascertained ; and if the
veople have done all they can to remove them, the residual excess may
ve held to be inevitable. But what is inevitable at one time and in one
lace is not inevitable at other times and in other places. It is there-
ore cf the utmost importance to keep steadily in view all the excessive
nortality over and above that which is implied in the great decree :
‘It is appointed unto man once to die”? In London during the
ixteenth century the population lived about twenty years on an average
md 50 died out of 1,000 living; consequently the excess over 17 mae
33. That this excess was not inevitable is now demonstrated ; for, with
\ great inerease in number, the population now lives about 37 years, and
he mortality has fallen to 25 in 1,000. Is the excess of 8 deaths a year
mong every 1,000 living inevitable? This cannot be admitted for a
noment, if we regard only the imperfect state of those sanitary
wrangements which the public authorities of London have within their
ower. Nor can it be admitted that the excess of 5 deaths—or 22 deaths
DEATUS. | 149

instead of 17—a year in every 1,000 living is inevitable in England and
Wales, with evidence before our eyes of the same violations of the laws
of nature in every district.

Whether the causes admit or do not admit of removal, the fact, then,
is incontestable, and must not be lost sight of, that the excess of deaths
in England and Wales over those from causes which exist in sixty-four
districts was 91,652 in the year 1857; for 419,815 persons died in that
year, and only about 328,163 persons would have died had the mortality
not exceeded the standard of 17 deaths in 1,000 living —(20th Annual
Report, pp. xxxv—xl.)

Exceptionally Healthy Districts, 1841—70.—There are two districts
in England exceptionally healthy; Glendale and Rothbury.* Their
annnal mortality during the 30 years 1841-70 was at the low average
rate of 15 per 1,000.

In Rothbury, a third of the population is employed in healthy
occupations connected with agriculture. The remarkable low death-
rates, ruling at the different ages, are shown in the subjoined table,
where they are compared with the rates in the healthiest parts of
England :

 

 

 

 

 

 

 

| Heaurny 'Diviston II.
Districts Souta
Rotusury District. of astern
ENGLAND. | COUNTIES.
AGEs. AwnuaL Mortatiry.
Mean |. Duatus <u
Sei vi the ORTALITY, §
Porcra ‘on DEATHS Yo 1,000 LIVING.
TION, years, Degatrus to || ———————_-
1861-71. | 1861-70. |y ooorivine.|| 1849-53. | 1861-70.
|
All Ages 7,114 1,105 15°5 17°5 19°1
0- 931 270 29°0 || 40-4 51-1
5- 834 56 6°7 ' 6°9 6°5
10- 751 34 45 | 4:8 3°9
15- 1,316 60 4-6 |! 7°3 6°6
25- 956 69 722 | 8°6 9°3
35- 768 74 9°6 | 9°6 11°9
45-— 627 65 10°4 12°3 15°1
55- 486 101 20°8 22°3 25°7
65- 293 150 51°2 52°3 56°1
75 and upwards 152 226 148°7 145°3 151°5

 

 

 

 

 

 

 

 

 

*In the Rothbury district the village of Harbottle has 120 inhabitants, and

Dr. Frank Richardson states that among them are 37 children under 14 years of
age. During-the last 20 years no child has died. He gives another instance of the
vitality of children in the parish. “A farmer and his three shepherds, who have
‘* occupied their present situations nearly 30 years, have among them 47 children,
* and not a single death has occurred in these families. The inhabitants have
abundance of plain substantial food, excellent water, good residences as a rule,
and regular but not severe work in a pure bracing atmosphere; they are highly
intelligent and generally abstemious. I am indebted to the Rev. A. Proctor, who
has been upwards of 40 years the esteemed vicar, fur the corroboration of tke
statistics of this parish which I have now given you.”
Such exceptional cases are well worthy of study; and our young heaith officers
may learn a useful lesson of hygiene from these farmers and shepherds living on the
southern slopes of the Cheviot Hills. Dr. Benjamin Richardson can scarcely hope
that the mothers of his Hygiea will be more successful in rearing children—their
lambs—than these shepherds’ wives.

‘

‘

“

‘

«
150 [PART lv.

The district of Rothbury contains several very large ancient parishes.
hat of Alwinton on the southern slopes of the Cheviots extends over
3,681 acres, and comprises 16 townships. The population of this
arish decreased from 1,325 in 1861 to 1,205 in 1871, when 39 births
ad only 9 deaths were registered, so the birth-rate of the parish in
371 was 32°4 per 1,000 of population, whereas the death-rate was but
‘5 per 1,000.

The nine deaths registered during that year included two of infants
nder one of age, one of a person 25 years, three aged 50 and under 60,
ne aged 68 years, and another aged 92 years.

In the year 1874 only six deaths were registered, and, assuming the
opulation to have been stationary since 1871, the mortality was at the
ate of only 5 per 1,000.—.(37th Annual Report, pp. xxi-xxii.)

Healthy and Unhealthy Districts of England, 1838-44.—Although
o regular Registers of Deaths were kept before the Reformation, the
hronicles show clearly enough that England has been periodically
evastated by famines and plagues from the earliest times. A large
roportion of the population of the island has been more than once
wept away by these visitations. The great plagues of the sixth and
eventh- centuries—which destroyed, according to some estimates, half
he inhabitants of the Eastern empire—extended to Britain. Besides
he Black Death in the fourteenth century, the sweating sickness of the
ixteenth century, and the plagues of the seventeenth century, termi-
‘ating in the plague of 1665, described in detail by the historians—a
ong catalogue of famines and epidemics may be given, which, though
wiefly and imperfectly noticed in the chronicles, were perhaps not much
ess fatal.

After the Revolution the great plagues ceased; but the mortality was
sept up by typhus, small-pox, influenza, and other zymotic diseases,
Che writings of Mead, Pringle, Lind, Blane, Jackson, Price, and
?riestley,—the sanitary improvements in the navy, the army, and the
orisons,—as well as the discovery of vaccination by Jenner,—all con-
luced to the diffusion of the sound doctrines of public health, and
iad a practical effect, which, with the improved condition of the poorer
slasses, led to a greatly reduced mortality in the present century. Since
1816 the returns indicate a retrograde movement. The mortality has
ipparently increased. Influenza has been several times epidemic, and
she Asiatic cholera reached England, and cut off several thousands of
che inhabitants in 1832. It reappeared and prevailed again, as we have
seen, With no mitigated violence, in 1849.

The health of all parts of the kingdom is not equally bad. Some
listricts are infested by epidemics constantly recurring; the people are
‘mmersed in an atmosphere that weakens their powers, troubles their
functions, and shortens their lives. Other localities are so favourably
sircumstanced that great numbers attain old age in the enjoyment of all
their faculties, and suffer rarely from epidemics. The variations in the
mortality are seen in the tables of the Ninth Annual Report. The rate
of mortality is calculated on 2,436,648 deaths in the 7 years 1838-44;
and on the population taken at the Census of 1841, in the middle of the
period, On tracing over 824 sub-divisions of the country, the force
of death in males and females of different ages, the most remarkable
lifferences are discovered. Here of 1,600 young children under 5 years
of age forty die, there a hundred and twenty die annually; here, of
1,000 men of mature age (85-45) nine die, there nineteen die yearly ;
of 1,000 men of 45-55 years of age twelve die in one district, thirty in
another; at the more advanced ages of the next decennium (55-65)
DEATHS. | 151

twenty-four die annually in one, jéfty in another district: of 1,000
females of all ages without distinction, 14 die annually in three districts,
15 die in eighteen districts, 17 (or less) in forty-eight districts. And
in strong contrast, 23 in 1,000 females die in twenty districts, 26 in
1,000 in three districts, 27 in seven districts, 31 in two districts.

The mortality at all ages, without distinction, differs much less than
the mortality of children, and less even than the mortality of men and
women of the age of 35 and upwards in the several parts of the country.
The population from the age of 15 to 35 is unsettled; at that age the
emigration of servants and artizans from the country to the towns takes
place; and as consumption, the disease then most fatal, is slow in its
course, its victims in many cases retreat from the towns to their parents’
homes in the villages to die. And the death is registered where it
happens, not where the fatal disease began, so that, on comparison, it is
told twice in favour of the towns; once in being withdrawn from the
town register, and a second time in being added to the country register,
to which it does not properly belong.

Independently of external causes, and by the force of a natural law,
the mortality varies at different periods of life; so that the rate of
dying in two mixed populations may differ according to the varying
proportions of children, young persons, or old people. The series of
tables shows the rate of mortality at six periods of life, under five years,
at 10-15, 85-45, 45-55, 55-65, and 65-75. It is shown in the extreme
eases, that when the general mortality is either high or low, the mortality
at nearly all these ages is high or low; anda collation of the whole
leaves little doubt on the question of the relative insalubrity of the
various parts of the country.

Upon looking generally at the health of the population, it will be
found that people suffer most in the great town districts. Liverpool
and Manchester are the places of highest mortality, then follow some
of the districts of London, Merthyr Tydfil, Bristol, South Shields,
Macclesfield, Hull, several districts of Lancashire, Sheffield, Nottingham,
Leicester, Stoke-upon-Trent, Wolstanton and Burslem, Leeds, Newcastle-
on-Tyne, Birmingham, Coventry, Wolverhampton, Newcastle-under-
Lyme, Derby, Salisbury, Northampton, Bradford, Gateshead, Shrewsbury,
Walsall, Norwich, Colchester, Sunderland, Exeter, Worcester, Bedford,
Dudley, Bath, Ipswich, Carlisle, Lancaster, Cambridge, Aylesbury,
Maidstone, Canterbury, Wycombe, Gloucester, Wakefield, and Reading.

The mortality is not increased equally at every age in these districts.
And it varies considerably in the two sexes ; the returns for childhood,
manhood, and old age, males and females, conspire in proving the
prevalence of general causes of insalubrity operating with different
degrees of intensity, but with much greater force than in other parts of
the country.

It is probable that under any circumstances a certain number of
children born will never reach maturity ; that in a numerous population
there will every year be deaths at all ages, from internal or external
causes. In the present state of mankind it is impossible to say how
small the inevitable loss by death is, as in every place, and among all
classes of people, certain known sources of insalubrity exist, which
unquestionably account for a part of the prevalent mortality. The
annual mortality of males and females of all ages in England is at the
rate of 22 in 1,000; in Glendale, Bellingham, and Haltwhistle, three
districts of Northumberland, the mortality in the same seven years was
14 in 1,000. Not to take an extreme case, a group of 21 statistical
districts has been formed, and a table of the mean mortality has been
deduced from the whole; which, as it represents the lowest rates of
152 [PART Iv..

ortality hitherto observed, over a period of seven years in a con-
derable population, may for the present be called the mortality of man
om natural causes. The excess of mortality over this standard may
> nnhesitatingly referred to artificial, unnecessary causes, in such tables
; the following, showing the waste of life and health in 40 town and
ty districts. An equal population (100,000) is taken at six ages; and
will be observed that the insalubrity tells with most effect against
iildhood: the mortality under 5 years of age is raised 124 per cent. ;
i manhood it is raised 77, 83, 70 per cent. at three ages, and in puberty
id old age 45 per cent. Out of a given number of men, at different
res, the deaths by unnatural causes increase every year ; for the table
ows that to 100,000 living in each period, the deaths are 700 by
nnatnral causes at the age of 385-45; and 1,060 at 45-55; 1,682 at
5-65. The vate of mortality is raised in a less ratio, but to a much
reater extent in old than in middle age, for the natural mortality in
ld age is high, The absolute number of deaths is greatest in infancy,
< the number of old persons living is small compared with the number
? children living in every population; so that whether the ratio of
icrease on the natural rate of mortality, the actual increase in the rate
f mortality, or the number of deaths he regarded, children are the
tost cruelly treated by the destroyer. Yet of every 17 men who die.
1 towns, 7 die by unnatural causes; and of 1,000 living at the age
E40, seven die; at the age of 50, eleven die; at the age of 60, seventeen
ie; at the age of 70, twenty-six die every year from causes evidently
sternal and unnatural. Women escape with the least loss; yet five
1 every fifteen annual deaths would not happen in healthy places.

NNUAL Rate of Mortality per Cent. [or per 100,000] in Healthy and
Unhealthy Districts, also the Excess of Mortality due to Unhealthiness.

 

 

 

 

 

Mates. FEMALEs.
Age. | Low. High. | Excess. Low. | High. | Excess. |
|

0—5 4°323 9°678 5°355 3°660 8°405 4°745
10-15 | °393 *572 ‘179 *460 ‘603 *143
35-45 | *913 1°618 *700 *992 1-411 “419
45-55 | 1°276 2°3386 | 1:060 1172 1°895 +723
55-65 2°396 4°078 | 1°682 2°131 3°323 1°192
65-75 5°657 | 8224 2°567 4°799 6°964 2°165

 

The table may be read thus without reference to decimal points. Of 100,000 boys
iving, 4,323 die in comparatively healthy places, and 9,678 in unhealthy places, the
xcess of deaths chargeable on the latter is 5,355. :

It often happens that unhealthy and healthy villages, streets, parislies,
ind towns are in immediate juxtaposition ; and constitute parts of the
same district. The effect of this admixture on the results is, that the
inhealthy districts are less unhealthy, and experience a lower rate of
moitality than they would if all the healthy parts were eliminated.
Upon the other hand, the healthy districts are made to appear less
healthy than they would if they consixted only of healthy pleces,
inhabited by people in good circumstances, under a proper course of
lict, discipline, and exercise. The difference in the mortality of the
‘wo Se of districts is therefore understated. (Cholera Report, 1849;
p- v-vi.
DEATHS. | 153

Excessive Mortality in Towns.—The influence of air, water, food,
and temperature on health and of the other conditions with which the
Health of Towns Bill deals, was emphatically stated 60 years ago by
Dr. Price, no mere theorist in this matter, but the scientific founder of
the Equitable Insurance Society. After showing, from a comparison of
the duration of life in London and Holy Cross, Stockholm and Sweden,
Manchester and the parts around, that human life is shorter by almost
one half in cities than in the country, he adds :—

“From this comparison it appears with how much truth great cities
have been called the graves of mankind. It must also convince all
who consider it, that, according to the observation at the end of the
Second Essay, it is by no means strictly proper to consider our diseases
as the original intention of nature. They are, without doubt, in general,
our own creation. Were there a country where the inhabitants led lives
entirely natural and virtuous, few of them would die without measuring
out the whole period of the present existence allotted them; and death
would come upon them like a sleep, in consequence of no other cause
than gradual and unavoidable decay. Let us, then, instead of charging
our Maker with our miseries, learn more to accuse and reproach
ourselves.

“The reasons of the baneful influence of great towns, as it has been
now exhibited, are plainly—First, the irregular modes of life, the luxurics,
debaucheries, and pernicious customs, which prevail more in towns
than in the country. Secondly, the foulness of the air in towns,
occasioned by uncleanliness, smoke, the perspiration and breath of the
inhabitants, and putrid streams from drains, churchyards, kennels, and
common sewers.”

This induction, drawn with great sagacity from a limited number of
facts, gradually acquired strength; the experiments in prisons and the
navy confirmed it; Mr. Milne, after Dr. Price, demonstruted the high
mortality of towns, and of marsh lands; and Mr. Edmonds in the Lancet,
proved from the Census and the returns, imperfect as they were, of
the parish registers for six towns of England, for London, and the several
counties, as well as from correct returns for Glasgow, that the mortality
at all ages was from about 2°8 to 3°0 per cent. in towns—nearly 2°1
per cent. in all England, and as low as 1°7 or 1°S in some counties.
Mr. Edmonds also showed that the mortality boars a certain relation to
sickness at each age. For every annual death, two persons are con-
stautly suffering from sickness, of a severity that disables labouring men
from work. According to Mr. Neison’s recent observations, there are
2°5 constantly sick in Friendly Societies to one death under 60; the
recorded sickness after 60 is greater; the sickness in infancy is unknown.
But if we assume that 2°5 are sick to one death—and this proportion
certainly does not include slight illness, or all for which people take
pbysic—the numbers constantly sick in London were 122,000, and the
annual attacks of sickness more than 1,220,000, during the seven
years 1838-44 ; the number of annual attacks would have been at least
850,000 less, and the number constantly sick would have been 35,000
less, if the health of London had been as good even as that of Lewisham,
one of the districts within its own limits. This view, and all the prin-
cipal facts known in connexion with the public health of England are
discussed in the article Vital Statistics, of McCulloch’s Statistical
Account of the British Empire, which appeared in 1837. The cholera
epidemic, followed by an influenza in 1837, more fatal tban cholera,
and an epidemic of typhus, had drawn attention to the state of public
health ; the Registration Bill was brought into operation ; Dr. Arnott,
154 [PART IV.

dr. Kay (now Kay Shuttleworth), and Dr. Southwood Smith, were
ppointed by the Poor Law Commissioners to inquire into the causes of
ever in parts of London in 1838; Mr. Chadwick conducted an inquiry
nto the health of many towns of the kingdom in 1839; subsequently,
, Committee of the House of Commons, of which Mr. Slaney was chair-
nan, collected evidence and drew up a report in 1840; and in 1843, a
%oyal Commission was appointed to inquire into the whole subject.
[he reports of the Commission appeared in 1844 and 1845.—(10th
\nnual Report, pp. xiii-xiv.)

Excessive Urban Mortality, London, 1838-44.—The English system
f registration, however imperfect it may still be, has realised the
xpectation held out in the opening speech of the minister who intro-
uced the measure to parliament, in so far as “it enables the Govern-
aent to acquire a gencral knowledge of the state of the population of
he country.”* In successive Reports the births, deaths, and marriages
ave been compared with the population of different districts; the
revalence of diseases has been traced in various parts; and the irre-
cagable proofs of the high mortality in towns induced the late Govern-
1ent to appoint a commission of inquiry, which resulted in a Bill
ubmitted to Parliament by Lord Lincoln and Sir James Graham, A
ew bill for improving the health of towns has been prepared and
rought in by the Viscount Morpeth, Lord John Russell, and Sir George
trey. As this Bill is likely to occupy the attention of Parliament in the
resent session, it may be useful to introduce here some extracts from a
aries of calculations, based on the Census returns of 1841, and the
eaths registered during the seven years 1838-44. The facts and
icthods of calculation are given at length in the Ninth Annual Report,
vo.; in the mean time it will be sufficient to observe that the object of
ie investigation is to exhibit the mortality at different periods of life
1 the divisions, counties, towns, and groups of country districts into
‘hich England and Wales have been divided. From these results the
uration of life can be deduced. Corrections have been made for the
1erease of population, deaths in hospitals, and other disturbing causes.

The mortality in Liverpool, Manchester, and some other places has
een before adverted to. The tables show the mortality of all the
istricts now included in the London tables of mortality. They afford
mple materials for reasoning; but I shall here only direct atten-
on to a few of the points bearing more immediately on the great
uestion of the health of towns. London contained 1,950,000 inhabitants
1 the middle of the year 1841; and 342,565 deaths were registered
‘ithin its limits in the septennial period of which 1841 was the middle
ear. The deaths on an average were 48,938 annually. To 1,000
males living at all ages 23 died, while to 1,000 males living at all ages
7 died yearly. The mortality of females in the neighbouring counties,
aring the same seven years, was from 18 to 20; of males 19 to 21 in
ie 1,000; the mortality of females in London was 5, of males 8 in the
000 more than in the healthiest county. Out of an equal number of
ales living, there were 3 deaths in London for every 2 in the healthy
yunties. Out of 1,000 boys under 5 years of age in Surrey, and
000 in Sussex, 48 and 50 died annually; out of 1,000 in London,
3 died annually. The mortality of children under 5 years of age is
vice as great in London as in the adjacent counties, including several
ywns,

 

* See speech of Lord John Russell on bringing forward the Bill for the Registra~
in of Births, Deaths, and Marriages.—Mirror of Parliament, 1836, p. 131.
DEATHS. | 1é5

 

 

 

 

Annual Deaths at all Annual Deaths under 5
Ages to Years of Age to
1,000 Remalea 1,000 Males | 1,000 Girls | 1,000 Boys
living. living. living. living.
Surrey - | 18 19 41 48
Sussex | 18 19 42 50
Hampshire - 18 20 44 52
Kent - 19 21 48 57
Berkshire | 20 20 46 53
London | 23 aT 80 93

 

 

 

 

 

The excess of deaths in London is not the result of climate, for the
climate differs little from that of surrounding counties; and some of
the London districts are not more unhealthy than many country
districts. Take Lewisham, for instance, comprising Blackheath, Syden-
ham, Eltham, and Lewisham itself. The annual mortality of females
was 16; of males, 18 in 1,000.

The deaths registered in London during the

7 years 1838-44 were - - - - 842,000
If the mortality during the period had not been

greater than in Lewisham, the deaths of

London would have been about - - 244,128

Excess of deaths in London - 97,872

Here are 97,000 deaths in 7 years from causes peculiar to London.
Other districts may be taken in the place of Lewisham, but the result
would ke the same.

A considerable part of the population of London is recruited from the
country, immigrants entering chiefly at the ages 15 to 35, in a state of
good health. The sick and weakly probably remain at home; many of
the new comers, too, unmarried, when attacked in London by slow
consumption— the most fatal disease at the ages 15 to 35—return to
their parents’ houses to die; so that the mortality of the great city is
made to appear in the returns lower at those ages than it is. If we take
children under 5 years of age, where neither these disturbing causes
nor occupation interferes, the deleterious influence on health of London
in its present state will appear undisguised in all its magnitude.

The deaths registered in London (1838-44)

under 5 years of age were - 139,612
The deaths, if the mortality had not been higher

than in Lewisham, would have been - - 80,632

Excess of deaths in London among children- 58,980

Here are more than 58,000 children destroyed in London within 7 of
the last 10 years.

In these plain and appalling facts—in the detailed statements that
follow of the mortality at each age of life in the several districts—or in
the circumstances of the several parts of the population, it is difficult
to discover any valid reasons for excluding London from the operation
of the measure of Her Majesty’s Government for “improving the Health.
“ of Towns in England.” ©
156 [PART IVe

There are, however, circumstances peculiar to the metropolis, which
present difficulties, and which must be taken into account. The Health
of Towns Bill—with the Improvement Clauses—proposes to enable the
nayor, aldermen, and burgesses of corporate towns to prepare plans and.
naps of their respective jurisdictions; to lay out, pave, improve, cleanse.
streets ; provide market-places and slaughter-houses ; remove nuisances
und dangerous buildings; regulate lodging-houses; secure the venti-
ation of public buildings; prevent smoke and extinguish fires; lay
lown sewers and drain houses; procure supplies of pure water and
wtificial light. Jt proposes to give the same powers to Town Com-
nissioners, two-thirds of whom are to be elected by the rate-payers—
me-third to be appointed by Her Majesty—in unincorporated towns.
‘t provides the constituted authorities with qualified officers. The Town
Jouncils or Town Commissioners are to appoint surveyors. The First
Yommissioner of Her Majesty’s Woods and Forests, and three others,
re to be “ The Commissioners of Health and Public Works” to carry
rut the Bill—appoint Officers of Health, Inspectors, Auditors, to advise
nd to aid the Local Authorities. The Bill gives the “ Commissioners
‘ of Health and Public Works” power to enforce few or no improve-
aents; they can only suggest them; nothing can be done without their
‘nowledge; some things require their approval. The peculiarity of
sondon consists in this, that of its 1,950,000 inhabitants, in 1841,
welling in 263,000 houses, valued at a rental of nearly 11,000,000Z.*
nd standing on 115 square miles of landt—only 124,915 men, women,
ud children, dwelling in 15,727 houses, valued at 1,399,1282., standing
nan area of less than a single square mile north of the Thames—have
be advantage of Municipal Institutions. The rest of the Metropolis is
averned by innumerable Vestries, Paving Boards, Sewers’ Commissions,
Vater Companies, Gas Companies, and other bodies, which escape
bservation, and, to a certain extent, responsibility. The Commissioners
ppointed to inquire into Municipal Corporations in 1837, reported that
1 1831 the assessed taxes paid by the City were 205,476/.; by the rest
f the Metropolis included in the Parliamentary Boroughs, 1,022,1314.

With respect,” they say, “to the nature of the population, it is well

known that, on the one hand, the City contains by far the most active

commercial district of the metropolis, and that it forms the northern
bank of the highest part of the Thames accessible to iarge vessels ;
and, on the other, that it does not contain either the Courts of Law.
the Houses of Parliament, or Government Offices, or, generally
speaking, the residences of the higher or more opulent classes.” The
Corporation Reform Act,” in other cities, brought all the parts that
ould popularly be termed the town within the scope of the municipal
ithority. Having “pointed out how small a proportion of the metro-
polis is comprehended within the municipal boundary,” they profess
iemselves “ unable to discover any circumstance justifying the present
distinction of this particular district fiom the rest, except that in fact
it is, and had long heen so distinguished.” The Health of Towns

ill, without raising the question of Municipal Reform, proposes to deal

nderly, but impartially with London ; it leaves the City ia possession

‘all its privileges, and will apparently give to it the same powers

ider the Act, and subject it to the same inspection as the Reformed

unicipal Corporations; while the rest of the metropolis is to be dealt

 

* Derived from the Return of Real Property assessed to the Property and Income
X, for the Year ending April 5th, 1843. The annual value of property in London
ed for the relief of the poor in 1841 was 7,810,216/.

{ ‘The area of the Thames in London is not included in this statement.

t Sce extract from the Commissioners’ Report, p. 14.
DEATHS. | 157

with on the same general principal as unincorporated towns, the Act
being put in execution by “Town Commissioners, possessed of real or
“ personal estates to the amount of 5,000/., or rated to the relief of the
“« poor upon the annual value of not less than 50/., of whom one-
* third shall be from time to time appeinted by Her Majesty, and the
“ remaining two-thirds shall be elected by the rate-payers of the several
“ parishes or places included within such district.” Such is a brief
outline of the important measure which has been proposed by Her
Majesty's Government to improve the Health of London, as well as of
the other Towns of the Kingdom, and so to put a stop if possible to the
sickness, suffering, and loss of life brought to light by the Registration
Returns.

Instead of the inhabitants of London “ measuring out the whole
4 period of the present existence allotted them,” it is found that, in
7 years, 139,612 perished in infancy (under 5 years of age) ; 40,830 in
youth (5 to 25); 109,145 in manhood (25-65); and that only 52,464
attained the age of 65 and upwards. Instead of “ death coming upon
“them like a sleep,” when the faculties are dulled by age and slow
decay,—it convulses tender infancy, falls with burning fevers upon man
in his prime, snatches away the mother with the babe still upon her
breast. But not to take an extreme view, nor to be too sanguine—and,
above all, to avoid any exaggeration—let us set down here the deaths in
London and the deaths which would have happened at different ages if
the mortality had not been higher than it was in Lewisham, where any
one who will take the trouble may ascertain that many obvious and
easily removed causes of insalubrity still exist.

 

 

Deaths that would
have happened |Kxcess of Deaths in
Age. Deaths in London. | if the Mortalityhad)] 7 years by causes
been the same as | peculiar to London,
in Lewisham.

 

 

0—5 189,612 80,632 58,980
5—25 40,830 35,706 5,124
25—65 109,145 83,447 25,698
65 and upwards 52,464 44,343 8,121
All specified Ages 342,051 244,128 97,923

 

 

 

 

Such is the excess of mortality. The excess of sickness must have
been stil] greater.

At the two or three meetings held to oppose the Government Bill
for improving the Health of Towns, by bodies holding local trusts, no
reference was made to the loss of life constantly going on in London.
It appears to have been unknown to the speakers, or to have been taken
for granted because the mortality is little more than half as high in the
present as it was in the 17th century, that the health of the metropolis
is perfect ; that plague having been expelled, typhus and consumption
may be tolerated. Now the plain truth is that one day with another
134 persons die daily in London; that the great majority are untimely
deaths,—children, fathers, mothers, in the prime of life; and that at
least 38 die daily in excess of the rate of mortality which actually pre-
vails in the immediate neighbourhood. 88 persons are destroyed every
day in London by local causes. If these deaths took place on London
Bridge or at Newgate, would any sensible man in the city oppose any
reasonable measure devised by a Minister of the Crown to put a stop
to the frightful sacrifice of life? The city has consented to sce Newgate
168 [PART Iv.

artly free from fever—inspected by an Officer of the Crown, Why is
he disease cast out of criminals to be allowed to enter and destroy the
abouring multitudes? Are their lives of less value? But the city
tself, it is said, is as healthy as it can be; the authorities have done
verything that can be done. A minister of health can suggest nothing
vhich the City of London has not already accomplished. Has the
sord Mayor ascertained this by personal inspection ? He has the
onservancy of the swans and fish of the Thames: and so weighty has
his duty been held that the first magistrate attended by the civic autho-
ities proceeds periodically to hold courts of inspection and to ascertain
he condition of these creatures. Jf some time after having been

To Thames’s banks which fragrant breezes fill,

nd seen the white swans on the river and the fishes glide through the
lear waters, on landing from his barge below Temple Bar he would
lace himself under the guidance of Dr. Lynch, a medical officer, and
Ay, Hutchinson,* a surgeon and registrar of the city, they could lead
he procession on the way to Newgate, Smithfield Market, Houndsditch,
nd the Tower, through alleys, and lanes, and up courts inhabited by
itizens of London, presenting a far different aspect; they would pass
hrough streets on which the sun rarely shines, houses saturated with
estilential vapours—and breezes fanning sewers and excremental
iatter—the most fatal field of fever in the metropolis. They would see
iscase gleaming in the eyes of children, wasting the bodies of women,
rostrating the strength of men. If they called for the registers of
eath for the City without the walls, they would find in them 13,637
ames enrolled in seven years—five thousand of which would have had
o place there if the ‘deliberate conviction ” of the Commission of
iewers were well founded that the “ City of London for health, clean-
liness, effective drainage, lighting, and for supply of water to its
inhabitants, cannot be surpassed.” (10th Annual Report, pp. ix-xvi.)
Area, Elevation, and Density of London, 1868.-—The area of London
3 122 square miles, equal to a square of a little more than 11 miles,
8 kilometres to the side. The Thames and the tides unite the great
ity to the sea. ‘The ground rises to an elevation higher than the hills
f ancient Rome, but a considerable part of the population on the south
ide of the river is living below or at the level of the Trinity high-water
uark. The average elevation of the ground at which the population
ves is 12 metres (=13 yards). The points below high-water mark on
he north side of the Thames are in Fulham, Pimlico, Westminster, and
he Isle of Dogs; on the south side in Battersea, Kennington, Cam-
erwell, Bermondsey, and Rotherhithe. The Plumstead marsh has the
west surface, from 5 to 11 feet below high water mark. ‘he highest
levations are at Hampstead (429 feet = 131 metres) in the north, and
‘hooters Hill (411 feet) and Sydenham Hill (860 feet) in the south,
Che site of the capital of the empire is an eliptical river basin round
he dome of St. Paul’s cathedral. ‘The population is unequally dis-
ributed, dense in the centre, less dense in the outside districts. The
ean density is expressed by nearly 100 people living to a hectare, 40
yan acre; the population density of the capital is 100 times the density
f the United Kingdom. The people live in 400,778 houses; the
vreets are irregular and often narrow, but the elevation of the houses
; not often so lofty as to cover the streets with unhealthy shadows.
“he annual value under county rate assessment exceeded 15,000,0002.
31st Annual Report, pp. lxiv—v.)

 

* See Mr. Hutchinson’s accurate account of the wretched state of parts of the
7est London District, 5th Annual Report, 8vo., p. 587,
DEATHS, | 159

Excessive Urban Mortality; Manchester compared with Surrey,
1838-44.—“ The Seventh Annual Report, 8vo. edition (pp, 880-338),
contains some calculations which set in a striking light the extent to which
human life and health have hitherto been sacrificed. The calculations
have been made with care; they are based upon the returns of deaths
for the seven years 1838-44, and the Census taken in 1841, the middle
of the period. It appears—to give a few examples of the results—
that the annual deaths in the town districts of Manchester to 1,000 males
living are 37, in the extra-metropolitan parts of Surrey 19 in 1000,
To take particular ages, the annual mortality of boys under five years of
age is 48 in Surrey, 148 in Manchester, to 1,000 living.

“ Of men of the age of 35 and under 45, the annual mortality is 11
in Surrey, 21 in Manchester to 1,000 living. The enormous difference
will be rendered more obvious to some by the simple facts :—

Deaths re-
gistered in
the 7 Years
1838-44.
“ Population of the Town Sub-Districts
of Manchester in 1841 - - 163,856 39,922
“ Population of the Extra-Metropolitan
Districts of Surrey - - = 187,868 23,777

 

Difference - 16,145

“ The population of Surrey exceeded that of Manchester, yet in
7 years 16,000 persons died in Manchester over and above the deaths
in Surrey, the mortality in which from the poverty of the labourer, and
slighter degrees of the influences so fatal in Manchester, is higher than
it should be. There were 23,523 children under 5 years of age in
Surrey, and the deaths of children of that age were 7,364; the children
in Manchester were 21,152, the deaths 20,726. In the 7 years, 18,362
children in Manchester alone fell a sacrifice to known causes, which it
is believed may be removed to a great extent and the victims in
Liverpool were not less numerous. Other parts, and particularly the
towns of England, are similarly afflicted.

“Tt is found from the returns of the 7 years 1838-44, that
the mortality of Liverpool and Manchester, and the worst parts
of other towns, is nearly double the mortality of tolerably salubrious
districts.

“Jt is well known that the decaying matters of marshes give rise to
agues, dysenteries, and fevers; and it is proved satisfactorily by the
facts collected under the Registration Act that the excessive mortality
from diseases of the zymotic and other classes, observed in towns, is
occasioned by animal or vegetable poisons, with which the atmosphere is
charged, in different degrees of concentration, depending on accumulated
filth, crowding in dwellings and workshops, the closeness of courts,
imperfect supplies of water, and the want of efficient sewers. The
high temperature of the summer of 1846, in which the mean tem-
perature ranged from 0°2 to 7°7 above the average during 10 weeks
out of 13, accelerated the decomposition, and increased the virulence of
these effluvial poisons as well as of the diseases which they promote,
Once grown epidemic, the diseases continued to rage during the rest
of the year. Thus the mortality of 1846 may be accounted for. If it
took place in obedience to any cyclical law, or to a general cause acting
simultaneously in Asia and Europe, the great fact remains, that the
deaths were nearly twice as numerous in ill-constructed towns, where

 
160 [PART Iy.

he poison is concentrated, as in the country, where it is diluted and
lestroyed by the fresh air.

“The precise degree of influence which the various agencies have
n causing the high mortality of towns is not easily determined.
)pinions differ as to what fraction of the suffering and death is to be
et down to the want of water or of sewerage ; crowded lodgings,
arrow streets, ill-ventilated workshops; the destitution of skilful
aedical advice ; the nezlect of children ; doses of opium and inroads of
‘uackery; sliughter-houses and rank churchyards.’—(9th Annual
Report, pp. 26-36.)

Loss of Life in large Towns, 1851-60.—The population was so
istributed in the thirty town districts, that at the rates of mortality
revailing in the healthy districts at eleven different ages the annual
leaths would have been 38,459 in the ten years 1851-60, when tie
1ean population was 2,541,630. The annual rate of mortality in the
wo sexes would have been 15°13 per 1,000. With the same distribu-
ion of population in respect to age and sex as existed in the healthy
istricts, the mortality would have been at the rate of 17°53 per 1,000;
thile the rate of a normally constituted population under the same Jaw
f mortality would have been 20°41 per 1,000.

The actual mortality deduced from the deaths and the population of
be thirty districts was at the rate of 28°01 in 1,000; and the corrected
iortality would exceed this number.

In comparing the mortality of town and country districts together,
rithout distinction of age, it must be borne in mind that the method is
omparatively favourable to the towns, as the proportion of the masked
iortality is in them greater than it is in the country districts.

YeaTHs in 30 Larce Town Districts in the 10 Years 1851-60; and
also the Dreatus which would have occurred if the Morrariry
had been at the same Rate as prevailed in the 63 HuaLtuy
Districts (1849-53).

 

 

 

Deaths Excess of

Deaths which would have| Actual Deaths in

s . occurred in the 10 Years over

AGES. in 10 Years 10 Years at Deaths at

1851-60. Healthy District | Healthy District

Rates. Rates.

All Ages 711,944 384,590 327,354
0- : 338,990 135,470 203,520
ae 2 31,319 19,290 12,029
10- 7 14,240 11,020 3,220
15- Z 43,807 37,550 6,257
25- 48,625 36,150 12,475
35- - 50,071 30,320 19,751
45- 49,638 26,680 22,958
55- 49,763 27,020 22,743
65— 3 47,445 31,510 15,935
"5- - 30,583 22,920 7,663
85 and upwards 7,463 6,660 803

 

 

 

 

 

The loss of life in the ten years under the sanitary arrangements
xisting is illustrated in the above Table. Thus, at the rates prevailing
t the several ages in the healthy districts, the annual deaths would have
mounted in the thirty town districts to 88,459; but the actual average
umber of deaths was 71,19f; there was consequently an annual excess
DEATHS. | 161

of 32,735 deaths, which may be justly ascribed to the unfavourable
sanitary conditions in which the people live and die.—(Supplement to
25th Annual Report, pp. xxvi-vii.)

Causes of Excessive Urban Mortality—The atmosphere, besides
oxygen and nitrogen, contains carbonic acid and aqueous vapour, The
mean proportion of carbonic acid is 49 volumes in 100,000 volumes of
air, according to the younger Saussure; who also states that it varies
from 37 to 62 volumes. Mr. Coathoupe has estimated the quantity of
air which passes through the lungs of a man of ordinary size in 24 hours
at 267 cubic feet, of which nearly 8 per cent. by volume, or 21 feet, are
exchanged for carbonic acid ;* the bulk would be equivalent to a cube
of 6'4 feet. If, for a mere illustration, we assume- that on an average
16 cubic feet of the gas are thrown off from the skin and lungs of each
person, 30 million cubic feet will be exhaled daily by the population of
the metropolis, distributed over an area of about 1,951 million square
feet. Add the amount of the same gas formed by animals of every
kind,-—fires, lamps—and multiply the sum by 100, inasmuch as respira-
tion for several hours in air which contains 1 or 2 per cent. of carbonic
acid has been found to produce alarming effects (Broughton), and it
will be seen that without effectual means of dispersion the amount of
air vitiated in the metropolis, by this element alone, would be by no
means inconsiderable.

Is the excessive mortality, then, in towns, to be ascribed to the
accumulation of carbonic acid, or of any similar gas, which is so rare
as to be innoxious in open districts? It was natural, when it had
been discovered that carbonic acid mixed in air destroyed animals, and
after many accidents in mines and closed chambers had been traced to
this agent, to ascribe the excessive mortality of towns to the same cause.
Further investigation must show, I think, that it has but a small share
in raising the mortality of towns, the provision for its dispersion is so
complete.

The velocity with which the air rushes into a vacuum is the same
as that of a body that has fallen from a height of about 26,000 feet
(nearly five miles) ; or, according to the Torricellian theorem, putting
v for velocity, g for the velocity acquired in one second by a body
falling freely, and A for the height of the homogeneous gaseous column,
v= /2gh. As g = 82°19 feet, and h = 26,000, the velocity is
1,296 feet in a second. But the height of the column is inversely pro-
portional to the density of the gas; the reciprocal of d (= the density)
must therefore be put under the radical, in applying the formula to any
other gas besides atmospheric air, which is taken as unity. The

 

density of carbonic acid is d = 1°524;andv = af? g he = 1,049.

The velocity with which carbonic acid rushes into a vacuun: is 1,049
feet a second. In applying the formula to different gases, 2 g h might
remain invariable ; d (= the density of the respective gases) would
vary, and the relation of v (the velocity) to d (the density) is such that
v would vary as the square root of the reciprocal of d. The density of
hydrogen is ‘069, and its diffusive velocity is 4,920 feet a second, or 3°8
times the diffusive velocity of atmospheric air, 4°7 times that of carbonic
acid; the diffusive velocity of carbonic acid is eight-tenths that of air.
Dalton discovered that carbonic acid entered the space occupied by
hydrogen in the same proportion as if no hydrogen had been present.

 

* Graham's Chemistry, p. 1016.
{ Poisson estimates the height of the atmospheric column at the temperature of
Zero, pressure 0°76 metre, to be 7950 metres.

L
162 [PART Iv.

Ie inferred that gases do not, like liquids, exclude each other, and
his is now admitted. So that if an air-tight chamber full of carbonic
cid communicate with the external air, the same quantity of air will
nd its way into the chamber as if no carbonic acid gas were present ;
nd if water were introdnced, the same amount of aqueous vapour
vould occupy the space as if neither gas were present. The elasticity
nd density of the atmosphere of the chamber would be the sum of the
ensities and elasticities of all the gases and vapours. It has been
ssumed here, to simplify the statement, that while the atmospheric air
ntered the carbonic acid gas remained; but it would in fact go out,
ov the same reason that the air entered in order to set the gases
vithout and within in equilibrium.

Professor Graham has investigated the rates at which gases are
liffused through small apertures and porous substances. To under-
tand the law of these movements, let us assume that two large equal
paces, A and B, 1,000 feet long, are separated by a partition ; that the
me (B) is a vacuum, the other (A) filled with carbonic acid gas; we
mow that if the partition were removed the gas would rush into the
mpty chamber with a velocity of 1,049 feet a second. If the partition
vere permeable the gas would enter, but at a slower rate, and different
rases would enter at different rates. If the partition were of stucco
dry), and A were filled with hydrogen, B with air, the hydrogen and
ir would both pass through the stucco, and if the quantities of air on
me side, and hydrogen on the other, were collected as they escaped, it
vould be found that the volume of hydrogen that passed in a second was
o that of air as 8°8tol. Professor Graham ascertained experimentally
he relative proportions transmitted—which he called diffusion volumes
—of these and other gases, and discovered that the “ diffusion volumes ”
vere as the reciprocals of the square roots of the densities of the several
rases. The ‘diffusion volume” is evidently the measure of the
velocity; 8°8: 1 is the relative velocity with which hydrogen and air
‘ush into a vacuum; and whiie the interposition of a porous substance
squally retards the velocities of gases, it leaves the ratio of these veloci-
‘les, which is as the square roots of their densities, unaltered. Graham’s
»xperimental method has the same relation to the movements of gases as
xalileo’s inclined plane to the fall of solid bodies; it is not only a
liscovery but an instrument.

The Professor remarks that the result of diffusion is, that gases enter
space in the same quantities ultimately as if no other gas existed in the
space: but that “the diffusive process takes place in different gases
‘ with very different degrees of rapidity. ‘Thus, the external air
‘ penetrates into a ‘diffusion tube’ with velocities denoted by the
‘ following numbers, 1277, 622, 302, according as the diffusion tube is
‘ filled with hydrogen, with carbonic acid, or with chlorine gas.”* This
s quite in conformity with Dalton’s doctrine, that ‘the resistance which
‘ the particles of one gas offer to those of another is of a very imperfect
‘ kind, to be compared to the resistance which stones in the channel of a
‘ stream oppose to the flow of running water.” + One gas does not pass
hrough another with the same velocity as it would through space ; and
he various retardations of the velocity of its passage through different
rases is no more a deviation from the law than the fact mentioned by
?rofessor Graham,—that the gases go more slowly through cork than
hrough stueco. That the presence of air retards the diffusion of vapour
s evident from Leslie’s experiment for freezing water under the air-
yump, in which the air is removed to facilitate the passage of vapour,

 

* Graham’s Elements of Chemistry, pp. 75, 76.
t Graham’s Elements, and Manchester Memoirs, vol. vy.
DEATHS. | 163

from the surface of the water to the sulphuric acid. All the phenomena
of evaporation into the atmosphere establish the same fact. The pouring
of carbonic acid from one vessel into another proves equally well that
the velocity of its diffusion is retarded.

To form an idea of the dispersion of the carbonic acid gas generated
in towns, according to the Jaw in pneumatics, assume that 1,000 cubic
feet are formed per second; it will be equal to a cube of 10 feet. Now
if this volume of carbonic acid were in the centre of a vacuum it would
disperse in every direction at a velocity of 1,049 feet a second. It is
nearly the velocity of sound. A particle would fly a mile in 5 seconds,
12 miles in a minute. The velocity of a “high wind” is 50 feet a
second, “a hurricane that tears up trees” 147 feet a second—one-seventh
of the velocity with which carbonic acid rushes into a vacuum. If the
gaseous film evolved every second over the area of the metropolis were
pure air, it would only move slowly away, by the impulse with which it
was thrown off, and because it was lighter than the atmosphere ; but as
it is carbonic acid, the surrounding atmosphere is a vacuum, into which
its rush is opposed only by the small quantity of carbonic acid gas
existing, and the sluggishness of the aerial particles. The rapid removal
of this gas from cities is effected by a force much greater and altogether
independent of the winds. It is carried rapidly through the air, until it
is fixed again by vegetation and exchanged for oxygen, which flows into
the atmosphere of cities, according to the same law, to replace the
oxygen consumed.

These results are confirmed by chemical analysis of the air. The
differences in the quantity of carbonic acid in winter and summer, night
and day, are ascribed by Dumas to more of the gas being absorbed,
retained, and brought down by rain in cold than in warm weather.
They are meteorological changes extending over all the atmosphere.
Chemists have hitherto failed to detect any excess of carbonic acid gas
in cities. A commission is now sitting in Paris, engaged in the analysis
of the atmosphere by Dumas’s method, which is held to yield the most
accurate results. Iam not aware that the air of any place in England
has been analyzed by the new method, but the observations in other
countries show no diminution of oxygen in the city air. Thus the
oxygen was to the nitrogen in the air of Paris as 230°0 to 770-0 (by
weight) ; and on Faulhorn, in Switzerland, 8767 feet above the level of
the sea, as 229°7 oxygen to 770°3 uitrogen.*

 

* The proportions in the subjoined table are by weight; the aqueous vapour and
carbonic acid were abstracted. They are all the analyses that have yet appeared in
the Comptes Rendus of the French Institut.

 

 

 

 

 

 

 

 

 

Oxygen. Nitrogen. Chemists.
Paris - 230°0 770°0 Dumas.
Brussels 230°6 769°4 Stas.
Geneva - 229°8 770°2 Marignac.
Berne 229°5 770°5 Brunner.
Faulhorn . 229°7 770°3 Dumas.
Groningen 229°9 77071 Verver.
Copenhagen - - 230°1 769°9 Lewy.
North Sea 226°0 774°0 Id.
North Sea 231°2 768°8 Id.
Elsinore 230°4 769°6 Id.
Guadeloupe - 226°8 773°2 Id.
Guadeloupe - 231°4 768°6 Id.

 

Recherches sur lAir, by M. Lewy, Copenhagen. Comptes Rendus, t.17. Aug.
1843, p. 235.

£2
164 [PART IV.

Carburetted hydrogen and sulphuretted hydrogen arising from graves
are less dense, and are dispersed more rapidly than carbonic acid:
searcely a trace of them can be detected.

Carbonic acid and other noxious gases can, as is well known, be con-
fined for a time in well-closed apartments, and oxygen can be excluded,
but the dispersive force is so great, that chemists have seldom succeeded
in detecting any difference in the proportions of the gases, even in the
ur of crowded hospitals. If any difference exist it must be small, and
might have a slight effect on health, but, as the experience of our
sollieries proves, would not raise the mortality to anything beyond a
raction of 40 per cent.; besides, the country is exposed as well as the
‘own population to the influence of deleterious gases in the close
thambers of small cottages.

It is, then, to matters suspended in the atmosphere of cities that the
»xcessive mortality must be referred. Smoke is heated gas, carrying
vith it unburnt particles in suspension; the carbonic acid is scattered
mmediately by its diffusive velocity, and the particles of solid matter,
‘arried up by the heated air into the sky, disperse, become invisible, and
all around insensibly, in a clear atmosphere, or at a distance when there
3 any wind. If watery vesicles are also suspended in the air, the
‘column of smoke ascends but a little, carbonic acid is absorbed, the carbon
mbibes water and air, it mixes with the watery clcud, and all the
shenomena of a London fog are produced. These fogs form apparently
vhen the temperature of the Thames is higher than the temperature of
he air,* which is calm (or if there be any wind it is nearly saturated),
he fogs generally disappearing as the temperature of the air is raised by
he sun.

That the smoke is irritating to the air-passages, injurious to health,
nd one of the causes of death, to which the inhabitants of towns are
aore exposed than the inhabitants of the country, is probable ; but if
he effect were very considerable it would be most evident in the dense
ogs, when the atmosphere is loaded with smoke, and is breathed for
everal consecutive hours by the population—men, women, and children.
Jow we have never observed any connexion between the increase of
he mortality and the London fogs. The diseases, again, caused by
moke must be of a mechanical nature, and affect the lungs and air-
assages ; it may increase the pulmonary diseases, but will assuredly not
roduce scarlatina, measles, typhus, and other diseases which prevail in
owns.

“Tt may be statel in general,’ says Dr. Price, “that whereas in
reat towns the proportion of inhabitants, dying annually, is from 1 in
9 to lin 22 or 28, and in moderate towns from 1 in 24 to 1 in 28;
1 country parishes and villages, on the contrary, this proportion seldom
xceeds 1 in 40 to 50.7

3?

 

* T believe that no comparative observations have hitherto been made in London
1 the temperature of the air and river; but Professor Fournet has shown, from the
gservations of four years at Lyons, on the confluence of the Rhone and Sadne, that
1e temperature of the rivers, from November to March, is considerably higber than
1e mean temperature of the air. The fogs set in in November. Méteorologie de
“aemtz.—_(Note by French translator, Ch. Martins, p. 111.) Kaemtz remarks
). 113) that ‘50 lbs. of incandescent carbon, exposed in the open air, will weigh
from 105 to 107 Ibs. in the course of a few days; a fact well known in powder-
maills. Hence the particles of carbon in escaping from the chimney absorb air and
become heavier. Nevertheless, the wind may carry them to a distance; but if the
air be calm and humid, the specific gravity of the particles augments rapidly, they

mingle in the fog, and spread over the neighbourhood.” ,

+ First Additional Essay, 1775. Works by Morgan. Seventh edition, vol. ii.

218.
DEATHS. | 165

The terms “great towns,” “moderate towns,” and “ villages,” are
not sufficiently specific for our present purpose; but the gereral prin-
ciple announced by Dr. Price is correct,—that the mortality of towns
has a tendency to increase at the same time as they extend. It isa
particular case of the law of density, The displacement of the atmo-
sphere of towns is effected by ascending columns and by circumfusion ;
it must diminish as the proportion of the surrounding to the enclosed
houses decreases. The four sides of a solitary house are exposed to
the currents of the atmosphere; of 16 houses built on equal squares,
in the form of a square, 12 face the open country, 4 are completely
enclosed. Of 10,000 houses on a square area, 9,604 are enclosed; a
city of 250,000 houses built on equal squares, and in the form of a
square, would be surrounded by only 1,996 houses facing the country.
The ratio of the total to the exterior houses built on a square area,

if » express the number on a side, will always be ee), and the
proportion of the exterior houses will diminish rapidly as 2 increase
in all other polygonal forms as well as squares. That this disadvantage
and that of density can be counterbalanced is seen by the fact that
while the population of English towns has increased the mortality
has fallen in the largest, below the standard fixed by Dr. Price for
moderate towns.

It is proved beyond doubt that, if the population be the same in
other respects, an increase of density implies an increase of mortality ;
and that the ratio of increase in the mortality is as certain roots of the
density. If a further and more extended inquiry, into which I have
not time now to enter, should confirm the principle that the mortality
in towns* is as the 6th roots of the density of the population, it will be
time enough to ask why this should be the particular ratio. But the
chemists must first discover means of determining the density of the
atmosphere of organic matter, which may be called the zymotic atmos-
phere, in different districts. The density of population is no strict
measure of the density of the zymotic atmosphere; nor, admitting that
the matter is a poison, does the relative density of the population
express the relative quantities inhaled in a given time; if it did, it is
improbable, and contrary to all analogy, that the mortality should
increase in the simple ratio of the dose. The exact effect of increasing
doses of poison has not been accurately determined; but it is well
known that small quantities of all poisons are taken with impunity, and
that the dose of arsenic, opium, or prussic acid may be increased up to
a given point, at which the disease produced is severe or fatal. Four
drops of prussic acid, diluted, may be taken with safety, when four
drops more would kill a certain number of persons. How large, or,
rather, how small, the dose of matter may be which will produce a
zymotic disease it is impossible to say; but if a minute diluted charge
of vaccinine (vaccine lymph) produced cow-pox, say one time in 100,
it would be an interesting problem to determine, by doubling the
quantity, in what ratio the proportions infected increased. (5th Annual
Report, pp. 411-24.)

The density of the population in the town districts was such in 1851
that 384 persons lived on a hundred acres, while in the country districts
28 lived on the same ground ; so that 14 were living in the same space
in towns as was occupied by one in the country. It was shown in the
Sixteenth Report that under our present imperfect sanitary regimen the

 

* I say “towns,” because the application of the formula must have a limit.
166 [PART Iv.

nortality of the population increases in proportion as the population
nereases in density ; and there must consequently be some relation
retween these elements.

The matter of which living beings consist is undergoing perpetual
thanges; it advances from the stages of water, air, salts, earth, and
‘ompounds of the other elements, into the vegetable and animal
ganizations of nature, where it exhibits all the phenomena of life. In
his highest state every heat of the heart, every movement of the limbs,
‘very sensation along the nerves, every emotion of the soul, every effort
f the intellect, discharges a certain number of atoms from their places
o escape in the breath and the secretions; at length the whole body
lies; and as its elements ascended through various degrees to the
uighest life, so they descend gradually after death through various
ransformations to simpler states. In several of these stages the
lecaying matter has, in the air, in the water, and in contact with the
kin, the power to harm the living; it has a tendency to impress its
‘wn action on their organs; and under certain circumstances the foul
natter is the breath of the noisome pestilence. In the air it is poison ;
inder the earth from which it came, it goes through its final stage of
lisintegration, and rises, by the quickening force ot seeds, again life-
tiving into the light.

In conformity with a law of nature the organic refuse in the atmo-
phere is converted by oxygen in a peculiar state into carbonic acid, or it
ssumes the form of volatile ammonia and of other compounds, which
re dispersed; the velocity of the conversion and of the dispersion
earing a certain proportion to the quantity of such matter, the agitation
f the air, and the temperature. The refuse in water is subject to
imilar changes under similar conditions.

Men then are always surrounded, in air and water, by an atmosphere
f decaying matter, which is given off from their own bodies and from
he animals by which they are surrounded; the quantity is in the same
onditions proportional to their numbers ; but the quantity of this matter
2 a noxious state is reduced to insignificance when a small number of
yen live ona large area, when their dwellings are on high ground,
nd when all the refuse is laid every day as it is produced under the
isinfecting earth from which it sprang. (19th Annual Report,
ip. XXV-Yi.)

Diseases of Town and Country.—Different classes of the population
xperience very different rates of mortality, and suffer different kinds of
iseases. The principal causes of these differences, besides the sex, age,
nd hereditary organization, must be sought in three sources—exercise
a the ordinary occupations of life—the adequate or inadequate supply
f warmth and of tood—and the differennt degrees of exposure to
oisonous effluvia and to destructive agencies.

The concentration of the population in cities doubles the deaths
rom zymotic diseases and diseases of the nervous system; the ratio
f deaths having been as 1 to 2°11, and 1 to 2°13; and upon reference
) individual diseases, it will be observed that the augmentation in the
vtter class occurs principally in convulsions and hydrocephalus :—
deaths by convulsions, counties 1,347, cities 3,723, ratio 1 : 2°76; by
ydrocephalus, counties 559, cities 1,540, ratio 1 : 2°75. It has already
een intimated that convulsion is a frequent intercurrent symptom in
iarrhoea and diseases of the epidemic class in infants; it may exist,
owever, as an independent affection, and in that case has clearly, as
rell as hydrocephalus, with which it is allied, an epidemic character.
. similar remark will apply to pneumonia and bronchitis, of which
DEATHS. | 167

1,209 cases were registered in the counties, 2,865 in the cities; ratio
1: 2-37. The pulmonary inflammation was, in many cases, developed
in the course of measles, influenza, and other discases of the first class.
The three following diseases, which principally affect adults between
the ages of 15 and 65, show that unhealthy places augment the fatality

 

of diseases in different degrees. Increase per
Counties. Cities. cent. in Cities.

Deaths by consumption  - 5,857 8,125 39

” childbirth = 217 372 71

” typhus” - 1,564 3,456 221

This gives the classification a peculiar property. Wherever the
absolute mortality is low, the number of deaths in the epidemic class is
less than the number in the pulmonary class ; and, on the contrary,
wherever the deaths in the first class exceed or equal those in the third,
it may be affirmed that the absolute mortality is high. ;

The occupations in cities are not more laborious than agriculture, and
the great mass of the town population have constant exercise and
employment; their wages are higher, their dwellings as good, their
clothing as warm, and their fcod certainly as substantial as that of the
agricultural labourer. The Poor Law. Inquiry,.and successive Parlia-
mentary Committees, Wave shown that the families of agricultural
labourers subsist upon 4 minimum of animal food, and an inadequate
supply-ot “bread “and ‘potatoes.- -The source of the higher mortality in
Cities is, therefore, in the insalubrity of the atmosphere, Every human
being expires about 666 cubic feet of gas daily, which if collected ina
receiver, would destroy other animals; and is constantly producing, in
a variety of ways, the decomposition of animal and vegetable matter,
yielding poisonous emanations in houses, workshops, dirty streets, and
bad sewers. The smoke of fires, and the products of combustion are
also poisonous. All gases and effluvia, like odours, are diffusible ;
they have a certain force of diffusion, which Professor Graham has
expressed numerically ; and all the emanations from human habitations
in the open country mingle, almost as soon as they escape, in the
currents of the atmosphere. But locate, instead of one individual toa
square mile of land (the supposed density of population in the uncul-
tivated forests of America and the steppes of Asia), 200,000 individuals
upon a square mile, as soldiers in a camp, and the poison will be con-
centrated 200,000 fold; intersect the space in every direction by 10,000
high walls, which overhang the narrow street, shut out the sunlight,
and intercept the movements of the atmosphere; let the rejected
vegetables, the offal of slaughtered animals, the filth produced in every
way decay in the houses and courts, or stagnate in the wet streets ;
bury the dead in the midst of the living; and the atmosphere will be
an active poison, which will destroy, as it did in London formerly, and
as it does in Constantinople now, 5°7 per cent. of the inhabitants
annually, and generate, when the temperature is high, recurring plagues,
in which a fourth part of the entire population will perish. But the
health will be a little more impaired by residence upon 1 than upon 100
square miles, if means can be devised for supplying the 200,000
individuals with 200,000,000 cubic feet of pure air daily, and for
removing the principal sources of poisonous exhalations. The latter
object is partly accomplished by paved, even streets, by the scavenger,
by an abundant supply of water, by large well-constructed trapped
sewers, and by domestie habits of cleanliness; but it is difficult to
perceive how volatile impurities can be removed, and how a stream of
uncontaminated air can be supplied where the sun cannot heat the earth
and air, where there are no open squares, or the streets are narrow, or
168 [PART Iv.

the houses are only separated by courts, or built in cud de sac. It will
be found, ceteris paribus, that the mortality increases as the density of
the population increases; and where the density and the affluence are
the same, that the rate of mortality depends upon the efficiency of the
ventilation, and of the means which are employed for the removal of
impurities. The next step in the argument is to establish these two
facts ; which will be done by showing that in 32 districts of one large
city the mortality increases with the intensity, and falls with the dimi-
nution of the causes, to which the excessive mortality has just been
ascribed. The necessary deduction from the series of facts, then, is
that the mortality has a tendency to increase as the density of the
population increases, but that the unhealthful tendency can be counter-
acted by artificial agencies. In other terms, the mortality of cities in
England and Wales is high, but it may be immeasurably reduced. A
good, general system of sewers; the intersection of the dense, crowded
listricts of the metropolis by a few spacious streets; and a park in the
East end of London would probably diminish the annual deaths by
several thousands, prevent many years of sickness, and add several
years to the lives of the entire population. Similar improvements
ould have the same effects in the other cities of the empire. The
roorer classes would be benefited by these measures, and the poor-rates
vould be reduced; but all classes of the community are directly
nterested in their adoption, for the epidemics, whether influenza, typhus,
yw cholera,—small-pox, scarlatina, or measles, which arise in the east
ond of the town, do not stay there; they travel to the west end, and
orove fatal in wide streets and squares. The registers show this; they
race diseases from unhealthy to healthy quarters, and follow them
rom the centres of cities to the surrounding villages and remote
lwellings. (1st Annual Report, pp. 108-16.)

In 1831 the city population enumerated was 3,079,292, the country
yopulation 3,255,479; with the corrections which have been suggested,
is the population increases faster in cities than in the country, the
yopulation in 1838 would be about 3,726,221 in the city districts, and
tbout 3,539,908 in the counties. The city was probably to the rural
sopulation as 1°053 to 1-000; and to this extent (5 per cent.) the deaths
n the counties should be augmented, to render the mortality strictly
‘omparable.

JEATHS by Twelve Classes of Fatal Diseases, in City and in Rural Districts.

 

 

 

 

—- City Districts.) Rural Districts.
Estimated population, June 30, 1838 - 3,726,221 3,539,908
1. Epidemic, Endemic, and Contagious Diseases - 23,655 13,685
2.. |, (Of the Nervous System . 15,651 8,177
8. % | Of the Respiratory Organs 28,973 18,508
4. § | Of the Organs of Circulation 1,301 712
5. & | Of the Digestive Organs 6,505 3,361
6. "5 * Of the Urinary Organs - 417 373
7. 7 | Of the Organs of Generation - - 984 547
8. & | Of the Organs of Locomotion 653 354
9. = | Of the Integumentary System 144 66
10. Of Uncertain Seat - - 10,447 10,529
ll. Age - - 7,374 8,874
12. Violent Deaths - 3,104 2,516
Causes not Specified - 1,811 2,708
Total Deaths 101,019 70,410

 

 

 

 

 
DEATHS. | 169

Besides the 70,410 persons who died equally in the dense and in the
more scattered populations, there was an exces in the cities of 30,609
deaths; 9,970 from diseases of the epidemic class, 7,474 from diseases
of the nervous system, 10,465 from diseases of the respiratory organs,
and 3,144 from diseases of the digestive organs. The annual rate of
mortality in the cities was 27, in the counties 2°0 per cent. ; and the
mortality in the cities 1°36 to 1°00 in the counties. The mean
duration of life in the two sets of circumstances would differ nearly in
the ratio of 37 years and 50 years.

In examining the special causes of death, three classes may be
distinguished ; one class which was exaggerated in cities to the highest
pitch, a third class in which the mortality was nearly the same or in
excess in the counties, and an intermediate class. To 1:00 death in
the counties the deaths out of the same amount of population in the
cities were by asthma, 3°80;* erysipelas, 2°71; convulsions and
teething, 2°57; cephalitis and hydrocephalus, 2°41; hydrophobia,
2-37; pneumonia, bronchitis, and pleurisy, 1°99; delirium tremens,
1°98; typhus, 1°88; small-pox, 1°73; heart disease, 1°73; child-
birth, 1:68; syphilis, 1°59; rheumatism, 1°58; gout, 1:55; hernia,
1°48; purpura, 1:46; sudden deaths, 145; liver disease, 1°45;
hepatitis, 1°35 ; tetanus, 1°32. The excess of mortality in cities_was.
less in_the following. cases: ..by..consumption 1:24; croup, 1°23;
violent deaths, 1° 17; stone, 1°11; mortification, 1°10; Geleeiatons
1:07; apoplexy, 1°07; hemorrhage, 1°02. The mortality by the
third class of causes was greater in the counties than in the cities: for
the mortality to 1:00 in the counties was in the cities, by paralysis,
+99; dropsy, ‘99; jaundice, °99; diabetes, -97; cancer, ‘92; hydro-
thorax, ‘88 ; hematemesis, *79; debility (frequently premature birth),
-75; atrophy, °75; scrofula, °46. It will be useful to compare all
the other diseases, but, in doing so, it must be borne in mind that
the diseases in the epidemic class fluctuate from year to year; that
when the number of cases is considerable the relative mortality is most
correctly expressed, and that slight differences deserve little attention.

The fatality of scrofula, purpura, cancer, stone, jaundice, diabetes,—
chronic diseases—in which there are new deposits, new formations, or
new secretions, is as great in the country as in cities; dropsy comes
under the same head. Their exciting causes are common to the two
classes of population.

It has been proved that the same injuries and diseases are more
deadly in cities than in the country ; which may account for the higher
mortality from violent death, hernia, and some other causes. Partu-
rition is as frequent in the country as in town; where it is nevertheless
so often followed by puerperal fever as to be 63 per cent. more fatal.

If the mortality in the counties has been taken for unity, and all

-above it has been termed excess, it must not be understood to imply
that less than 70,410 deaths may not be expected to occur out of a
population of 3,539,908. The population of the counties, which have
been held to represent the country, included the inhabitants of several
cities. The mines of Cornwall caused many deaths ; and anyone who
has visited the ill-ventilated dwellings of the poor, and is acquainted
with their limited command of clothing, firing, and substantial food in
agricultural districts, cannot come to that conclusion. The minimum
degree of sickness which a well-educated, affluent people would

 

* The 2629 deaths in the cities from asthma were to 658 as 4°00 to 1:00; but
the population in the two cases was as 1‘053 to 1:'000; divide, therefore, 4:00
by 1:053, to obtain the true relative mortality. It was, as is stated in the text,
3°80 to 1°00.
170 [PART IV.

experience, and the years which they would number in the circumstances
most favourable to health, are unknown; for the majority of the rich
and middle classes whose lives have been observed, live principally in
ill-constructed cities, and are exposed to the epidemics generated
among their unhappier neighbours. It will be prudent, therefore, not to
speculate upon astate of things of which the registers afford no examples,
as it may sound paradoxical to fix more than fifty-five years for the
average duration of human life; and it would not be practicable to
suggest any means for improving by immediate measures the health of
agricultural districts more effectual than the improvement of the cities
in their centres, from which so many diseases radiate.

Is the excessive mortality of cities inevitable? It has not long been
established to the public satisfaction that the mortality in dense popu-
lations is excessive. The simple process of comparing the deaths in a
given time out of a given number living is « modern discovery; and
as some individuals died at all ages in the healthiest, or attained the
highest ages in the unhealthiest classes, and epidemics desolated the
country as well as towns, though to less extent, the unaided reason was
bafiled in its attempts to unravel the intricate facts, and to draw con-
clusions which could justify, or stimulate public interference. If the
law of nature had been, that all the inhabitants of an unhealthy place
attained the age of 40 years, and of a healthy place the age of 50
years, and then invariably died, the difference would have been per-
ceived in two or three generations: but the law of nature was different ;
in both cases infants died at the breast, men perished in the prime of
life, and old men grew gray with age; the proportions only varied,
and the difference was in the average duration of life, which varied
from 20 to 50 years, and yet remained undetermined. It was probably
not generally known before the publication of the first Report, that
the mean duration of life was from 25 to 30 years in the east districts,
and from 40 to 50 years in the north and west districts of the
metropolis ; it is not therefore surprising, that the relative mortality of
remote districts remained so long undiscovered.

The first writers who established satisfactorily the high mortality of
cities took a gloomy and perhaps a fanatical view of the question. Cities
were declared vortices of vice, misery, disease, and death; they were
proclaimed “the graves of mankind.” ‘The population of the country,
it was said, was drawn to them to be sacrificed ; and those who entered
left all hope behind, for no prospect of health in cities was beheld.
Happily the further application of the methods which those eminent
writers employed, and the facts which the registers furnish, enable us
to analyze the causes of death in cities; and to show that while the
mortality is increased as much as they stated, the apprehensions into
which they were betrayed were ill-founded when applied to the future.
There is reason to believe that the aggregation of mankind in towns is
not inevitably disastrous. Health and life may be preserved in a dense
population, provided the density be not carried beyond certain limits.
Of this the nature of the causes to which the mortality is due, as well
as the rapid improvement in the health of London within the last two
centuries, is presumptive proof; and the favourable condition of several
districts of the metropolis leaves little room for doubt on the subject.
The city population of England is greater than that of any other country
of Europe, and it increases more rapidly than the population of the
rural districts. In this there is nothing to regret; for if the general
progress of civilization compensated the loss of life in the cities of the
ancient world and of the middle ages, the advantages of cities are not
less evident in the present time. (2nd Annual Report, pp. 80-98.)
DEATHS. | 171

The general principles connected with this subject have been dis-
cussed in the Appendices to former Reports; and the circumstances
were pointed out, which, it is believed, increase the mortality in towns,
cities, and dense populations of every kind. The number of deaths by
different causes in the metropolis, and 24 of the principal town or city
districts, are now contrasted with the deaths from the same causes in
counties containing a less dense population, chiefly engaged in agri-
culture. The following table shows the annual mortality of 1,000,000
living, and the relative excess in the town districts. The way in which
the population, in the middle of the two years (January 1, 1839), was
estimated, has been already explained. The population enumerated in
1831 was assumed to have increased at the same rate as in the 10 years
1821-31.

 

Area in Estimated Deaths Inhabitants | Annual
— Square Population, | Registered to One Mortality
iles. Jan. 1, 1839. |in Two Years. | Square Mile.| per Cent.

 

Country Districts - 17,254 3,559,323 129,628 206 1°821
Town Districts - - 747 3,769,002 197,474 5,045 2°620

 

 

 

 

 

 

 

 

The density of the country districts was to that of the towns as 10 to
245, the mortality as 100 to 144. The mean duration of life in the two
classes of districts differs nearly 17 years; it is in the proportion of 55
years (country) to 38 years (towns). The difference is greater than
was given in the calculation founded on the facts observed in 1838,
when the deaths in Bristol, Clifton, and Norwich were (by error) not
subtracted from the deaths in the counties of Gloucestershire and
Norfolk. The mortality in the town districts, however, declined in
1889 more than the mortality in the country districts. As the popu-
lation increases faster in the town thau in the country districts, the
difference in the mortality was greater than it is represented to be by
these numbers.

The diseases chiefly incidental to childhood are twice as fatal in the
town districts as they are in the country.

The deaths by several diseases of old age were almost equally
numerous in the towns and the couutry. Asthma is, however, an
exception.

It must be borne in mind that the number of children and old people
living in the towns is less than in the country districts; while the
number of persons in the middle of life is proportionally greater in the
towns than in the country.

The following diseases, occurring generally between the ages of 15
and 60, were from 25 to 50 per.cent. more fatal in the town than in the
country districts.

 

 

 

Deaths Registered Deaths to 1,000,000
in the Living in the
— Excess,
Country Town
Districts. | Districts. Country. Towns.
Typhus_ - - 6,462 10,852 941 1,461 55 per cent.
Consumption - = - | 24094 32,436 3,508 ése7 | oa
rH ena and Diseases of} pena daa eee
waiver - - . 1,085 1,623 158 219
Diseases of Childbearing - 909 1,560 182 210 a ‘
Rheumatism B24 531 47 val 52 2
Paramenia - : 19 35 3 5 70 ay

 

 

 

 

 

 

 

 
172 [PART Iv.

The tendency to consumption was increased 24 per cent., to typhus
55 per cent., in the town districts; but as the absolute mortality from
consumption is three times as great as from typhus in towns, and nearly
four times (3°73) as great in the country, the excess of deaths by
consumption, caused by the insalubrity of towns, is greater than the
excess of deaths by typhus—a fact which has hitherto been overlooked.
Thus, 24,094 deaths from consumption occurred in the country, 32,436
in the town districts; the excess amounted to 8,342 deaths; 6,402
deaths from typhus occurred in the country, 10,852 in the town districts ;
the excess amounted to 4,450 deaths. The difference is more correctly
exhibited by a comparison of the mortality from the two diseases.

The facts show the propriety of the ordinary medical advice to place
persons of a consumptive habit in a pure atmosphere; but they militate
against sending them to reside in the continental towns, in many of
which the mortality is as high as it is in Bethnal Green and White-
chapel. Paramenia (mismenstruation), though rarely fatal, is a very
common disease, and one which greatly embarrasses the medical prac-
titioner. The facts in the table point out the utility of the country
watering-places to patients afflicted with the complaint in cities. The
excess of deaths by childbirth in the town districts is striking. Out of
nearly the same number of deliveries, 909 mothers died in the country,
1,560 in the town districts.

The causes of the excessive mortality of towns are well known; and
it cannot be too frequently repeated, that they admit of removal to a
great extent.

_* The mortality increases, ceteris paribus, as the density of the effluvial

poison generated in cities, and not strictly as the density of the popula-
tion. The indigence of the inhabitants, or an insufficiency of proper
food—even when not carried to the extent of starvation or famine—has
also a decided effect on the production of effluvial poisons, as well as on
the tendency to diseases of every kind. Hence the mortality is not
always greatest in the densest parts of cities.

This principle explains the facts that, although the mortality is in-
creased 44 per cent. by the present condition of the towns in England,—
where the proportion of town population is greater than in any other
country in Europe, except Belgium,—the mortality of the nation has.
been much below the average during the whole of the present century ;
and, up to the present day, the expectation of life remains higher in
England than in the rest of Europe. The industry and intelligence that
have created flourishing towns have ameliorated, though not so rapidly
as they might have done, the sanitary condition of the people. (8rd
Annual Report, 98-101.)

Relation between Density of Population and Death-rate—It is welt
established that the mortality of the populations of cities is generally
higher than the mortality of people in the country. And it has been
shown in the annual Reports that there is a constant relation between
the density of the population and the mortality. This has been further
tested by arranging all the districts in the order of their mortality during
the ten years, and then determining the density of their population.
A Table presents a summary view of the results.

The general mortality of the 631 districts ranged from a rate of 14 to
33 deaths in 1,000 living. If the facts are arranged in five great groups,.
the following result is obtained :—

1. Where the mortality was 14, 15, or 16, the population was in the

proportion of 86 persoxrs to 1 square mile.

2. Where the mortality was 17, 18, or 19, the population was 172

persons to a square mile.
DEATHS. | 178

oo

. Where the mortality was 20, 21, or 22, the population was of the
density expressed by 255 to a square mile.
4, Where the mortality was at the rate of 23, 24, or 25, the population
was of the density expressed by 1,128 to a square mile.
And where the rate of mortality was 26 and upwards, the average
density was expressed by 8,399 persons to a square mile.

wr

Thus in these five groups there is a constant increase of mortality
running parallel with the increase of density.

Not only is that the case in great groups, but the same law reigns over
the two series of ratios—the ratio of deaths to the living and the ratio
of the living to the area of land on which they dwell—when the groups
are multiplied and the facts are subdivided so as to give rise to some
disturbance; which almost invariably admits of explanation. For it
happens when there is a discrepancy that the population is lodged on a
small portion of the area of a wide district, and in that case the density
of the part in which the people dwell is not accurately expressed by the
method here employed. When the groups are larger, the effects of these
perturbations are less visible, as the disturbing causes neutralize each
other to some extent.

The population of the denser districts differs in many respects from
that of the thinly peopled districts of the country; but there can be no
doubt that mere proximity of the dwellings of the people does not
necessarily involve a high rate of mortality. When any zymotic matter,
such as varioline, scarlatinine, or typhine finds its way into a village or
street, it is more likely to pass from house to house than it is where the
people are brought less frequently into contact. The exhalations into
the air are thicker. But if an adequate water supply, and sufficient
arrangements for drainage and cleansing are secured, as they can be by
combination in towns, the evils which now make dense districts so fatal
may be mitigated. Indeed, some of the dense districts of cities are in
the present day comparatively salubrious. (Supplement to the 25th
Annual Report, pp. xxxiii-v.)

Effects of Density of Population on Health.—-The term town implies
municipal government and industrial organisation. But it will be con-
venient to discard for the moment every other consideration except the
density of the population. This is shown by dividing the population by
the square miles of area on which they are living, ‘his has been done;
and there is found to be a general relation between the mortality and
the density of the population. Thus, in the healthy districts, during
1861-70, there were 166 persons to a square mile; in all England, 367;
in Liverpool, 65,823, And this implies that the mean proximity of
person to person in the three groups was 147, 99, and 7 yards; the
proximity being as the square root of the density.*

The density of population as usually calculated assumes that the
numbers are distributed evenly over the area; but this is scarcely ever
the case; for the English towns and districts include open spaces unbuilt
on, which conduce to the free aeration of the place, but in very different
degrees. In some districts the greater part of the population is crowded
on a portion, while the rest is thinly scattered over the remainder of
their area. Thus the density of the population of London is expressed
by 25,671 persons to a square mile; but the density of the Central

 

1

Be sip oh SS 2 1760 i
* p=proximity in yards == x Lise (where D = population to a square mile.)

opt
See extract on pp. 35-36.
174 [PART lv.

districts is 107,729; of Westminster 153,976. In one sub-district of
Westminster, Berwick Street, the density is 278,587, while in Hamp-
stead it is 7,315. The proximity in London is 11°8 yards; and of the
densest sub-district of London (Berwick Street) 3°6 yards. The
Moecchester district besides the dense parts contains much open country.
Upon the other hand, Liverpool, Birmingham, and Bristol districts
comprise the densest parts of the towns of those names; the towns being
more extensive. The local divisions of the kingdom have grown up;
they are multiplied unnecessarily ; they are so conflicting and the names
are so confusing that it is difficult to use them without creating mis-
apprehension, "We may hope to see a remedy some day applied to this
state of things. In the meantime the readers of the Registrar General’s
Reports will bear in mind, that districts conterminous with unions are
referred to unless the contrary is stated.

In the years 1861-70 the population of an average district was 34,555 ;
the annual births 1,212; the deaths 775; the excess of births 437.

To investigate more exactly the relation between density of population
and the mortality, which we know increases in some proportion to
density, the districts have been grouped in the order of the mortality at
all ages. The groups are eighteen ; commencing with a mortality at 15,
and ascending to 39.

The area, population, births, deaths, and mortality of each group have
been determined ; and are shown in the Tables. The irregularities that
are encountered in dealing with single districts are in part effaced ; and
the general result is that in all the large groups the density and the
mortality follow the same order.

In the Appendix to the Fifth Report I endeavoured to show that
within certain limits there was a definite relation between density of
population and mortality. And it was found that the mortality of
districts did not increase as their density, but as the 6th root of their
density. Thus the female mortality of St. James Westminster district
was ‘02145; its density was 145,059 persons to a square mile; the
density of St. George Hanover-square being 39,018. What was the
mortality ? By calculation from the density it should have been +017 2,
and it was ‘0171.* The same relation existed between the mortality
and the density of population in other districts of London.

A larger basis is now supplied by the facts of 10 years recorded in all
the districts of England and Wales. They have been arranged in the
Tables ; and with this result, that in every group the mortality increases
with the density, but happily not in the direct proportion of the density,
London has been excluded in the following calculations. Thus in the
345 districts with a mortality of 19°2 the density was 186 persons
to a square mile; in the 9 districts with a density of 4,499 what was
the mortality ? In the first place it was not expressed by the proportion
186 ; 4,499 :: 19°2: a but by this proportion nearly—

(186)"" ; (4499) :: 19-2: 4 = 28-1

The accompanying Table shows a comparison between the actual and
the calculated mortality.

 

* See Registrar General’s Fifth Report, Appendix, pp. 420-424, The constitution
of the above two districts has since been changed. See Extracts on pp. 161-5.
DEATHS. | 175

AwnvaL Rate of Morrarity per 1,000, in Seven Groups of Districts
of England and Wales (exclusive of London), and the Mortality
deduced from the Densities of Population in those Groups.

 

 

 

 

DENSITY—
| Number Number of ee Persons |Proxrurry| OBSERVED CaL-
of Districts toa Mor- uerey
: Mor- Square | in Yards Mor-
Group. in each Group.}| TALITY. : ‘Mile " | TALITY. TALITY.
Columns - 1. De 3. 4 5. 6.
ENGLAND &
WALES (ex- 693 15-39 315 107 22°00 20°41
clusive _ of
Lonpon) -
I, 53 15-17 166 147 16°75 18°90
II. 345 18-20 186 1389 19°16 19°16
Ill, 187 21-23 379 97 21°88 20°87
IV. 47 24-26 1,718 46 24°90 25°02
Vv. 9 27-30 4,499 28 28°08 28°08
VI ee) 82 12,357 7 32°49 87°70
: ee ¥
jiverpoo ‘ .
VII. District ; 39 65,823 7 38°62, 88°74

 

 

 

 

 

 

 

 

 

FormuLa.—m being the mortality in any group and m’ being the
higher mortality at any other group, D and D’ being the density of
population in the two groups, then

SA (5) =" 5)
D D

The mortality of districts is nearly as the 12th root of their densities.
The starting point being 19°16, the calculated rates (see col. 6) in
the other groups are deduced by the formula from the densities as given
in column 3; or taking the above value of , and p and p’ as the mean

2n.
proximity of person to person, we have m’ = m ( 5) So the mortality
of districts is nearly as the 6th root of the proximities.

The table may be read thus :—In 47 districts having a density of
1,718 persons to a square mile, a proximity of 46 yards, the annual
mortality (1861-70) ranged from 24 to 26—the exact mortality was
24:90—per 1,000. The mortality calculated from that of the 345
districts having a mortality of 19°16, a density of 186 persons toa
square mile, was 25°02, thus differing from the actual mortality by
only 0°12,

It will be noticed that there is not much difference in the density
of groups I. and II., and yet the mortality in group I. is much lower
than the mortality in group II. It may therefore be inferred that there
are many more small towns in group II. than in group I., and in those
small towns the effects of a higher density are felt, whereas in group I.
the population is more evenly distributed over the area. Were the
population aggregated to the same extent as it is in group IL, it is
probable that the mortality would approximate to 18°90.
176 [PART Iv.

The districts being grouped in the order of the mortality the density
of population is always found to increase with the mortality, but more
rapidly. The greater the proximity of man to man the greater is the
mortality. ‘To show how far the effect of the causes of mortality varies
in dense and open districts at different ages in the two sexes the following
Tables have been framed. The 593 districts are arranged in seven
groups ; under which the mortality of males and females is given at 12
ages. Only the London districts have been excluded, and that on
account of the difficulty of distributing the deaths at different ages in
hospitals over the districts to which they properly belong.

The mortality per 1,000 wnder the age of five years is in the seven
groups —

No. of group II UW. iv. v. Vi. VII.

For females 34 44 58 76 89 106 1384
5, males - - 41 51 68 88 101 118 145
Excessive mortality of males - 7 7 10 12 12 12 #11
Mean of malesand females - 388 48 63 82 95 112 140

It will be noticed that the groups are numbered in the order of their density,
No. L. being the least dense and No. VII. the most dense.

After examining the mortality at the various ages in the seven groups
of different densities, this general law may be deduced irom the facts.
As the mortality of males and females increases at all ages with the
density of population, so it increases at every group of ages, but in very
different proportions ; most in early childhood (0-5); least at the two
quinquennial ages 15-20 and 20-25, when immigrants enter towns;
another maximum being attained at the ages 45-65, immediately after
reproduction ceases. At the ages of 65 and upwards the effect of
density in increasing the mortality diminishes. The effect is not con-
siderable at any age after 35 in the 345 districts (group IT.), having a
density of 186 persons to a square mile; there the chief effect is
produced in childhood.

In the 137 districts, having a density of 879, the effect of density after
the age of 15 remains nearly uniform, and increases the mortality by
about one-fifth part.

In the 47 districts, having a density of 1,718, the mortality is doubled
in childhood ; and is raised by about a half at the ages 45-65.

London, though with a density of 25,671 persons to a square mile,
follows for childhood the same law as the 47 districts; the mortality
is doubled ; then at the ages 45-65 it is still higher than in the
47 districts, for the mortality being increased by nearly three-fourths
approaches the mortality of the 9 districts. But London presents this
exceptional fact; the mortality at the ages 15-20 and 20-28 is below the
mortality in the healthiest districts. The cause of this will be discussed
hereafter.
DEATHS. | 177

Incrrasz of Mortatiry at each of Twelve Age-Periods in Seven
Groups of Districts experiencing different Rates of Mortality at all
Ages.

 

Annual Rates o:

 

 

 

 

 

f)
Mortality per | Range 18-20 | 21-23 24-—26 27—30
1,000 Persons 24 . ia 82 39
living at all | Mean - 19 22 25 28°5
Ages, 1861-70 -

4 Number of Districts Man- |7; ol
at the above rates} 345 187. | London. 47 9 chester pavennoe)
of Mortality - - District.

INCREASE per cent, ON THE RATES OF THE FIFTY-THREE HEALTHY DISTRICTS.
ALL AGES >| 13°2 29°3 44°3 46°5 65°4 94°3 128°3
Under 5 - - | 25°7 66°8 115°9 117'°2 151°4 | 196°0 269°1
5- 7 = -} 10°1 39°9 65°0 66°1 89°3 131°3 186°4
10- : -| 11°0 30°7 14°9 40°9 40°3 69°9 W711
15- : - 7 84 23°4 27 27°3 42°1 49°7 51°9
20- - > 9°2 18°5 —4°5 15°6 23°9 40°2 66°7
25- - - -| 85 20°71 17°9 20°3 41°2 66°4 124°7
35- - - 3°7 20°6 50°7 32°3 61°5 113°7 172°2
45- - - 3°9 23°1 74°0 46°1 84°3 149°3 217°9
4 55- - : 4°8 25°4 71°0 53°7 77°0 14h 184°4
65- - - 21 18°0 42°7 38°1 54°8 93°0 104°2
75- - : 17 9°5 22°3 24°1 32°1 48°3 38°6
85 and upwards - 9°8 11°8 10°6 16°1 15°6 22°9 =r

 

 

 

 

 

 

 

 

 

 

This Table of the increase of mortality may be read thus:—In 345 Districts having a
mortality at all ages of 78—20 per 7,000, the mortality at the ages under Jive_years shows an
excess of 25°7 per cent. on the rate at that group of ages in the 53 Healthy Districts ; in'187

istricts having a mortality at all ages of 21—23 it is 66°8 per cent. in excess;......in Liverpool
it is 269°1 per cent. in excess, or out of the same numbers of Children living, the deaths are
between three and four times as many in Liverpool as they are in the Healthy Districts.

The accompanying Table shows, in a comparative view, how differently
the various causes of mortality operate at different ages in the eight
groups of districts. This is mainly due to the varying powers of
resistance.

The exposure of children, of men and women in the prime of life, and
of old people to causes of death, varies in different circumstances ; but
it is evident, after every allowance has been made, that the power of
resisting the noxious influences at work in the thickest peopled districts
is yreatest at puberty, least in childhood and in manhood.

The following Table shows this more clearly; for it shows at each
age out of what numbers living there are 100 deaths in the healthy
districts; and then in other columns how many die in the seven other
groups of districts out of the same numbers living. Thus to 10,050
persons living of the age of 35-45 only 100 die annually in the healthy
districts ; and 104, 121, 132, 162, 214, and 272 in six other groups of
districts. In London the deaths out of the same numbers are 151.

M
178 [PART Iv.

Rexative Morrariry, 1861-70, at each of Twelve Age-Periods in
Eight Groups of Districts, the Deaths at each Age in the 53
Healthy Districts being represented by 100.

 

 

 

 

 

 

 

Annual Rate of Mor- 5
tality per L000 .$| 15-17 | 18-20 | 21-23 | 24 | 24-26 | 27-30 | 32 | 39
Persons to one sq. mile 166 186 379 25,671 1,718 4,499 | 12,357 | 65,823
DEATHS, OUT OF NUMBER OF PERSONS as given in Column 2,
Persons
Aazs. Inss | In | In to | te | gp
living. | Healthy} 345 137 In 47 9 Ghiestor ool
Dis- Dis- Dis- |London.| Dis- Dis- Dis- igs
tricts. | tricts. | tricts. tricts. | tricts. trict. | trict.
ALL AGES - 5,903 100 118 129 144 146 165 194 228
0- 2,646 100 126 167 216 217 251 296 369
5- 18,116 100 110 140 165 166 189 231 286
10- 27,624 100 111 181 115 141 140 170 177
1b- 17,825 100 108 123 97 127 142 150 152
20- 13,210 100 109 118 95 116 124 140 167
25- 11,990 100 109 120 118 120 141 166 225
35- 10,050 100 104 121 151 132 162 214 272
45- 7,874 100 104 123 174 146 184 249 318
55- 4,425 100 105 125 171 154 177 244 284
65- 1,902 100 102 118 143 138 155 193 204
75- 100 102 110 122 124 182 148 139
85 & upwards 361 100 110 112 111 116 116 123 99
Columns - 1 2 3 4 5 6 7 8 9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Table may be read thus :—Out of 2,646 Children living under five years of age, 100 die
annually in the Healthy Districts; 126 in 345 Districts having rates of mortality of 18 to 20;
«...«296 in Manchester District ; and 369 in Liverpool District.

Female children with a lower absolute mortality than males under
five years of age suffer relatively in every group more than males in the
denser districts. At 5-10 the mortality of males is but slightly in
excess and at all other ages the males are the greatest sufferers from the
unsanitary conditions. Their occupations come into play—(Supple-
ment to 35th Annual Report, pp. xxiii-v.)

Improvement of Health in Towns.—Although the time may be
distant when cities will be as healthful as rural districts, or the inferiority
which our English poet ascribed to “the town” as the handiwork of
man become much less apparent in point of salubrity than it is at present,
it cannot be questioned that large populations have even now advantages
of a nature favourable to health which villages do not possess. The
highest attainable health is probably to be sought in a happy combination
of both states—rus in urbe. The words of an excellent popular writer
may prove to be no dream, but a well-founded expectation; he believes
that we shall ultimately obtain “a complete interpenetration of city and
“ country, a complete fusion of their different modes of life, and a
“ combiration of the advantages of both, such as no country in the
“ world has ever seen.’* But it may be asked, whether it is for-
bidden by this last expression to accept as a perfect model even
Nebuchadnezzar’s Babylon, which the distinguished writer himself has
extolled. (23rd Annual Report, p. xxi.)

 

* Charles Kingsley’s Miscellanies : Great Cities.
DEATHS, | 179

8. Morvtaity aT DIFFERENT AGES.

Census Ages, and Ages in Death Registers.—With respect to the
subdivision of the first year, it must be observed that more than a fifth
of the whole number of deaths registered in the year ending June 80,
1838, namely, 71,888, out of 335,956, are under 1 year of age; that the
distinction of months at that early period will exhibit circumstances more
important with respect to the expectation of life, than that of years at
later periods ; and that the expectation of life on the day of birth differs
greatly from that at six, three or even one month old. It appeared to
me, therefore, that such distinctions ought not to be overlooked; and
that the abstract should be framed rather with reference to the as-
certained ratios of mortality than to an equal division of the periods of
age. After the first year, the ratio of mortality rapidly declines; and
this decrease is shewn by the enumeration of deaths for each of the four
following years. It may, perhaps, be thought that this subdivision
ought to have been rendered more minute, and that I have passed too
abruptly from the six-fold division of the first year to the exhibition of
whole years immediately afterwards. But I must state in reply to any
such objections that the Registers do not enable me to divide the years
after the expiration of the first. In cases of death under 1 year of age,
the number of months, and often of days, is stated with precision; but
where the age of the child has exceeded 12 months, “ One year” is often
the only entry in the column headed “Age,” leaving it doubtful to
what period between the end of the twelfth and of the twenty-fourth
month the death is to be referred. The same observation is still more
extensively applicable to deaths after the second year.

After the fifth year, I have combined the ages in quinquennial
periods, a system which, after much consideration, I deemed preferable
to that adopted in the abstracts for the first year of registration, namely,
of stating the number of deaths at each successive year of age.

To the statement of deaths at each successive year, it might be
objected that it was delusive, and assumed an appearance of minute:
accuracy which was not founded on truth. This objection is not
applicable to the reported ages of children. Their recent births are
fresh in the recollection of their parents or guardians, and their age is
stated with sufficient accuracy. But it is not so with respect to the ages
of persons far advanced in life; many of whom, especially among the
poorer classes, are ignorant of their exact age, and when they die, leave
no record which enables their surviving relatives to state their ages with
precision, An evidence of the vagueness attending statements of age is
“the tendency to speak in round numbers” noticed in the preface to the
Abstract of the Population for 1831, a tendency causing a great apparent
excess of mortality in the decennary periods at 30 and upwards, and of
which the following remarkable instances may be found in the Abstract
of Ages published in the preface to the Population Abstract for 1831,
extracted from burial registers in England and Wales for 18 years :—

 

 

Ages. Ages. Ages. Ages. Ages.

29 26,630 | 89 23,778 49 23,689 59 25,782 69 33,038
80 31,027 40 33,513 50 38,527 60 48,273 70 53,953.
31 22,301 41 20,989 51 20,911 61 26,084 71 32,162

 

Experience has shown that this incorrectness also exists in the state-
ments of ages in the registration of deaths, as will appear upon reference
to the abstracts for the year ending June 30, 1838. a

An abstract of deaths at every successive year of age is, therefore,
confessedly incorrect ; and, in stating this, I am stating a strong reason

M 2
180 [PART Iv.

against its continuance; for by exhibiting such an abstract, I should
commit a fault which I deem it most important to avoid,—that of
assuming the delusive appearance of more minute accuracy than actually
exists. By combining the deaths at different ages, after the fifth year, in
quinquennial divisions, not only are errors and irregularities materially
diminished, but the abstracts are rendered in a form more useful,
more conducive to the fulfilment of those practical objects for
which such abstracts are principally compiled. (2nd Annual Report,
pp- 12-13.)

Age Constitution of the Population—The deaths in the ten years
amounted to 55 hourly on an average, or to nine deaths every ten
minutes ;* but it is not so much with these deaths in themselves that
the inquiry is concerned as with the numbers living at every moment of
the decenniad. Upon the state of the twenty-one millions living the
mortality depends; out of them the minutely death flows. Now the
population increased ; and this increase, which is a continuation of the
process that has been going on for a century at variable rates, has
produced large alterations in the proportions of the 21,389,245 living at
different ages. This must be so. There were 7,636,233 births in the
ten years 1861-70, of which the children under the age of ten enumerated
at the beginning of 1871 were the survivors. But at the same Census
507,522 persons of the age of 70-80 existed; and they were the
survivors of the children born in the ten years 1791-1800, which, it is
pretty certain, did not exceed 2,988,439 in number. Had the children,
born then been as many as in 1861-70, the living at 70-80 would have
been raised in that proportion to 1,296,850. And so of other ages.
Now similar but not the same alterations in the proportions have taken
place in every district of the kingdom. How can this difficulty in
instituting just comparisons be obviated ?+

As the mortality—and the fatal diseases—vary with age it is evident
that the population and the deaths must be divided into a certain
number of corresponding groups in order to determine the mortality and
the fatal diseases of each group; we can then proceed to compare the
rates of mortality and of disease in the several districts of the country.
(Supplement to 35th Annual Report, p. xx.)

Mortality at groups of ages in England, Carlisle, Belgium, and
Sweden.—The deaths at different ages are so closely connected with
health and with the great apparent changes in the diseases of this country,
that we shall here present a comparative view of the rate of mortality
that prevailed in England, Carlisle, Belgium, and Sweden, from an
article in the British Medical Almanac for 1836.

Here it appears that the mortality of the whole English population,
between the ages of 20 and 40, was higher than in Belgium and Sweden,
while the mortality in early life was much lower; and if the Carlisle
observations ever approximately represented the mortality of England,
the waste of life in the five years of infancy has almost diminished one-
half during the last 100 years. Other observations support this
probability.

Contrary to the Swedish observations, the mortality of females between
the ages of 10 and 40, is higher than that of males: it is only in child-
hood, and after the 50th year, that the mortality of females is lower than
that of males. (McCulloch’s Account of the British Empire, article
Vital Statistics, Vol. 2, pp. 543-4.)

 

* The hourly births were 86 ; or 14 every ten minutes.
+ See a paper on “The Value of Death-rates; by Mr. Noel A, Humphreys.”
—Journal of Statistical Society, vol. xxxvii.
DEATHS. | 181

DeAtTH-RATES per 1,000 Persons living in Encranp, SWEDEN, and
Be.erum, at 13 Age-periods.

 

 

 

 

 

England and Wales. | Carlisle. | Belgium. Sweden.

Ages. 18 Years, 1813-30. 9 Years. sae 21 Years, | 20 Years,
1779-87. Persons 1755-75. | 1776-95.

Males. | Females. Persons. Persons. | Persons.

o— 53°5 46'0 82°3 65'8 90°1 85°0
5— 73 6°7 10°2 8°7 14°2 13°6
10— 5:0 O72 5:0 54 6°6 6°2
15— G2 7°6 6°8 6°6 7°6 7°0
20— 10°1 10°4 75 9°1 9°2 8°9
30— 11-4 12°4 10°6 10°0 12°2 11°6
40— 14°9 14°9 14°38 13°6 17°4 16°1
50 — 23°4 21°6 18°3 21°7 26°4 23°9
60-- 45°3 41°2 41°2 38°5 48°1 49°3
70— 101°2 90°9 83°0 90°9 102°3 104°1
80— 227-1 214°6 175°6 178°8 207°8 197°4
90— 370°1 371°9 284°4 304°7 894-1 351°3

Above 90 611°1 560°6 -— — _— —

All ages 21*7 20°7 25°0 o2°7 28°9 26°8

 

 

 

 

 

 

 

 

 

Mortality of Males and of Females at Groups of Ages, 1838-44.
—The following table is valuable as showing the rate of mortality of
each sex, at 17 groups of ages, during the first seven years of Civil
Registration in Hngland and Wales. The figures are especially useful
for comparison with the rates prevailing in more recent periods.

 

PopuLaTion 1841. Deavtis Annual
(Estimated to the ia Seven Years Rate of Mortality
Ages. Middle of the Year.) : per Cent.

 

Males. | Females. |; Males. | Females. || Males. | Females,

 

 

 

 

 

o— 210,841 | 218,851 301,378 | 236,261 20°510 | 15°440
j— 215,322 | 214,250 100,874 95,764 6°706 6°393
2— 218,035 219,006 53,785 53,449 3°531 3°490 [
3 203,492 | 206,368 || 35,826 | 35,802 || 2:520| 2-481
4— 201,080 | 200,263 26,034 25,634 1°853 1:831
0— 1,048,270 {1,058,738 || 517,897 | 446,910 || 7-072 | 6-037
5— 953,235 | 952,450 61,659 59,903 *926 *900
10— 880,907 | 852,517 31,028 32,662 *504 * 548
15— 1,507,944 |1,633,939 || 84,838 | 95,152 +805 °833
25— 1,178,181 {1,275,849 79,703 89,967 “968 1°009
35— 871,845 | 902,863 76,093 78,431 1°249 1°242
45-- 621,142 653,065 77,047 70,680 1°776 1°548
55— 398,937 | 433,202 87,539 84,275 3°141 2°782
65— 224,863 | 259,283 103,873 | 106,692 6°613 5° 885
75— 86,736 | 103,707 87,218 95,723 || 14°394 | 13°201
85— 12,635 17,906 26,167 34,497 || 29°646 | 27°553
95 and upwards - 579 1,091 1,727 3,112 || 42-697 | 40°795
Allages specified |7,785,224 |8,144,610 ||1,234,784 {1,198,004 — =
Not specified — — 2,505 1,355 _ —_
All ages - 7,785,224 |8,144,610 {11,237,289 |1,199,359 2°270 2°104

 

 

 

 

 

 

 

 

 

Note.—The mortality was not disturbed by any great epidem‘cs in these years, and it believed
that they will serve well as the basis of Tables for use by Life Offices.

(20th Annual Report, p. 20+.)
182 [PART Iv.

Mortality of Males and Females at various Age-periods, 1838-62.—
We have from the three Censuses of 1841, 1851, and 1861, in which the
ages of the population were enumerated, the means of determining very
nearly the numbers living in each of the twenty-five years (1838-62)
during which the registration of deaths has been in operation.

The specification of the numbers living at each separate year of age is,
except as a matter of curiosity, utterly useless, for in the first place great
numbers of the people do not know their exact age within a year or two,
and in the second place the actual numbers at each year of age fluctuate
considerably from various causes, and an annual Census alone could
supply the true numbers living foreach year. By collecting together all
the numbers returned in each five years of age under fifteen, and in each
ten years after that age, groups of population are obtained at the Censuses,
of sufficient magnitude to allow us to determine the years of life, and the
rate of mortality at each important period of life in each of the twenty-
five years. The weight of the results is increased by the extended area
of observation, which covers the whole of England and Wales, for a
quarter of a century.

The deaths vary considerably in number in the various groups; thus
under the age of 5 the number of boys dying ranged from 70,000 to
100,000 annually ; at the age 10 and under 15, the deaths of boys ranged
from 4,200 to 6,100 ; while at each of the decennial periods afterwards,
from 15 to 85, the number of deaths ranged from 10,000 to 21,000; in
the decennium, from 85 to 95, the numbers fell to 4,000 or 5,000; and
for 95 and upwards are about 200 to 800 men, and twice as many
women.

The mortality of the two sexes differs considerably at different ages ;
thus in the first five years of life the excess of mortality among boys over
that of girls is in the ratio of 7°216 and 6°216, or 1°000 per cent.; in
the next period it is only slightly in excess; but from the age of 10 to
25 and 35, the young women die in a greater proportion than young
men, the cause of which it is important to investigate; at the age of 45
and upwards, the women die at a lower rate, and live longer afterwards
than men.

The mean mortality among boys of 10-15 is at the rate of 5 in 1,000;
of young men in the next ten years (15-25) the mortality is somewhat
less than 8 in 1,000, and in the following decennial periods the numbers
dying per 1,000 run up to 10, 18, 18, 31, and 67 (at the age 70=65
~75), 147, 303, and 486, which is the rate carrying off the old men of
95 and upwards.

The mortality among women goes through similar variations.

It will be observed that the mortality at the same periods of life
fluctuated. Thus while the mean mortality of boys under five years of
age was 7°216, their mortality in the year 1846 was as high as 7-781,
and in 1845 as low as 6°683 per cent. The one was ‘565 above, the
other *533 below the average, making the total range in the rate
1-098.

Generally at all ages, from 5 to 65, the mortality was highest in the
year of the great cholera epidemic (1849), and lowest in the years 1856,
1860, and 1861.

The mortality rate never falls so. much below the mean mortality
as it is raised above it by epidemics especially, and while the absolute
difference of the rates is naturally greatest at the advanced ages, when
the rates themselves are high, the relative rise and fall is greatest in
childhood after tle age of 5 years and under 15, when the zymotic
diseases of that age are most prevalent. Women of the age of 15 and
under 45 were cut off in great numbers in the cholera years,
DEATHS. | 183

The following are examples of the fluctuations of the rates of mortality
in the twenty-five years.

The mean annual mortality of men of the age 25-35 was “975, but
the mortality of men of that age in 1849 was 1°236, and in 1850 it was
as low as °877 per cent. The range was *359; in the one case it was
more than 26 per cent. above *975, and in the other 10 per cent. below
that mortality rate.

The mean annual mortality of men of 55-65 was 3° 136, but in 1849
the rate was 3°653, in 1850 it was 2°979; thus the range was 674 in
the twenty-five years.

‘An insurance office upon a large number of these lives of 55-65 would
pay at the rate of 31 policies in 1,000 during ordinary years, but it may
pay on 37 or 30 deaths in years of high or low mortality. The relative
fluctuation is greater when small numbers are concerned.—(25th Annual
Report, pp. Xvi-xviii.)

Mortality of Males and Females at Groups of Ages, 1838-71.—The
most important deductions in this Report are drawn from a comparison
of the registered facts with the population enumerated ; and having now
determined by the analysis of the Census returns not only the numbers
living, but their ages, I am able to show the mortality of persons of both
sexes at 12 different groups of ages for each of the 34 years 1838-1871.
This is one of the most important series of facts relating to the life of a
nation ever published; and it is worthy of remark that the mortality
at the several ages for the 34 years differs little from the mortality of
the 17 years, 1838-54. The mortality of males at all ages was 2°33 per
cent. in 1838-54, and 2°33 per cent. in 1838-71; of females for the
same periods, 2°16 and 2°15.

AynuaL Morratiry per Cent. of Males and Females in England and

 

 

 

 

 

Wales.
Males. Females.
AGES. AGEs.
1838-54. 1838-71. 1838-54, 1838-71.
(17 Years.) | (34 Years.) | (17 Years.) | (34 Years.)
ALL AGES 2°33 2°33 2°17 2°15 ALL AGEs.

o— 7°25 7°26 6°23 6°27 o—
5— °92 °87 “91 "85 5—
10— *52 *49 "54 *50 10—
15— *82 *78 °85 *380 15—
25— 1:00 “99 1°06 1°01 25—
35— 1°28 1°30 1°27 1°23 35—
45— 1°85 1°85 1°59 1°56 45—
55— 3°18 3°20 2°82 2°80 55—
65— 6°69 6°71 6°00 5°89 65—
75— 14°76 14°71 13°44 13°43 75—
85— 30°14 30°55 27°92 27°95 85—

95 & upwards 44°03 44°11 43°22 43°04 95 & upwards

 

 

 

 

 

 

 

 

Note.—The Table may be read thus :—Of Males of the Age 25 and under 35 the
rate of mortality per cent. was 1-00 in 17 years 1828-54; and ‘99 in 34 years
1838-71, and so for other ages. The rates of mortality for 1838-54 are taken from
the English Life Table, pp. xviii-xx; the rates for 1838-71 are the arithemetical
means of the several rates for each of the 34 years.
184 [paRT Iv.

The coincidence between the rates of mortality at the ages when
insurance is effected are equally remarkable. This is a descisive proof
of the solid foundation of the English Life Table, which was calculated
on the population living at two Censuses, and on 6,470,720 deaths; for
the rates are in complete accord with the rates deduced from the living
at four Censuses, and from 14,330,919 deaths, distinguishing the
numbers living at 12 ages into which human life is divided in our
tables, science being no longer contented with the seven ages of the old
times.

The mean lifetime of the English people is by the table 40°86 years.
That is the average number of years children born in England live.

It is gratifying to me at the end of 34 years to be able to say that
one of the objects for which registration was established has been
accomplished, and that the expectations held out in the following
passage of the first Report from this office have been realised :—

“The recommendation of the Report” [of the Select Committee of
the House of Commons on Friendly Societies in 1827, pointing out the
insufficiency of the data hitherto collected, and the contradictory nature
of the several Life Tables founded on them], “that measures be adopted
“ for making ‘an accurate and extensive collection of facts,’ whereby
“ may be facilitated ‘the solution of all questions depending upon the
“ ¢duration of human life,’ is at length carried into effect; ample
“ materials, thus conducing to ameliorate the condition of the working
“ classes, are now afforded in the certified copies of registers deposited
“in the General Register Office, and each year’s accumulation will
“ increase the value of such records, by augmenting the number of
“ facts upon which calculation may be brought to bear.”*

The National Table is, it will be seen, a safe basis for the insurance
of lives, as it includes all the population ; and in the degree that persons
living in unfavourable conditions, or labouring under diseases are
excluded, will be the proportion of profits dependent on the mortality.—
(34th Annual Report, pp. v-vi.)

Proportional Mortality at different Age-Periods.—If we take the
general mortality of the population from the English Life ‘Table, it is at
the rate of 24°47 per 1,000 of the living at all ages; and the mortality
is made up of deaths occurring at the ages shown in the annexed table;
that is 6°44 at the age 0-5, 2°52 at the age 5-25, and 6°62 at the age
65-85.

As the births increase every year in England, the population and the
deaths in the earlier ages are in undue proportion; thus the general
mortality, instead of 24°47 per 1,000, becomes 22°45 for years 1838-54;
but for ten years 1851-60 it was 22°17, and of the 22°17 deaths not
less than 8°98 are children under 5 years of age, while only 3°70 are of
the ages 65-85.

The general mortality, without distinction of age, is to a considerable
extent made up of children’s deaths, and its variation in different
districts depends largely upon this element.

In the healthy districts, where the general mortality was at the rate
of 17°53 deaths in 1,000 living, 5:29 of the said deaths were of children
under five years of age.

In thirty large town districts the general mortality was at the rate of
28-01 deaths to 1,000 living; and 13°84 of the deaths were those of
children under 5 years of age.

 

* First Report of Registrar General for year ending 30th June 1838, p. 16.
DEATHS. | 185

PROPORTION OF DEatus at different Ages to 1,000 Living at all Ages.

 

 

 

English 30 Large 63 Healthy
AGES. Life Table gas ae Town Districts Districts

(1838-54). * | (1851-60). | (1849-53).
ALL AGES 24°47 22°17 28°01 17°53
0- - 6°44 8°98 13°34 5°29
5- - 2°52 3°00 3°52 2°65
25- - 3°20 2°90 3°88 2°22
45- 4°75 3°07 3°91 2°46
65- - 6°62 3°70 3°07 4:14
85 and upwards “94 52 "29 “77

 

 

 

 

 

 

 

 

The total difference between the rates of mortality, in the Large
Town and Healthy Districts, is 10°48 ; of which 8°05 is accounted for
by the deaths under 5 years of age. Of all England, and the healthy
districts, the difference in the mortality is 22°17—17°'53=4-64; of
which the children’s deaths account for 3°69 =3-98—5:29.

This principle must be borne in mind, as well as the disturbances
which are produced by the increase of births, and by migration, by
hospitals and by lunatic asylums, in studying the series of Tables
exhibiting for each district the density of the population, and the rates
of mortality per 1,000 during each of the ten years 1841-50 and
1851-60 ; or the mean rate in the twenty years 1841-60.

The two long periods, each of ten years, and the size of the districts,
justify us in instituting a comparison between their rates of mortality.

In the whole kingdom the mortality was near the same rate in each of
the decennia.—(Supplement to 25th Annual Report, p. xxvii.)

Mortality of Males and of Females at various Age Periods, 1861-70.
—tThe vitality is measured either by the years of life out of which one
death occurs, or by the death out of a wnit of lifetime. Thus in
England, according to the life table, 1 in +1 living dies annually. The
death out of a unit of lifetime is ‘02447. As this implies that 2-447
die in a year out of 100 living, the mortality is said to be 2:447 per
cent. annually; or, to speak in round numbers, 24 in 1,000. Make the
numbers living constantly sustained 1,000, then if 24 die in a year the
mean interval between each death is 15 days; and if a death occur out
of the 1,000 every 24 days the rate of mortality will be retarded, as
it is in inverse proportion to the interval between each death. The
faster people die in a city the greater is its mortality. Thus any two
of three variables being fixed, the vitality is measured by the variation
of the third.

For the rate of mortality—expressed briefly by the mor!ality—involves
three elements—time, numbers living, numbers dying ; the time being
fixed at a year, and the living through that time at 1—which may be
called a year of life—the rate of mortality is a fraction, easily con-
vertible into a whole number by multiplying this fraction into 1,000, or
any greater number. Tere the rate at different ages is expressed as
the mortality of the living at those ages. Thus, taking the boys of
England (1861-70) under five years of age in one group, it is found
that the mortality was at the rate of 7°316 per cent. per annum; then
boys of the age of 5 and under 10 die at the lower rate of -815*; and

~ * By a mere change of the place of the decimal point to the right this may of
course be read as 8°15 per 1,000.
186 [PART Ivy.

boys of 10-15 as they enter puberty die at the still lower rate of *446.
In the next five years of age the mortality of youth rises; and at 20-25
the mortality is 845, nearly the same as that of boys 15 years younger ;
through manhood the mortality rises slowly up to 3°300 at the age
55-65 ; and as age advances still more until at 85 and upwards
‘it is at the rate of 31°357. The mortality of females goes through
a similar cycle; descending to a minimum at the first great change of
formative energy in puberty, and then ascending with age until subsiding
life is converted into the other forces of nature. The law implies first an
increasing and then a continually decreasing power of sustaining vitality.

But the law varies with the conditions of existence; and though
these conditions vary infinitely—some being favourable and others
unfavourable to life—there are large masses of the population, whole
regions and cities, where the results of all the agencies in operation
differ widely.

Take for example the group of 51 districts called healthy for the sake
of distinction, and here it is found that the annual mortality per cent.
of boys under five years of age was 4°246, of girls 3°501. Turn to
the district of Liverpool*: the mortality of boys was 14°475, of girls
13°429. Here it is evident that some pregnant exceptional causes
of death are in operation in this second city of England. What are
these causes? Do they admit of removal? If they do admit of
removal, is this destruction of life to be allowed to go on indefinitely ?
It is found that of 10,000 children born alive in Liverpool 5,396
live five years; a number that in the healthy districts could be
provided by 6,544 annual births. This procreation of children to
perish so soon—the sufferings of the little victims—the sorrows and
expenses of their parents—are as deplorable as they are wasteful.
In Liverpool the death of children is so frequent and dreadful, that
a special system of insurance has been devised to provide them with
coffins and burial ceremonies. The mother when she looks at her baby
is asked to think of its death, and to provide by insurance not for its
clothes but for its shroud and other cerements. There are cases where
a wretched parent has insured the life of her baby, and realised money
by the transaction ; but there is no statistical evidence to show that
this is a systematic trade; rather the reverse ; all that is certain is that
the children are bred in such unfavourable and unnatural conditions
that they perish in excessive numbers. The extent to which the several
causes contribute to their destruction requires further investigation ;
but enough is known to justify the belief that such causes may be to a
considerable extent removed.

Then the sacrifice of the lives of men at the most productive ages,
from 35 to 55, is almost equally great ; the deaths out of the same
uumbers living are as ¢hree in the Liverpool district to every one in
the natural state of the working population of extensive districts of the
kingdom.

The thousands of families of the Liverpool district are of various
grades, and live in very different sanitary conditions; some may be as
healthy as groups of families anywhere else, and others may suffer to
the extremest extent; but the general result is seen in the Table, which
may for the moment represent the unhealthy classes, as the other Table
represents the healthy classes, of the nation. Every great city has in it
a bit of Liverpool. Between the extremes of mortality, high and low,
lies a series of intermediate rates, and the aggregate of the whole mass
is expressed in the rates for all England.

 

* The Borough of Liverpool extends over a part of West Derby. The District
is co-extensive with the parish.
DEATUS. | 187

AVERAGE ANNUAL Rate of Morratriry per Cent., 1861-70, at different
Aces in Firty-onn Heattuy Districts, in the whole of ENGLAND
and Wates, in Lonpoy, and in Mancuxsrer and LiverPoou
Districts respectively.

 

 

 

 

 

MALEs. FEMALES.
3 m 3 om

* . s ae a * Bb * a oy =
gei| 42 | 2 | 3 | 82 | eee) s8| ¢ | 22) 82
pape] a = = e342 = os 4
=o = 5 aA | SA peeal] # 5 eA a

BA) Sie |?" 48 S| oe
Allages -] 1°756 | 2°361 | 2°655 |) 8°538 | 4°097] 1°623 | 2°128 | 2°234 | 3°046 | 3°636
0- 4°246 | 7°316 | 8°691 | 11°790 | 14°475 | 3°501 | 6°348 | 7°632 |10°590 |13°429
5- *566 °815 937 1°401 | 1°647 562, “776 “885 | 1°152 | 1°514
10- °346 “446 “424 *651 "668 390 “448 “407 “579 "614
15- 483 °616 “582 °939 *945 “628 | °662| ‘510 | °740] °758
20- *738 °845 "823 | 1°167 | 1°422 °734| °796 | °622| °955 | 1°102
25- "824 “990 | 1°086 | 1°469 | 1°998 °807 | °968 | °880 | 1°307 | 1°749
35- 1°007 | 1°346 | 1°714] 2°325 | 3°007 *975 | 1°203 | 1°284 | 1°926 | 2°408
45- 1°346 | 1°916 | 2°568} 3°455 | 4°372 |] 1°176 | 1°555 | 1°852 | 2°876 | 3°701
55- 2°372 | 3°300 | 4°385 ] 6°017 | 7°095 ] 2°114 | 2°777 | 3°345 | 5°031 | 5°760
65- 5456 | 6°669 | 8°283 | 10°876 | 11°918 | 4°995 | 5°880 | 6°723 | 9°426 | 9°564
75- 13°128 | 1£°658 | 16°902 | 20°978 | 19°488 } 12°378 |13°443 14°654 |17°300 |16°281
85 & upwds. | 28°492 | 31°357 | 82°142 | 40°714 | 29°600 | 26°400 |28°364 |29°142 |27°387 |25°446

 

 

 

 

 

 

 

 

 

 

 

 

* In this Table two districts are excluded from the fifty-three Healthy Districts shown in
other Tables, namely, Barnet and King’s Norton, on account of their proximity, the former to
London and the latter to Birmingham.

The above table exhibits the rates of mortality of males and females
respectively, at 12 groups of ages, in London, contrasted with the rates
at the same groups of ages in 51 Healthy districts, in all England, in
the district of Manchester, and in the district of Liverpool. Arranged
in the order of mortality at all ages, as in the Table, it will be noted
that London ranks next to all England, Manchester following, and
Liverpool standing last, with the high rate of 4°097 deaths per cent. of
males and 3°636 of females.

If we take 15 great town districts in different parts of the kingdom—
including Manchester—and compare the rates of mortality at different
ages with the mortality at the same ages of the 17 great town districts,
including, besides the 15 districts preceding, Liverpool and London,
the rates will be found to differ but little, and that is through London
being included in the 17 towns which contain on the average of the
ten years 1861-71 no less than 4,981,258 inhabitants, or nearly a fourti:
of the population of England and Wales. The rates very fairly represent
the death-tax which the great city populations of England now pay.

The causes that make the rates of mortality vary may be considered
under two heads—

(1.) Causes inherent in the population itself, such, for example, as
sex and age.

(2.) Causes outside the population, such as air, water, food, clothing,
dwellings, or such groups of causes as are involved in residence,
and relation of the several parts to each other in time and space.

Mere inspection of the Tables 49, 50, 51, establishes under the first

head two things; («) that the mortality of males everywhere excecds
the mortality of females at nearly all ages; (6) that the mortality is at
a@ minimum at the age 10-15; and increases in two directions, as we
approach birth, and as we recede to lengthening age.

Under the second head it is established by the facts that the mortality

in all the great towns is high at nearly all ages; and also that the rates
188 [PART IV.

of mortality of the populations in mass under all the local conditions.
vary generally in the same direction as the mortality at their several
periods of life. In fact the causes of insalubrity affect people of all
ages; but it will be shown hereafter that their effects differ in degree at.
different ages.—(Supplement to 35th Annual Report, pp. xxi-ii.)

4. Inrant AND Cuitp Mortatity.

Mortality of Children—It must’ also be borne in mind that the
proportions of the deaths of children, though showing a high mortality
in some places as compared with that of others, must not be regarded
as true criterions of the comparative mortality, unless the proportions
of living children to living adults were in those different places the
same. Neither must it be supposed that the proportion of children
dying out of 1,000 deaths at all ages, whether given for the whole or
for any part of England and Wales, will afford the means of expressing
correctly the proportion of such deaths to the living population. This
would not be the case unless the population were stationary, the deaths
being equal to the births; but in England and Wales the number of
births greatly exceeds that of the deaths, as will appear from the
following abstracts. Even though the registration of births is still
deficient (and there is reason to believe that the number registered im
every one of the 25 divisions falls short of the actual number), yet,
even with this admitted probable deficiency, the number of births, if
applied as an element of calculation, will show a mortality much less
than it appears in the Comparative Table of Deaths. Neither of these,
however, can be accepted as correct ; and even the proportion of deaths
under 1 year to 1,000 registered births is a little higher than the truth.
—(2nd Annual Report, p. 16.)

Mortality of Infants——As there are difficulties in determining the
ages of the oldest people in the population, so there are great difficulties
in determining the rate of mortality among infants, from the want of
exactly observed facts. The infants in the first year of life are to some
extent mixed up with infants in the second year of age; and their num-
bers fluctuate from year to year, owing to fluctuations in the births, and
‘the mortality from zymotic and other diseases, so that the years of infant
life cannot be accurately deduced from decennial enumerations of the
infants living at the date of the Census. Again, the mortality diminishes
so rapidly after the date of birth, and at such various rates under
different conditions, that it is necessary to subdivide the first year into
months, and even days, to get results exactly comparable. The still-
born children in England are not registered; and a certain number of
infants that breathe for a short time are, it is believed, to save the burial
fees, interred as the still-born are buried, and so escape registration.
Upon the other hand, the deaths of premature children born alive are
registered; and they amounted to 45,814 out of 626,340 deaths of
infants under 1 year of age in the six years (1858-63) that they have
been distinguished from infants dying of debility. The recognised
proportion is 7°315 per cent., so that to obtain the rate of mortality
among children born at the full term of nine months, the premature
children, if we had the means, should be struck out of the account both
of the living and dying. This is impossible in the present state of
statistical observation. But it happens that these deaths of premature
children serve as probably more than a sufficient set-off against the
infants of full term dying soon and escaping registration,

The age of man is reckoned from the date of birth ; but before that
date the foetus has lived its intra-uterine life, and the instant in which
the sperm-cell and germ-cell intermingle is the true time of the embryo’s
DEATHS. | 189

origin. Respecting the rate of embryonic mortality there is little definite
information; but it is probable that as the mortality in the first year of
breathing life rapidly increases as we proceed backwards from the
twelfth to the third, second, and first month, the same law prevails during
embryonic life, until we arrive at the destruction of an.immense propor-
tion of the spermatozoa and ova which are provided to secure the con-
tinuation of the species. This question well deserves the attention of
the Obstetric Society, and is intimately connected with abortions,
miscarriages, and still-births.*

Encutso Lire Tasre for each Month of the First Year of Age, and
Annual Rate of Mortality per cent. of Children in each Month under
1 Year of Age.

 

 

 

 

 

 

 

 

 

 

4 ANNUAL RATE of
LIvING at 0 and at the DeEarus in cach Morra.iry per Cent.
end of each Month Month of Age. in each Month under
of Age. 1 Year of Age.
AGE. AGE.
L. d., Mey
ir 12 12
Both Both Both | s
Ww oth zi ‘ot a: oth + 2
(Months. Sexes, || Boys:| Girls. | sexes, || Boys. | Girls. 7 sexes, Boys. | Girls. (Months.)
| t
0 1,000,000 |, 511,745] 488,255 | 46,503 | 26,787 , 19,716 | 57°132 || 64°501| 49° 455 0—
1 953,497 || 484,958] 468,5894 17,195 || 9,640 | 7,555 | 21°S37 |) 24°093 | 19°507 1
2 936,302 || 475,318} 460,984 12,178 || 6,758 | 5,420 | 15°710 || 17°184] 14°192 2—
3 924,124 || 468,560| 455,564} 19,100 || 5,598 | 4,502 | 13°1S7 |) 14°428]11°918 3
4 914,024 || 452,962] 451,0624 9,550 |; 5,320 | 4,230 | 12°604 || 13°869 | 11°306 4—
5 904,474 | 457,642 446,832] 9,033 || 5,044 | 3,989 } 12°050 || 13°299] 10°761 5—
6 895,441 | 452,508 442,843} 8,547 || 4,771 | 8,776 | 11°509 || 12°717] 10°276 6—
7 886,894 || 447.827] 439,067] 8,087 || 4,498 | 3,589 | 10°992 || 12°114] 9°849 i—
8 878,807 || 443,329] 435.4784 7,657 || 4,229 | 3,428 | 10°501 |/11°502} 9°484 s—
9 871,150 || 439,100] 432,050) 7,253 || 3,959 | 3,204 | 10°033 ||10°863} 9°184 9—
10 863,897 || 435,141] 428,756} 6,872 || 3,691 | 3,181 | 9°584 ||10°222) 8°936 10—
11 857,025 || 431,450) 425,575} 6,518 |) 3,424 | 3,094 | 9°161 || 9°561| 8°756 11—12
12 850,507 | 428,026; 422,481 = = = =. = - _—

 

 

 

 

 

 

 

 

 

 

Note.—This Table was calculated from the Corrected Births and from the Deaths registered
in the 17 Years 1838-1854 under 3 months, at 3 and under 6 months, and at 6 months and under
‘Lyear (see Note to Table VII., p. xxiii of English Life Table). Of 1,000,000 persons born, 953,497
were living at the end of the first month of age, 46,503 having died in the interval, of whom
26,787 were Males and 19,716 were Females; 936,302 were living at the end of the second month,
and the deaths in that months were 17,195, of whom 9,640 were Males and 7,555 were Females.
The Annual Rate of Mortality per cent. of infants under 1 month was 57°132, viz., Males 64°501,
Females 49°455, and so on for other ages.

The annexed Table from the English Life Table shows the estimated
numbers of males and females surviving each month, and the annual
rates of mortality in each month. It will be observed that the rate of
mortality rapidly declines month by month ; and that the mortality of
boys in every month exceeds that of girls, so that at the end of the first
year the number of boys does not greatly exceed the number of girls.

The mortality of infants in France was such in the first year as to
reduce 1,000,000 to 820,065, according to the experience acquired by
following the births in 1856-60 for the 12 months following. The deaths
were 179,935, and the probability of dying 0.179935.

 

* Dr. Granville has the merit of having called attention to the importance of the
subject. In his Report of the Practice of Midwifery at the Westminster General
Dispensary, for 1818, he showed that of 490 pregnant married women who applied
at the Dispensary 128 had miscarried within the previcus ten years one time or
more ; in all 305 times. The 128 women had given birth during the same term of
years to 556 live children, 305 dezd embryos. 272 of the women had not miscarried
at all; and Dr. Granville does not say to how many living children they had given
birth. Of the 305 miscarriages, 185 occurred in the first 3 months of pregnancy
65 in 3-6 months, and 55 in 6-8 months. (pp. 39-48.) :
190 [PART Iv-

The French returns show the deaths in the first week of life; and by
the returns of 1856 the mortality was at the rate of 154 per cent. per
annum in the first seven days, 120 in the second seven days, and 54 in
the sixteen days following. The mean births were 927,226; the deaths
in the three periods were 27,002, 20,517, and 20,618, making 68,137
deaths in the first month of life. So out of 1,000,000 births 29,121 die
in the first week, 22,128 in the second week, and 22,236 in the sixteen
days following.

In England and Wales the deaths of 2,374,379 infants in the first year
of age were registered in the 26 years 1838-63; and of the number
1,329,287 were boys, 1,045,092 were girls, The deaths at the same age
registered in the ten years 1851-60 were 996,630; of boys 557,218, and
of girls 439,417. Nearly 100,000 infants died annually; in the
proportion of about 56 boys to 44 girls, (Supplement to 25th Annual
Report, pp. v—vi.)

Mortality of Infants under one year, and its causes.—The high rate
of infant mortality continues to occupy the earnest attention of medical
statists. The death-rate of infants* in England and Wales, in 1875,
was 158 per 1,000, or 4 per 1,000 above the average rate in the 10 years
1861-70. This implies that the mortality among infants is increasing.

The subjoined Table shows the death-rate of infants from all
causes in 18 large towns. The highest rates in 1875 prevailed in

 

Mortatity or CHILDREN under OnE Yusr or AGE from All Causes
in EKighteen Large Towns, 1870-75.

 

 

 

 

PROPORTIONAL NuMBER of DEATHS
under One Year to every 1,000 Births registered in 52 or
53 Weeks in each Year.
Boroveus, &c. Average
Number
1870. | 1871. | 1872, | 1873. | 1874. in the 1875.
5 Years |!
1870-74. |
Portsmouth - 160 144 146 139 151 148 133
London 163 171 159 159 155 161 162
Bristol - 196 165 151 157 153 164 166
Wolverhampton 163 185 176 175 169 174 161
Sunderland 150 222 177 163 166 176 169
Oldham —_— 188 178 169 190 181 177
Birmingham - 181 190 166 180 180 179 196
Hull - - 176 177 204 174 Ly2 181 191
Sheffield - 180 208 185 180 188 188 176
Nottingham 186 187 207 172 195 189 199
Salford - 191 221 173 185 189 192 178
Norwich - 221 200 210 159 177 193 210
Newcastle-on-Tyne 183 223 177 186 198 193 187
Bradford - - 208 209 197 206 189 202 200
Manchester 203 221 191 198 197 202 184
Leeds 217 205 212 192 200 205 197
Leicester 235 241 228 213 215 226 245
Liverpool - - 259 269 222 213 233 239 210

 

 

 

 

 

 

 

 

 

 

 

 

* By the death-rate of infants throughout this Report, is meant the proportional
number of deaths of children under one year of age to every 1,000 births. ‘ Death-
rate” under 1 is used for its shortness instead of the more correct term “ probability
DEATHS. | 191

Leicester, 245 per 1,000, Liverpool 210, Norwich 210, Bradford 200,
Nottingham 199, Leeds 197, Birmingham 196, and Hull 191.
Portsmouth had the lowest rate, 133 per 1,000.

What are the causes of such high death-rates of infants in large
towns ? ‘This is a question of vital importance, and to assist in giving a
satisfactory answer, the average annual death-rates of infants from each
of eleven causes, in the three years 1873-5, have been calculated for
15 large towns. The results are shown in the subjoined table.

Morratity of CHILDREN under Onz Year of Acre from different Causrs in
ENGLAND, in SCOTLAND, and in FirrEen LarGe Towns, 1873-5.*
ZL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNUAL NuMBER of Deatus of CHILDREN under One Ygar of Age in the
three years 1878-5, to every 1,000 BrrTHS,

q | v . : Vv B 2 d

Boroveus, &e. ; | 2 ; eal &) By oe 4)/84) 4/8.) 8
ai | 22| 2 |2s/2s| | 4 | ea) 23| 28) = | as] 3

42/R2] S$ |83/858| 8] 8 | BS)22) 38) & | se] 8

SO] so] aja |Se] 8] 8 | 84 Aa) 2s! 5S | eh| &

a | BP || a a Ao) a
Eneuanpt - | 152°7 | 131°G || 2°2 | 1°4] 5°9 | 2°9 | 17°1 | 25°1 | 26°S | 9°8 | 26°7 | 19°8 | 14

enue
ScorLanDt - | 125°7| 94°3 || 2°2) 1:9] 64] 3°4/ 770] 5°5 | 25°2] 11 30°7
ne

Portsmouth + | 145°9 | 180°9 |} 2°8 | *3] 5°38 | 3°0 | 32°2 | 21°5 | 242 | 11°7 | 22°7) 61] 11
London - = | 159°1 | 185°6 || 8°12 | 1°1 | 8°8 | 3°6 | 20°4 | 18°5 | 31°9 | 13°8 | 20°5 | 10°4 |] 4-0
Wolverhampton - | 166°0 | 140°9 || 2°4 | 1°5 | 5°9 | 1'1 | 22°0 | 30°4 | 31°2 | 9°4 | 26°4 | 10°2 “4
Sunderland - —- | 167°6 | 147°6 |] 1°5 | °6 | 7°3 | 8°2 | 21°38 | 28°2 | 2574 | 6°4 | 89°41 13°6 6
Oldham - - | 180°1 | 150°9 || 3°0 | 1°6 | 7°5 | 4°8 | 16°4 | 26°0 | 86°2 | 11°8 | 27°38 | 16-3 | —
Norwich - | 183°4 | 161°8 6 | —]9°8 | 2°0 | 27°2 | 22°9 | 208 | 6°9 | 63:0] S86] --
Salford - - | 183°9 | 151°7 || 7°0 | 1°7 | 4°2 | 2°2 | 81°6 | 25°0 | 27°7 | 91 | 82°4] 10°83 6
Sheffield -  - | 18671 | 148°8 || 1°6 | 3°2 | 6°65 | 5°2 | 31°0 | 33°0 | 36°9 | 8°0 | 10°4 | 12°5 3
Birmingham _ - | 187°0 | 160°0 || 2°0 | 2°4 | 7°5 | 1°6 | 83°9 | 13°4 | 98°3] 7°1 | 39°7 | 14°1 | 10°0
Nawcastle-upon- ¥) 190-6 | 164° |] 2°0 | 2-7 | 5-2 | 2°6 | 24-4 | 87-7 | 245 | 18°9 | 87°9 | 12°0] 1°6
Manchester - | 192°9 | 157°4 || 3°1 | 2°1 | 6°5 | 2°9 | 28°7 | 28°1 | 31°3 | 9°0 | 33°9 | 11°1 aa
Nottingham - | 199°5 | 184°8 |] 3°9 | 1°9 | 5°83 | 2°7 | 33°7 | $2°1 | 25-4 | 15°4 | 47°0 | 16°83 ‘6
Leeds - - | 201°1 | 162°7 || 2°0 | 2°6 | 5°5 | 8°5 | 30°9 | 2h°2 | 82°4| 9°8 | 32°2] 166] 1°0
Leicester - + | 217°3 | 203°1 || 2°8 | 171 | 6°0 | 4°1 | 54°5 | 31°6 | 23°1 | 11°8 | 50°7 | 16°6 8
Liverpool - - | 218°9 | 191°2 || 61 | 4°9 | 9°0 | 2°2 | 81°9 | 28°6 | 89°4 | 12°6 | 87°7 | 10°6 | 8-2
Mean - | 185°3 | 159°5 || 2°9 | 1°8 | 67 | 8°0 | 29°8 | 2679 | 29°3 | 10°4 | 34°8 | 12°4) 2°70

 

 

 

 

 

 

 

 

 

 

 

* The results for the fifteen large towns are deduced from returns supplied by the Medical Officers
of Health. As far as practicable differences in nomenclature have been adjusted.

ma England, in the three years 1873-5, the causes of death of 5,354 infants (1°4 per cent.) were not
stated.

} The results for Scotland are for the three years 1870-2. The causes of death of 2,894 infants (6°6 per
cent.) were not stated in those three years. Dr. Robertson, the Superintendent of the Statistical
Department of the (yeneral Register Office, Edinburgh, states that it cannot be assumed that the
popular but utterly unscientific term “bowel hives” is now used by informants in any large propor-
tion of these 2,894 cases; the term being rarely observed in the certificates of death.

 

“« of dying under the age of 1.” The births, out of which the deaths under 1 year
of age occurred in the year 1875, were those registered in the two years 1874 and
1875. To obtain the proportional number of deaths (0-1) to births, the deaths (0-1)

. B,, + B
should be divided by ( 7+?) the mean number of births in 1874-75 ; but as

the mean number differed so little from the annual number, the births in the year
1875 were used in obtaining the results relating to infant mortality. In calculating
the death-rates of infants, it has been found more accurate to apply the number of
births to the deaths under one year of age, than the numbers enumerated at the
Census, as it is believed these were not always accurately returned. The practice
sometimes being to put down children in the first, second, and third years of age as
1, 2, 3, instead of 0, 1, 2, a certain number of children in the first year of age, who
should have been returned as 0-1, were returned as 1-2.
192 [PART Ly.

The table deserves careful study, for the agencies which destroy
infant life are many, and they vary in different localities. Some of the
principal causes are improper and insufficient food, bad management,
use of opiates, neglect, early marriages, and debility of mothers; but
whatever may be the special agencies at work which are so prejudicial
to infant life, it must be borne in mind that a high death-rate is in a
great measure also due to bad sanitary arrangements.

In towns such as Sunderland, Wolverhampton, and Newcastle-upon-
Tyne, where the iron and coal mining industries prosper, and where the
marriages of minors are in excess, mismanagement through ignorance is
probably one of the causes of a high infant death-rate, while in towns
such as Oldham, Norwich, Salford, Nottingham, Leeds, Leicester, and
Manchester, where the women are more or less employed away from
home in the manufacture of textile fabrics, it is probable that one of the
causes of the high rates of infant mortality is maternal neglect. In the
hardware manufacturing towns, such as Sheffield and Birmingham,
comparitively few women are employed in the factories.

As regards illegitimate infants, the chief causes of the high mortality
are no doubt improper food and neglect; but the death-rate of children
born out of wedlock will be discussed further on.

The causes of death which are more directly the result of neglect and
mismanagement, are convulsions, diarrhcea, and atrophy.

In Scotland, infant mortality is not so high as it isin England. In
the 10 years 1861-70, the average annual death-rate was 154 per 1,000
in England, and 121 in Scotland, and it is remarkable that the excess in
the number of deaths from convulsions, diarrhcea, atrophy, and pre-
mature birth, accounts for nearly the whole of the difference in the high
rate of infant mortality in England, compared with that of Scotland.
The number of deaths of infants in England, in the 10 years 1861-70,
from convulsions, was 208,320, and from diarrhcea, 119,480. In Scotland
the respective numbers were 5,801 and 6,156. The births registered
during the same period in England were 7,500,096, and in Scotland
1,120,791. Thus the average annual death-rate of infants in 1861-70,
in England, from convulsions, was 27°8, and from diarrhea 15°9 per
1,000, whereas in Scotland the respective death-rates were only 5:2 and
5°5 per 1,000. In the above table, average annual rates of infant
mortality in England and Scotland are shown from each of eleven causes
of death.

The cause of this high mortality of infants from convulsions and
diarrhoea in England, compared with Scotland, is supposed to be due to
bad feeding.*

Compared with the fifteen English towns the mortality of infants from
all causes in the city of Glasgow in the three years 1873-75, was com-
paratively low, viz., 163°3 per 1,000 births. Only Portsmouth and
London have a lower rate of infant mortality. The death-rates per
1,000 in the city of Glasgow from each of several causes were as follows:
measles 4° 3, scarlet fever 3:4, whooping-cough 8°9, diarrhoeal diseases
12-1, lung diseases 37°7, atrophy and debility 23-5, premature birth
14:9, fever 0°5, small-pox 1°0, croup and diphtheria 2°3, consumption
2-3, nervous diseases 25°4, and from other causes 27:0.

The mortality in the mining and manufacturing towns of England
from convulsions, diarrhcea, atrophy, and premature birth together, was
86 per 1,000 in Oldham, in Sheffield 87, Wolverhampton 89,
Salford 99, Birmingham 101, Manchester 102, Sunderland 103,

 

* See Paper by Dr. Stark, M.D., F.R.S.E., as to treatment of infants in Scotland,
in Vol. XXIX. of the Journal of the Statistical Society, pp. 13-17.
DEATHS. | 193

Leeds 106, Neweastle-upon-Tyne 112, Norwich 122, Nottingham 180,
and Leicester 153.

No comparison, however, of infant mortality, in different towns
should be made without looking to the occupations of the women,

In seven of these fifteen towns, women are employed in greater or less
numbers, at the mills and factories, in textile manufactures. In Oldham,
these four causes of death (convulsions, diarrhoea, atrophy, and pre-
mature birth) represented only 48 per cent. of the total mortality of
infants. In Salford, the proportion was 54 per cent., in Manchester 53,
and in Leeds 53. In Norwich, Nottingham, and Leicester respectively,
these four causes represented 66, 65, and 71 per cent, of the total
mortality of infants.

Turning to the mining, and hardware manufacturing towns, these
four causes represented 47 per cent. of the total mortality in Sheffield,
and 54 in Wolverhampton and Birmingham. In Newcastle-upon-Tyne
and Sunderland the respective proportions were higher, viz., 59 and
61 per cent.

In Oldham, the rate of infant mortality was high, viz., 180 per 1,000 :
the excess is no doubt partly owing to the mothers being employed at the
mills. About three weeks or a month is the average time they remain
at home efter the birth of a child. Dr. Sutton recommends the
establishment of day nurseries for the better protection of infants during
the hours they are deprived of maternal care. It is remarkable that,
although the proportion of women, aged 20 years and upwards, employed
in textile manufactures was highest in this town, 346 per 1,000, yet the
rate of infant mortality was relatively lower than in any of the other six
textile manufacturing towns. The mortality from lung diseases was
excessively high in Oldham.

In Norwich, the death-rate of infants was higher than in Oldham,
being 183 per 1,000. ‘The proportion of women employed in textile
manufactures was lower in this town than in any of the others; it was
58 per 1,000 living. Dr. Crosse reports that much ignorance prevails
among the poorer classes as to the proper way of rearing infants, and
this appears to be borne out by the results, for the mortality from
atrophy was at the high rate of 68 per 1,000; it is the highest rate from
this cause in any of the fifteen large towns.

In Salford, the rate of infant mortality differed from that in
Manchester. In the former the rate was 184; in the latter it was
193 per 1,000. The proportion of women employed in the textile
manufactures, in these two towns, was 152 per 1,000. In Salford,
Dr. Tatham reports that the high death-rate was chiefly due to the
mothers leaving their offspring soon after birth, in order to work at the
cotton mills: their infants, thus neglected, soon fell un easy prey to the
first disorder that attacked them.

In Salford, the mortality from diarrhcea, and in Manchester from
convulsions and lung diseases, was higher flan the mean for the fifteen
towns.

In Nottingham, the mortality of infants reached the high rate of
200 per 1,000. The proportion of women engaged in textile manu-
factures was also high, viz, 249 per 1,000. Dr. Seaton states that
although the death-rate of infants was unduly augmented by married
women being thus employed, he is of opinion that infants were not
deprived of maternal care in Nottingham to the same extent as they
were in some other so-called textile manufacturing towns. Of the

N
194 [PART IV.

6,758 women thus employed, 1,487 were engaged in hosiery manu-
facture. ‘Che death-rate from atrophy was excessively high in
Nottingham, viz., 47 per 1,000.

Noumprr, and Prorortion per 1,000, of Fematrs 20 Years of Act
and upwarps employed (1) in TexTire Manuractures and (2) in
Hovsrnoip Dutixs, according to the Census of 187] ; together
with the rate of Inranr Morracity 1873-5; in the SEVEN
Facrory Towns, and in Porrsmoutu, and Lonpon, arranged in
the order indicated by the Results in Col. +.

 

 

 

 

 

 

 

 

 

 

Females 20 Years of Age and upwards in 1871. Infant
Mortality,
To every 1,000 living | 1873-75.
Towns Females | Number engaged in the proportion
ae enumerated: employed in
20 Years : — . Death-
of Age and | _ Textile House- Textile House- rate
upwards. | Manufac- hold Manufac- hold per 1,000
tures. Duties.* tures. Duties.* | Births.
Cols. - i: 2, 3B | b 6.
= I
Oldham - - 32,343 11,178 15,961 346 493 180
Nottingham - 27,171 6,758 12,429 249 457 200
Manchester and Salford 150,019 22,750 81,245 152 t 542 188
Leicester - 27,677 3,368 15,017 122 F 543 217
Leeds - : 72,719 6,776 47,873 93 658 201
!
Norwich - - 25,684 1,478 13,847 : 58 : 539 183
\ \
Portsmouth 4 31,504 = 21,460 — | 6s 146
Tondon + - -| 10x49 | = 585,508 —- | 3573 159
|

 

 

 

 

 

 

* The results in this column represent the number of women at home ; generally engaged in
household duties, but in certain cases assisting in their husbands’ business.

In Leeds, the rate of infant mortality was as high as 201 per 1,000.
The proportion of women employed in textile manufactures was 93 per
1,000.

In Leicester, infant mortality was greatly in excess, being at the rate
of 217 per 1,000. The proportion ef women employed in textile
manfactures was 122 per 1,000. Of the 3,368 women working in these
fabrics, 1,840 were engaged in hosiery manufacture. The rate of
infant mortality from diarrhea and atrophy in Leicester was exces-
sively high, viz., 54°5 and 50°7 per 1,000 births.

Infant mortality was lowest in Portsmouth, and the death-rate from
each of the eleven causes in this town was lower than the mean for the
fifteen towns, except from teething, the mortality from which was the
same as the mean; from diarrhoea, and from tubercular diseases, the
mortality exceeded the mean.

In Liverpool, the death-rate from lung diseases was excessive,
39°4 per 1,000, or 10°1 per 1,000 above the mean. The mortality
from lung diseases was also very high in Sheffield, Oldbam, Leeds,
London, Manchester, and Wolverhampton.

The high mortality from suffocation in Birmingham and Liverpool
demands the attention of the coroners.

In the factory towns of Nottingham, Leeds, Leicester, and Oldham,
the mortality from premature birth was excessively high.
DRATHS. ] 195

Causes of Inrant Morratity in Towns in the Three Years 1873-5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mean The Seven Textile
Death- | PortsMoUTH | LivERPooL. || Lonpon.| Manufacturing
rate per} Towns, ees p. 194,
1,000 ; i ;
in 15 n n n
Causes oF Dratt. Towns. |Death-| defect |Death-| excess || Death- | Death- | excess
(See rate or rate or rate rate or
Table | per | excess | per | defect per per defect
on 1,000. | of the | 1,000. | of the 1,000. 1,000. of
p. 191.) MEAN. MEAN. | Lonpoy.
Cols. L 2 | 38 4 | 5 || 6 1. 8.
ALL CAUSEs - -| 185°3 | 145°9 | —389'4 | 218°9 | +33°6 | 159°1 194°0 +349
Thellsubjoined Causes} 159°5 | 130°9 —28°6 | 191°2 | +31°7 185°6 167°5 | +31°9
|
Measles _- - - 2°9 ars | -o1 G1) + 32! 31 3°2 + 0'1
Scartlet Fever - -| 1°'8 3/—-15] 4:9] + 3°71 11 V6 | + 05
Whooping-cough - 6°7 5°3 | +14 90 | + 2°3 83 64 | -—1°9
Teething - - os 3°0 3°0 00 2°2 | — 0°8 3°6 32 | — O'4
Diarrhea - 29°3| 82°2 | + 2°9 | 31°9] + 2°6 20°4 31°9 +11'5
Convulsions - 26°9 | 21°5 | — 5°4 | 28°6 | + 17 18°5 27'4 | + 89
Lung Diseases - 29°3 | 242) — BL | 39°4 | +1071 31°9 23'1 | — 3°8
Tubercular Diseases - 10°4} 11°7} + 1°38} 12°66] + 2°72 13 8 10°56 | — 3:3
Atrophy and Debility 34°83 | 22°7 | —12°1 | 37°7) + 2°9 20°5 40°9) | +20°h
Premature Birth - 12°4 61} — 63) 10°6 | — 1°8 lu*4 13°8 | + 3°4
Suffocation - - 2°0 | lL} -—0'°9 82] + 62 4°0 05 | — 35

 

 

In the above table (cols. 6, 7, and 8) the death-rates from each of the
eleven causes in these seven textile manufacturing towns in the
ageregate are compared with those in London, and the results indicate
in a striking manner that—over and above a certain proportion of the
mortality which may be attributable to indifferent sanitary arrangements
—the causes most fatal to infant life in factory towns, and which are
inseparable from bad nursing and feeding, are diarrhcea, convulsions,
and atrophy. The mortality from premature birth was also in excess.
Thus the respective death-rates of infants in London, and in the seven
factory towns, were, from diarrhoea 20°4 and 31°9, from convulsions
18°5 and 27°4, from atrophy 20°5 and 40°9, from premature birth
10°4 and 13°8 per 1,000.

The death-rates in the seven factory towns from whooping-cough,
teething, lung-diseases, tubercular diseases, and suffocation, were lower
than those in London. (88th Annual Report, pp. xl—xlvi.)

Child Mortality in London, 1730-1830.—The method pursued in
obtaining the following results is unexceptionable, and demonstrates
that for the last century the mortality of children in London has
constantly been on the decline.

Birtus and the Deatus under 5 Years of Age, according to the
“London Bills cf Mortality,” for 100 years, in 5 Periods of
20 Years each; and the Numprer pyine@ under 5 Years out of
100 bora.*

 

1730-49. | 1750-69. | 1770-89. | 1790-1809. | 1810-29.

 

Total Births - | 315,456 | 307,395 | 349,477 | 386,393 477,910
a at 235,087 | 193,694 | 190,058 | 159,571 151,794

 

74°5 63:0 51°5 41°3 31:8

 

Dying per Cent.
under 5 Years -

 

 

 

 

 

 

 

On the diminution of the mortality of infants in Englard, by T. R. Edmonds, Esq.—
Vol. I., 1835-36, 8 y sq.—Lancet,

nN 2
196 [PART IV.

In the 20 years, 1730-49, out of 100 born, 74°5 died under the age
of 5 years. During the 20 years, 1810-29, only 31°8 died out of
the same number. This table is from a paper of Mr. Edmonds, to
whose investigations of the English population returns we shall have
frequently to refer.

Tf half the children formerly ent off at an early age in England be
now reared, and form part of the adult population; while the annual
deaths betaveen 20 and 30, instead of being 7°6, or 9:1, or 8°9 per
1,000, as in Carlisle, Belgium, and Sweden, are LO’1; it will appear
that a vast number of weakly children are every year introduced into
the English population, and that, unless proper means be taken to
fortify the constitution in inanhood, the relative vigour will not increase
in the same ratio as the population. (McCulloch’s Account of the
British Empire, Article Vital Statistics, Vol. 2, pp. 643-4.)

Mortality of Illegitimate Infants—As the law of bastardy was
essentially altered by the new poor law, has been again amended in one
of its most important principles, and has latterly attracted 1 good deal
of publie attention, I have thought it right to submit to you a general
Abstract of the number of illegitimate children registered in England,
and to point out some of the particulars to be attended to in drawing
inferences from results collected under a great variety of circumstances.
But the most important matter, in « political point of view, is the
condition of the illegitimate children themselves. If the mortality were
not greater among them than among legitimate children, every fifteenth
person in England must be of illegitimate extraction. But the mortality
of illegitimate children is, as in other countries, no doubt greatly above
the average ; for, without any crime whatever of his own, the ille-
gitimate child is often exposed to dangers, hardships, and ignominy from
his infancy ; the law pronounces him flins naélias ; he, nevertheless,
escapes in England the tender mercies of the Foreign Foundling
Hospital, and in our great towns and colonies has probably a better
chance of attaining the station to which his personal conduct may
entitle him than in any other country in Europe.

To make the statistical information respecting illegitimate children
as complete as it might be, the age and occupation of the mothers
should be ascertained, as well as the proportion of children who are
formally recognised by the fathers. JI conclude my remarks upon this
subject with the judicious observations of one of the ablest. statistical
writers of the present day. “The proportion of illegitimate children
“ cannot serve as a standard of morality ; nevertheless a remarkable
frequency of such children is without doubt in many respects a great
“evil. The invariable fact that the mortality among the illegitimate
“ is far greater than among the legitimate, and that many more of them
are still-born, shows clearly enough how much more unfavourable
their position is from the first. Who can doubt that their bringine
“ up is much harder and more difficult ? that the existence of a eee
of men, bound to society by few or no family ties, is not a matter of
* indifference to the State? The great majority of foundlings are
‘“ illegitimate, which of itself shows how little, as a general rule, the
“‘ mothers can or will care for these children, It is beyond doubt that
“fewer illegitimate children grow up to matnrity ; that they get
through the world with more trouble than children born in wedlock ;
“ that more of them are poor; and that therefore more of them become
“criminals, Tegitimacy is in itself an evil to a man; and the State
should seek to diminish the number of these births, and carefully
DEATHS. | 197

. inquire to what circumstances any increase is to be ascribed.”*
(6th Annual Report, pp. xxxvii-viii.)

In the five years 1871-5, infant mortality was excessively high in the
districts of Leicester, Liverpool, and Preston, where the respective
rates were 229, 223, and 222 per 1,000, and as the death-rate among
illegitimate infants is known to be higher than it is among legitimate
infants, it was believed that the rate of illegitimacy in 1871-5 (the
number of children born out of wedlock to every 1,000 births) would
bear some relation to infant mor tality, but such is not the case, the rate
of illegitimacy in Leicester aud in Liverpool being 44 per 1,009, while
in Preston it was 71 per 1,000.

Deatu-ratus of Lueiriate, and of Iniecrrimare Inranrs; Per-
ceutage of Marriaces of Minors to Tota MARRIAGES, and
Inuecrrmate Birtus to 1,000 Brrrus, in twenty-four districts,
in five years 1871-5.

 

 

 

 

 

 

 

 

 

 

 

DEATUS OF
Legiti- | Legiti- | Legiti- | IMegiti- Percentage | Children
mate and | mate and pate, ee of wrtaer of eee on
Name een aves oe On ee ne Total Marriages, | Wedlock
of District. Infants | Infants | Legiti- | Illegiti- 1871-75. to every
to 1,000 to 1 mate pate Bes
Births. | Births. | Births. irths. 1871-75.
iste ie In 1875. Men. | Women.
TWELVE DistRicTs with Hicgu Rates of INFANT MoRTALITY.
Leicester - 229 245 239 386 Ad
Liverpool - 223 214 205 448 44
Preston - - 222 230 214 AAS 71
Radford - 196 204 187 547 5k
Nottiugham - - 193 202 191 365 12". 24°8 65
Goole 2 - 175 196 192 257 83 B02 53
Keighley - - 175 181 175 825 9°8 2072 51.
Guisborough - 174 206 202 292 8°5 Bn2 dy
Mansfield - - 174 189 180 52k 17°3 BLS. 80
Haslingden + - 174 189 181 355 13°8 24°1 44
Driffield - : 172 206 168 596 GS 26°9 116
Basford. 5 - 170 179 169 B41 20°1 B34 64
Mean - - 190 203 192 383 12°5 28°3 61
TWELVE DistRicts with Low Rares of Inrant MorTALITY.
Ledbury - oe 96 102 94 222 4°9 17°5 74
Reeth - 100 107 106 118 2°4 25'9 89
Kendal - - 103 105 91 329 63 20°7 67
Stratford-on- Avon 106 83 69 293 51 16°6 55
Leominster - 108 104 95 244) 2°6 12°5 2.
Easingwold - - 109 97 84 227 5°6 21°2 95
Wetherby 112 104 99 182 48 15°8 66
Stipstonon-Stour 113 120 112 237 69 18°5 73
Helmsley - 114 87 75 184 75 23°9 133
Hickmond : 117 122 114 231 3°8 19°4 75
Hereford - 119 128 114 313 34 13°9 75
Market Harborough 120 121 116 286 5°8 13°9 50
Mean - - 110 107 97 239 4°9 18°3 17

 

 

 

 

 

 

 

 

 

 

 

* Handbuch der Populationistik von D. Chr. Bernoulli, pp. 180-1.
198 [PART LY.

The results in the preceding Table show that the rate of illegitimacy
bears no relation to the death-rate of infants, and it is remarkable that
the districts with a high rate of infant mortality are generally those
with a comparatively low rate of illegitimacy, and vice versd. ‘Thus in
the twelve urban districts with a high mean death-rate among infants,
in 1871-5, of 190 per 1,000, the rate of illegitimacy was 61 per 1,000,
while in the twelve rural districts, with a comparatively low mean
death-rate among infants of 110 per 1,000, the rate of illegitimacy was
77 per 1,000.

It is not improbable that a certain number of illegitimate children
are registered as legitimate in towns, while in the country they are
correctly registered as illegitimate, the circumstances connected with
their birth being too well-known to allow of any false representation
being made : some illegitimate births have no doubt escaped registration
altogether.

For each of the 24 districts in the Table, the number of deaths of
illegitimate infants weve abstracted from the death registers for the
year 1875. The results are instructive ; and I hope at some future time
to publish similar facts for each of the 631 registration districts in
England and Wales.

Twenty-four districts have been selected as examples, out of 631,
viz., twelve with a high rate of infant mortality, and twelve with a
comparatively low rate. Had a selection been made from the 2,194
sub-districts, it is probable that death-rates could have been reviewed
exceeding even those in Leicester, Liverpool, and Preston.

Turning to these results in the Table it will be seen that the death-
rate, in 1875, among illegitimate infants in Liverpool, was 418 per 1,000,
and in Preston 448 per 1,000 ; double the rates among the legitimate
infants, which were 205 and 214 respectively. The mean death-rates
in the twelve urban districts, among the legitimate, and illegitimate,
were 192 and 388 respectively.

In the urban district of Radford the mortality among legitimate infants
was 187 per 1,000, whereas among the illegitimate it was 547 per 1,000!
or nearly three times as high, and in Driffield the respective rates were
168 and 596 per 1,000 !

In the rural districts, where the death-rates of infants were not so
lugh, the mean mortality of the illegitimate was rather more than double
that of the legitimate. The mean death-rates in the twelve rural
districts, in the year 1875, were 97 per 1,000 among the legitimate, and
239 per 1,000 among the illegitimate. In Kendal the mortality among
legitimate infants was only 91 per 1,000, while among illegitimate infants
it was 329 per 1,000, or nearly four times as high; and in Stratford-on-
Avon the respective rates were 69 and 293 per 1,000.

It will be observed in the Table that in the districts where there was
an excess of early marriages, the mortality of infants born in wedlock
was comparatively high, Thus the mean infant mortality in the twelve
urban districts, in the year 1875, was 192 per 1,000, and the mean
proportion of girls who married under age to 1CO marriages in these
districts was 28, whereas in the twelve rural districts, where the mean
infant mortality was 97 per 1,000, the proportion was only 18,

Dr. Russell, the Medical Health Officer of the city of Glasgow, has
furnished the particulars, relating to the death-rate among legitimate
and illegitimate infants for that city, which I subjoin, and which confirm
the results observed in the 24 districts in England.
DEATHS. | 199

Morratiry of Lecitimare and ILeEGitmatr INeants in the
City or GLascow, 1873-5.

 

 

 

 

 

 

cae th ILLEGITIMATE |
LEGITIMATE INFANTS. INFANTS. | DEATHS
I |
ae | ae i ten it t
Deaths iH] Deaths cg! Imate » egitimate
Births. under || Births. under ae | eae
lyear. | lyear. | Togitimiate | Illegitimate
| ' | Births. Births.
; ' i
h
1878 18,416 2,845 1,786 523 15t 203
1874 19,178 2,863 1,785 495 |: liv hE
1875 19,104 2,905 1,714 491 152 286
1
1873-5 56,698 8,613 5,285 1,509 | 152 286

 

 

 

 

 

 

The number of legitimate births in England and Wales, in 1875, was
809,794: the number of illegitimate births was 40,813, so the total
number of children born was 850,607, and the mortality in their first
year of age was 158 per 1,000.

Since it has been ascertained that the mortality among illegitimate
infants is about double that among the legitimate, then from the mean
proportions observed in the twelve urban and in the twelve rural
districts, it follows that the lives of 7,020 illegitimate infants were
sacrificed through neglect and improper food in the year 1875. This
is on the assumption that the death-rate among illegitimate infants
should be the same as that which prevailed among legitimate infants,
viz., 148 per 1,000.

But the general death-rate of infants, instead of being 158 per 1,000,
should at least be as low as that in some of the healthiest parts of
England. By the healthy district life table it was only 111 per 1,000.
If 111 per 1,C00 be taken asa standard rate, for the present, which is
47 per 1,000 less than the rate for all England, then no less than
40,197 deaths of infants occurred in 1875, in excess of the number that
would have been registered at the rate that prevailed in the healthy
districts. (38th Annual Report, pp. xlvi—viii.)

Mortality of Infants at each Month of the first year of alge ;
England, Healthy Districts, and Liverpcol.According to the life
table, of 100,000 children born in the healthy districts of England,
96,339 are alive at the end of the first month, 3,661 having died in the
interval. Of the same number born in Liverpool, only 94,551 are alive
at the end of the first month, 5,449 having died in the interval.

At the end of the second month, 95,178 are alive in the healthy
districts, 1,161 having died in that month; in Liverpool 92,088 are living,
2,463 having died in the month; and so on until at the age of seven
months the numbers living are reduced te 91,932 in the healthy districts,
and to 84,373 in Liverpool.

In the healthy districts, the mortality rapidly decreases, month by
month. Thus the rate was 448 per 1000 living under one month of
age, 145 at one month of age, 102 at two months, 76 at five months,
71 at six months, and 58 at 11 months of age.
200 [PART iy.

Lire Taste and Annuat Deatru-Rate for rAcH Monta of the Firsr
Year of Acr, in the Heartrny Districrs of ENGLinp AND
Wates; in Eneranp anp Wates generally; and in the District
of LivERPOoL.

 

 

 

 

 

 

 

 

see
Livine at 0 eva ANNUAL RATE OF
and at the end of each DuATIS if gas Mouth |) yforrarrry per cent. at
Month of Age. \ or ARC. each Month of Age.
AGE. 1
2 ba | in Mea
12 = | Be ae
13 | 1 12
MonrTus. '
In y. In ||_ In By In In By in
Healthy} Euglish} Liver- Healthy English) Liver: ||Healthy English) Liver-
Dis. | Life | pool | Dis-’ | Life | pool Vis- | Life | pool
tricts. | Table, |District.:| tricts. | Table. District. | tricts. Table.* District.
0 100,000 | 200,000 | 100,000 3,661 4,650 5,419 440751 | 57°132 | 67°219
1 96,339 95,350 94,551 1,161 1,720 2,463 14°549 | 21°837 | 31°672
2 95,178 93,630 92,088 806 1,218 1,724 10°205 | 15°710 | 22°678
3 94,372 92,412 90,364 683 1,010 1,563 8°716 | 13°187 | 20°937
4 93,689 91,402 88,801 631 955 1,506 8°109 | 12°604 | 20°525
5 93,058 90,447 87,295 584 903 1,469 7°554 | 12°050 | 20°365
6 92,474: 89,544 85,826 542 855 1,453 7054 | 11°509 | 20°489
7 91,932 88,689 84,373 504 808 1,458 6°597 | 10°992 | 20°917
8 91,428 87,881 $2,915 470 766 1,482 6°185 | 10°501 | 21°6 £2
9 90,958 87,115 81,433 441 9725 1,528 5°832 | 10°033 | 22°730
10 90,517 86,390 79,905 416 687 1,594 5°528 | 9'584 | 24°180
11 90,101 85,703 78,311 396 652 1,680 5°286 | 9°161 | 26°023
|
12 89,705 85,051 76,631 = = = _ = _
|

 

 

 

 

 

 

 

 

 

 

 

Nore.—By moving the decimal one place to the right in each of the last three columns, the
results will represent the annual rate of mortality per 1000.

* Sce Supplement to Registrar General’s 25th Annual Report, p. vii.

In Liverpool the mortality was 672 per 1000 under one month of age,
317 at one month, 227 at tivo months, and 204 at five months, after
which age, the mortality, instead of decreasing, as in the healthy districts,
increases to 205 at six months, 216 at eight months, 242 at ten months,
and 260 at eleven months of age.

So unfavourable to infant life are the unsanitary conditions of large
towns—especially Liverpool—that not only is the mortality at some
months of age twice as high as it is in the healthy districts, but at
7 months of age and upwards it is three times as high. The mortality
of infants by lung diseases is higher in Liverpool than in any other
large town.

The mortality of children under one year of age ix 111 per 1000 in
the healthy districts of England, and 229 in Liverpool, but the rate at
each month of age differs considerably, decreasing rapidly from birth, as
will be seen by reference to the above Table.

The subjoined Table shows in « striking manner how much depends,
at, the starting point of life, whether infants breathe tbe poisoned air of
large towns, or the fresh pure atmosphere of healthy districts.
DEATHS. | 201

Number and Proportion of Dearus at pirrerent Monrus of AGE
to 1000 Brrrns in the Heatruy Districts and in LiverPoot in
the Hight Years 1839-46.

 

 

 

 

 

 

Prorortion of
DEATHS. Deratus at cach Month

of Age to 1000 Brrrus.| Excess

Monrns. in

In 63 cae In 63 fare Liverpool.
Healthy | ™ Live | peatthy | 1 Tiver-
Districts. | P°°% |) Districts. | PO

Total under 1 year - 52,833 16,133 110°5 228°9 118°4
0 18,790 3,762 39°3 53°4 14°71
1 5,956 1,700 12°5 24°] 11°6
2 4,135 1,190 86 16'9 8°3
3 3,505 1,079 7°3 15°3 8:0
al “ 3,239 1,040 6:8 14°7 79
5 + 2,997 1,014 6°3 14°4 81
6 2,781 1,003 5°8 14°2 8:4
7 2,586 1,007 574 14°3 8-9
8 2,411 1,023 5:0 14°5 9°5
9 2,264 1,055 4°7 15°0 10°3
10 - 2,136 1,100 4°5 15°6 111
11 2,033 1,160 4:3 16°5 12°2

 

 

 

 

 

 

 

 

Nortt.—The total births in the eight years 1839-46 were 478,048 in the Healthy Districts, and
70,491 in Liverpool.

Thus in Liverpool the mortality of children under one year of age
was at the rate of 229 deaths per 1000, 53 of which deaths were of
infants under one mouth of age, 24 of one month of age, and so on for
each month of age in the Table.

In the healthy districts the mortality of children under one year of
age was at the rate of 111 deaths per 1000, 39 of which deaths were of
infants under one month of age, and 13 of one month of age.

The difference, therefore, in the rate of mortality of children under
one year of age in Liverpool, and in the healthy districts, was 118, of
which, 14 were by deaths under one month of age, 8 by deaths at two
months of age, and so on. (88th Annual Report, pp. xlviii-1.)

Mortality of Children (0-5) in Registration Districts 1851-60.—
Death in childhood is an unnatural event, inasmuch as the regular series
of development of the human structure from the germ-cell to the
perfect man in his prime, and in his last declining stage of existence, is
interrupted. But life at all ages depends upon so many conditions, and
is exposed to so many risks, that out of given numbers living some die
at every age, and we can only take for a practical standard the lowest
authenticated rates of mortality,

Thus in the 63 Healthy Districts of England the annual mortality of
boys under five years of age was at the rate of 4°348, and of girls 3°720
per cent.; the mean being 4°034.

Twenty-eight districts have been selected, showing the low annual
rate of mortality 3°348 for the mean of the rates of the two sexes: the
boys dying at the rate 38°576, the girls at the rate 3'120,
£02 [PART IV.

The twenty-eight districts are found in all the regions of Mngland
and Wales, from the northern limits of Northumberland to the New
Forest on the Southampton Waters.

The mortality was at the annual rate of 2°317 in Bellingham ;
2-593 for boys, 2°040 for girls. ‘This rate is only slightly exceeded in
the adjoining district of Rothbury, also on the border of North-
umberland; and in Bootle north of the Duddon on the coast of
Cumberland.

The mortality among the families of the British Peerage has been
investigated with much care and ability by Mr. A. H. Bailey and
Mr. A.’Day.* They confined their investigations to the peers, the
children of peers, and the children of the eldest sons of peers living in
the present century. The numbers existing on December 31, 1855,
were 4,282; 2,283 males, and 1,999 females.

The mortality of peers’ children under five years of age was at the
rate of 2°069 per cent.; among boys under five years of age 2°227,
girls 1-882.

The number of facts for the peerage is small; as the deaths of boys
were 274, of girls 196; or 470 in the aggregate. For Bellingham the
deaths of boys in ten years were only 112, of girls 82; 194 in the
aggregate. The districts of the lowest mortality are very thinly peopled,
but there is no reason to suspect that any of the deaths are unregistered.
And the mortality only proceeds gradually step by step up to 3°500 in
many other districts.

Dr. Joseph John Fox, in a valuable paper on the vital statistics of the
Society of Friends, found that by the returns in the “ Annual Monitor”
the mortality under five years of age in 1842-52 was at the rate for boys
of 3°190, of girls 2°383.t This mortality differs little from the mortality
of the peerage. Another return makes the mortality of the boys of
Friends 5°598, of the girls 4° 733.

The mortality of 1,087 children of the clergy has been investigated
hy the Rev. John Hodgson, M.A., who procured returns in 1829 and
1858 from the parents; the mortality of the boys was at the rate of
3°729, of the girls at the rate of 2302 in the years under observation ;
making the mean mortality of the sexes 3°027.t

Very different are the rates of mortality among children in one
hundred and fifty-one districts; where the lowest mortality among boys
is at the rate of 7°084, and the highest at the rate of 13-741 per cent.
annually. The mean mortality of the districts was for boys 8° 593, for
girls 7°482, for both sexes 8:013.

These mean rates are obtained by adding up the district rates, and
dividing by the number of districts.

The population of children in the one hundred and fifty-one districts
was 1,391,420 in 1861; and the annual deaths at the rate (3'348)
of twenty-eight healthy districts would be 45,585; while at the
mean rate (8°013) it would be 111,494. Thus there is an annual
sacrifice of about 64,909 children’s lives by various causes in one hundred
and fifty-one districts of the kingdom.

The mean annual mortality of children under five years of-age was
10°022 per cent. in Sheffield, 10°149 in East London (City), 10°203 in
Coventry, 10°219 in Nottingham, 10°246 in Whitechapel, 10°277 in

 

* Assurance Magazine, vol. ix., pp. 305-326.

+ Journal of Stat. Society, vol. xxii., p. 219 and p. 220. Dr. Fox says this
rate “is obviously much too low,” and on that ground suspects that the returns are
defective.

{ Observations on the duration of life among the clergy by the Rev. John
Hodgson, M.A., Table 4, p. 36.
DEATHS. | 203

Leeds, 10°480 in Wolverhampton, 10°852 in St. Giles (London), 11°725
in Manchester District, and 13°198 in Liverpool District.

' There is no doubt great negligence on the part of the parents, great
ignorance of the conditions on which hea'th depends, and great privation
, among the masses of the poor, but there is no reason to suspect that any
| great number of the infants in these districts fall victims to deliberate
| crime; yet the children of the idolatrous tribe who passed them through
| the fire to Moloch scarcely incurred more danger than is incurred by the
\ children born in several districts of our large cities.

~ A strict investigation of all the circumstances of these children’s lives
might lead to important discoveries, and may suggest remedies for evils
of which it is difficult to exaggerate the magnitude.

The weaklier lives, it is said, are, under this state of things, cut off;
but it must also be borne in mind that many of the strongest children
are wounded and are left weakly for life——(Supplement to 25th Annual
Report, pp. ix—xiii.)

Mortality of Children (0-5), 1861-70.—The first thing to observe is,
that the fatality children encounter is primarily due to the changes in
themselves. Thus 1,000,000 children just born are alive, but some of
them have been born prematurely ; they are feeble; they are unfinished ;
the molecules and fibres of brain, muscle, hone are loosely strung
together ; the heart and the blood, on which life depends, have under-
gone a complete revolution; the lungs are only just called into play.
The baby is helpless; for his food and all his wants he depends on
others. It is not surprising then that a certain number of infants
should die; but in England the actual deaths in the first year of age
are 149,493, including premature births, deaths by debility and atrophy ;
diseases of the nervous system 30,637, and of the respiratory organs
21,995. To convulsions, diarrhoea, pneumonia, bronchitis, their deaths
are chiefly ascribed ; little is positively known; and this implies little
more than that the brain and spinal marrow, nerves, muscles, lungs,
and bowels fail to execute their functions with the exact rhythm of
life. The first two are said by pathologists to be often rather symptoms
of diseases unknown than diseases in themselves. The total dying by
miasmatic diseases is 31,266; but it is quite possible that several of the
children dying of convulsions die in the early stages of some unrevealed
zymotic disease, whose symptoms have not had time for development.
Convulsion is a frequent precursor in children of measles, whooping-
cough, scarlet-fever, fever: indeed, Dr. C. B. Radcliffe well remarks
“in the fevers of infancy and early childhood, especially in the
“ exanthematous forms of these disorders, convulsions uot unfrequently
“ takes the place occupied by rigor in the fevers of youth and riper
‘* years.”* Many of the cases of pneumonia may also in like manner
be whooping-coughs and other latent zymotic diseases. In the second
year of life pneumonia, bronchitis, and convulsions are still the
prevalent, and most fatal diseases ; many also die then of measles,
whooping-cough, scarlatina, and diarrhcea. Scarlet fever asserts its
supremacy in the second, third, fourth, and fifth years of age,
Whooping-cough is at its maximum in the first year, measles in the
second, scarlatina in the third and fourth years. Thus these diseases
take up their attacks on life in succession and follow it onwards.

The deaths from all causes under the age of five years are 263,182,
The number ascribed to infanticide is very few; but the deaths b
suffovation (overlaying) &c., are more numerous; and so aré the

 

* A system of Medicine by Reynolds, vol. 2, p. 593. Article on Diseases of
Spinal Cord.
204 [PART Iv.
deaths directly referred to the “ want of breast-milk.” The total
deaths by burns, injuries, drowning, and all other kinds of violence,
are 5,175,

By a physiological law 511,745 boys are born in England to 488,255
girls ; and by another law 141,387 boys and 121,795 girls die in the first
five years of life; so that at the end of five years the original disparity
in the numbers of the two sexes is so much reduced that at the age of
five years the boys only slightly exceed the girls in number. The
greater mortality of boys is due to difference of organisation, for the
external conditions are substantially the same in which boys and girls
are placed.

Great as is the influence of organization itself, the difference of
external circumstances and sanitary condition exercise a very real
influence on life, disease, and death in childhood.

‘Thus, even in the healthy districts of the country, out of 1,000,000
born, 175,410 children die in the first five years of life; but in Liverpool
District, which serves to represent the most unfavourable sanitary
conditions, out of the same number born, 460,370, nearly half the
number born, die in the five years following their birth. This is
284,960 in excess of the deaths in the healthy districts.

Of 1,000,000 CuiLpRen Born ALIveE in the Hveattuy Districts in
ALL ENGLAND, and in the Disrricr of Liverroo., the NumBeErs

 

 

 

 

dying under Five Years of Age from Ninereun Groups of
Causes.
Hearruy : _, | LIVERPOOL
Districts. ENGEAND, Distrricr.
DuaTHs FROM ALL Causes 175,410 263,182 460,370
TotaL Zymotic Disuases - 49,761 87,099 171,009
Small-pox 602 3,331 5,175
Measles - pede 11,507 25,514
Searlatina 11,373 17,959 26,818
Diphtheria - 4,184 2,425 3,395
Whooping-cough - 9,650 14,424 32,551
Fever (Typhus, Enteric, and Simple) 2,807 5,401 9,297
Diarrhea and Dysentery 9,354 20,344 51,911
Cholera - 399 1,129 4,255
Other Zymotic Diseases 6,135 10,579 12,093
Cancer - - 110 71 62
Serofula and Tabes Mesenterica 5,335 8,115 11,694
Phthisis - - 2,656 4,469 5,116
Hydrocephalus - 6,604 9,296 14,972
Diseases of the Brain 22,692 40,065 49,240
Diseases of the Heart, and Dropsy 1,304 1,507 2,038
Diseases of the Lungs - 27,884 41,476 79,893
Diseases of the Stomach and Liver 4,431 4,778 4,874
Violent Deaths - 4,232 5,175 17,107
Orgrer Causys 59,401 61,181 103,765

 

 

 

 

 

 

The above Table shows how many children die from the several
groups of causes (1) in the healthy districts, (2) in all England, and
(8) in the Liverpool District. There is a greater increase in Liverpool
from small-pox and measles than from scarlet-fever ; aud diphtheria
was more fatal in the healthy districts than in all England. Diarrhea
and cholera were greatly aggravated in. the other districts of England ;
DEATHS. | 205

so were whooping-cough, and fever, under which were registered
typhus, typhoid, infantile remittent, and relapsing fever. The diseases
of the lungs are more fatal to children in Liverpool than diseases of
the brain.

The children of Norway fare better than the children of sunny Italy ;
to which it may well be still an officina gentium. Out of 100 children
born alive the deaths in the first five years of life are in Norway 17,
Denmark 20, Sweden 20, England 26, Belgium 27, France 29, Prussia
32, Holland 33, Austria 36, Spain 36, Russia 38, Italy 39. Russia is
almost as fatal to her children as Italy.

In a paper* read before the Statistical Society the methods of deter-
mining the rates of mortality were described, and I collected information
as to the treatment and management of children in Scotland, Norway,
Sweden, France, and Austria, The subject was taken up in England
by the Obstetrical Society, who published an able report based on
returns, on the birth and treatment of English children.f I have not
yet received papers from Russia or Italy.

The mortality .of infants evidently depends, to some extent, on the
midwifery of a country; on the way the children are fed by the
mothers ; on the water;.and on the cleanliness observed, as well as
the other sanitary conditions.—(Supplement to 35th Annual Report,
pp. XXvili-xxx.)

Mortality of Children in European States.—In the first place, let us
ask how many children out of 1,000,000 born alive sce their fifth
birthday—live five years ?

In the north, there is the fine free population of Norway, scattered
over the habitable parts of a large well-watered territory, in some parts
fruitful or covered with pine forests, in other parts sterile: in addition
to fish in their waters and agricultural produce, they derive profits from
timber, mines, and ships. The climate is severe, but on the western
Atlantic slope the severity is softened by the Gulf Stream. In some of
its features we are reminded of Scotland.

Out of 100 children born in Norway, 83 attain the age of 5 years ;
in Sweden 80; in Denmark 80, including Schleswig and Holstein down
to the Elbe, the country of the Angles of old; in England 74; in
Belgium 73; in France 71; in Prussia 68; in Holland 67; in Austria
64; in Spain 64; in Russia 62; in Italy 61.

Thus the chance is always in favour of the life; but here it is 8 to 2,
there only 3 to 2.

What is the proportion of deaths under the age of 5 out of 100
children that see the light? In Norway 17; Denmark 20; Sweden
20; England 26; Belgium 27; France 29; Prussia 32; Holland 33;
Austria 86; Spain 36; Russia 38 ; Italy 39.

Thus Death, drawing lots for the lives of children, has in one part
of Europe 2, in another 4 out of 10 in his favour.

Out of 100 cbildren born in addition to the number 17 dying in
Norway, 3 die in Denmark, 3 in Sweden, 9 in England, 10 in Belgium,
12 in France, 15 in Prussia, 16 in Holland, 19 in Austria, 19 in Spain,
21 in [ussia, 22 in Italy. Thus in the sunny climate of the south,
death carries off two children from Italians for every one he takes in high
latitudes from Norwegians.

Tn all England 26 children under 5 years of age die out of 100 born ;
but in her healthy districts she loses only 18, nearly the same number

* Mortality of Children in the Principal States of Europe, in the Journal of
Statistical Society, vol. xxix., pp. 1-35.

{ Republished in the Appendix to the Registrar General’s 34th Report,
pp. 225-9.
206 [PART Iv.

as Norway ; while in her thirty large town districts,* 36 perish. There
is the same contrast between the country and the city as there is
between Norway and Italy. In France I find contrasts of the same
sort in the departments.

If we turn to particular classes the mortality presents still larger
contrasts: according to the peerage records, out of 100 children born
alive, 90 survive; 10 die in the first 5 years of age. The deaths
among the children of the clergy are nearly in the same proportion.f

The proportions have been reversed in some foundling hospitals.

For reasons which I have explained, the rate of mortality is only
exactly determined by comparing the average numbers living with the
deaths in a given time. That we can do for eleven of the States of
Europe.

We are able in some States to marshal our little troops in three
regiments, the first of babes under 1, the second of children of 1—3,
the third of children of 3—5.

By the English Life Table, of 100 children born, 15 die in the first
year, 5 in the second, ¢ in the third year, 2 in the fourth, and 1 in the
fifth; making 26 in the 5 years of age. Of the 15 who die in the first
year, 5 die in the first month of life, 2 in the second, and 1 in the third.

The annual rate of mortality in the first week of life in France is
154 per cent.; and the greater the mortality in any country generally,
the greater is its excess in the first days of life.—(Journal of Statistical
Society, Vol. xxix., pp. 3-5.)

Infant Mortality, and Census Enumeration of Children—A few
preliminary observations are necessary in reference to the facts, to the
mode of their record, and to the trustworthiness of the evidence of their
observers. The facts themselves are sufficiently obvious: the birth,
and the death, and the existence of a child admit, except in the rarest
instances, of the easiest possible verification. With regard to the
designation of age, that is a different affair; on an average nearly 2,000
children are born daily in England and Wales; 14 every 10 minutes—
more than one per minute. Hence if for the sake of great scientific
precision, the age of infants in their first year had to be expressed in
minutes, we should have them of all ages—from one minute to 525,949
minutes. Mothers state the age in weeks or months, up to twelve or
twenty-four montlis, and after the age of one year, people are generally
satisfied with the age stated in years. Unfortunately among the highest
ciass of authorities, there are two different common modes of expressing
the approximate age ; and two different ages are expressed by the same
numbers. Thus, a person of the age 31 and 360 days, is set down as
32 at an insurance office, and as 31 at an office for the sale of annuities.
He is 31 or in his 32nd year in ordinary language: his nearest age in
years is 32 years, as he would be called if fractions of years were
expressed decimally, and decimals were dropped. Thus it is the rule
to write 31°4 in ronnd numbers 31, and 31°5 is written 32. The
ordinary practice is to call a man 31 until he is 32; and it is usually
assumed, with sufficient accuracy, that of a body of men so called, the
mean age is 314 years. There is, however, another mode in use; thus
a child of two years and 11 months, is in séme places, and by some

 

* Comprising St. Giles, Holborn, East London, St. George-in-the-Kast, St. Saviour,
Southwark ; St. Olave, Southwark; St. George, Southwark ; Southampton, Yar-
mouth, Norwich, Salisbury, Exeter, Bristol, Wolverhampton, Birmingham, Leicester,
Nottingham, Derby, Liverpool, Wigan, Bolton, Salford, Manchester, Ashton-under-
Lyne, Preston, Leeds, Sheffield, Hull, Newcastle-upon-Tyne, and Merthyr Tydfil.

t See authorities cited in Supplement to Registrar-Gcneral’s Twenty-fifth Report,
p. xii.; reprinted in this Vol. on p. 202.
DEATHS. | 207

classes, called a child in its third year of age. They write its age as
3 years in figures, whereas, according to the other mode ef expression,
the child’s age is 2 years.

The mode of stating age among statists is by no means settled: our
life and population tables now begin with zero, thus :—

 

 

Age. Living. Dying. | Population.
0 1,000 149 | 903
1 851 54 818
2 - 797 aR 781

 

 

The table is read thus ; of 1,000 children born simultaneously, 851
live one year, 149 die in the first year of age, and 903 will, on an
average, be found living at a Census in the first year of their age.

Instead of ages 0, 1, and 2, Halley wrote 1, 2,38. Again, the ages
grouped in decennial periods are differently expressed by different
writers; thus in France, Sweden, England, and other countries, they
write—

0 and under 5 = 0—5.
20 38 30 = 20—30.

The same facts as to age are expressed by Mr, Neison and by some
other actuaries, thus: 0 to 4; 20 to 29, This is not a little puzzling ;
it is not exact; and it would be well if all could agree upon one system
of expressing age, so as to avid ambiguity. In our reports I find it
convenient to write the age of the last birthday, and when the interval
of ave in a group of persons exceeds 1 year, to write the series of ages
accordivg to the same analogy in figures followed by a dash :—

Age.
0o— - = - 787
o— - 643
10—_ - : 511
15— - - - 473

Note.—The table is read thus: 643 persons are of the age 5 and
under the age 10, &c.

With so much variation in the expression of the time a man has
lived—called age—we can scarcely feel surprised to find in the various
censuses of Europe errors in the statements of age directly traceable to
ambiguities of language. In the early years of life these mistakes
demand attention, otherwise they may lead us into such grave mistakes
as we have to notice.

The ages of the population were enumerated in England in the year
1841 for each year of age under 15; and the following is the series of
children returned and classified by the Census Commissioners :—

Children at
Age. each Year of Age under 5
as returned at
the Census of 1841.

o— 6 “ - 427,601
1I— - - 427,966
2— 5 4 - 435,413
ae “ - 408,332

dns B - 399,840
208 [PART IV.

You will observe that. not only the children of 1 and under 2, but
also the children of 2 and under 8 years of age are returned as more
numerous than the children in the first year of age (O—1) ; which,
looking at the increase and great regularity of the births, as well as at
the great number of deaths in the first two years of life, is impossible.
Tn reflecting upon this, it appeared evident to me that this discrepancy
in the ages arose from a certain number of the children in the first year
of age, who should all have been placed against zero (0), having been
earried on to 1; while children in the second year of age, who should
have been set down against 1 year of age, were carried on to 2; where
the excess was at a maximum; the errors afterwards more nearly
counterbalancing each other. We despaired in 1851 of being able
entirely to overcome the difficulty of getting the ages of young children
exactly stated; and the ages of that Census were all given in quin-
quennial periods, as we had better methods of getting the numbers at
the carly ages; and I foresaw that, if the uncorrected facts were
published, they could, for various reasons, be of little use, and might
mislead some unlucky person into an attempt to determine the mortality
of infants by such data.

All the children under 1 year of age on 8th April 1861, must have
been born in the preceding twelve months, when the births registered
were 678,801. If we knew the precise number of births, the deaths
out of that number, as well as the inflow and the outflow of migration
in those twelve months, we should obtain the precise number of infants
living under 1 year of age on the Census day. Such precise knowledge
is not within our reach—the majority of the births are registered within
the first six weeks after their occurrence, and the infants’ deaths of a
year include the deaths of infants born within that year and the year
preceding it. But an approximation to the numbers surviving can be
obtained sufficiently near for the purposes of our argument, from the
mean births of 1860-G1, and the deaths under 1 year of age in 1861.
If the number of annual births remain constant, the number of infants
living in any year must lie between the annual number of births and
that number diminished by the deaths under the first year of age. It
would be nearer the latter than the former number, on account of the
excess of deaths in the first months of life.

The average annual births in the two years 1860-61 were 690,227.
Let us deal, for the sake of simplification, with 1,000 dat/y births, then
of the 1,000 born on the first day of a year a certuin number die day
by day through the year; and as every day a fresh wave of 1,000 lives
emerges to die off at the same or at a similar rate, you will find by
enumeration decreasing numbers one day, two days, three days . . .

. 865 days old in your population. The 365,000 under 1 year of
age are reduced to 829,515 by death. By the English Life Table the
numbers surviving out of 1,000,600 births at the end of every month
of the first year of age are shown; and if it were necessary, the numbers
for each day could be interpolated. From this table carried on the
numbers maintained in the first, second, third, and succeeding years of
life are readily deduced.

The births increase variously in England and Wales, and the deaths
fluctuate ; but by taking the mean births in 1856-57 we get an annual
number of births out of which it may be assumed the deaths in the
first, year of age oceur in 1857, the deaths in the second year of age
oceur in 1858, the deaths in the third year of age oceur in 1859, the
deaths in the fourth year of age occur in 1860, and the deaths in the
fifth year of age occur in 1861. By subtracting the deaths in each
DEATHS. | 209

year of age from the births we get the survivors. The births of 1857-
58 are treated in the same manner.

We thus obtain numbers living at each year of age which will serve
for comparison with the numbers enumerated at the corresponding ages
in the Census year.

Now, if the ages of the children have been at all mis-stated, according
to our hypothesis, the Census numbers of children will be understated
against the ages 0 and 1; but after that age the Census numbers will
be somewhat in excess of the calculated. That, you will observe, is the
case. The Census numbers under five years of age are actually in
excess of the calculated numbers.

The variation in the practice of returning the ages of children is
great in different towns ; and so is necessarily any defect in the regis-
tration of births. And furthermore it is impossible to pass by one
general ratio from the births in a town to the nambers surviving at a
Census; as the deaths in infancy are differently distributed in every
town and year, according as this or that form of disease is prevalent :
convulsions kill the infant of the first month; measles, scarlatina,
whooping cough, kill him later, or in the tenth, eleventh, and twelfth
month. The ages at which the deaths oecur affect the numbers to be
enumerated ; thus, if 200 infants die out of 1,000 in the first hour of
their birth, the Census will find only 800 living under 1 year of age ;
if they die on the last hour of the year 1,000 will be enumerated ; and
under the prevailing laws of mortality the actual numbers will range
between these extremes from 800 to 850, 900, 920, and so on. In
particular towns there will be a greater range of variations between the
numbers of infants living deduced by one formula from the births, or.
the deaths under 1 year, and the numbers actually living on a given day
under 1 year of age. — (Journal of Statistical Society, Vol. xxviil.,
pp. 125-137.)

5. Causes of Draru (GENnrRAD) ; their NoMENCLATURE, CLASsIFICa-.
Tion, and Morratiry.

Importance of Registration of Causes of Death.—Wong before the
commencement of Registration, my attention was turned towards au
object admitted to be of great importance to the improvement of medical
science, namely,—to obtain a faithful statement.of the cause of Death
in the column of the Register set apart for that purpose. It is obvious
that such statements, in order to obtain due credit, ought to be derived,
whenever it is possible, from the medical attendant of the deceased
person, and that therefore it was only from the co-operation and
assistance of the practising members of the medical profession that a
satisfuctory attainment of this important, object could be expected. I,
therefore, in the spring of 1837, communicated on this subject with the
President and Fellows of the Royal College of Physicians, the President
and Members of the Royal College of Surgeons, and the Master and
Members of the Society of Apothecaries, and obtained the concurrence
of those bodies, signified by the signatures of their respective Presidents
and Master appended to a joint circular address, pledging themselves, in
every instance which may fall uncer their care, to give an authentic
name of the fatal disease, entreating all authorised practitioners
throughout the country to follow their example, and to assist in esta-
blishing a better Registration, and inviting them for that purpose to
attend to a subjoined explanatory statement, wherein they would see set

oO
210 [Part ry.

forth the provisions of the recent statute, and the means whereby the
important object so recommended might most effectually be obtained.
The “ Explanatory Statement ” which [had submitted to these corporate
bodies, and which thus received their combined approval, after stating
who are the persons who, according to the Act for Registering Births,
Deaths, and Marriages, in England, must give information to the
Registrar on being requested so to do, “ earnestly recommended that
“ every practising member of any branch of the medical profession
who may have been present at the death, or in attendance during the
last illness of any person, shail, immediately after such death, place in
the hands of such other persons as were in attendance, of the occupier
of the house in which the death occurred, and of some inmate who
may probably be required to give information, written statements of
the cause of death, which such persons may show to the Registrar,
and give as their information on that subject.” Saving done this, I
caused copies of the circular address, with the sabjoined explanatory
statement, to be sent to all authorised practitioners of medicine and
surgery throughout England and Wales, whose names and addresses I
was able to obtain. I have the satisfaction of stating that the measures
thus adopted have been eminently successful, and that even in this first
year of registration-—the commencement of a new system—the result is
such as will not disappoint the expectations of those who hope to derive,
eventually, from that source, materials of vast importance to the
advancement of the science of Vital Statistics.

In order that these materials should be available for such beneficial
purposes, it was obviously essential that they should be duly arranged.
The execution of this task, for the first and second quarters, has been
committed by me to Dr. Farr, a gentleman of the medical profession,
whose scientific knowledge and intimate acquaintance with statistical
inquiries were ample pledges of his peculiar fitness, and whose letter,
including Abstracts of the Causes of Death, and explaining the classifica-
tion which has been adopted, I have the honour to lay before your
Lordship in the Appendix to this Report. (1st Annual Report,
pp. 11-12.)

[The above extract from the First Annual Report of the first Registrar
General, Mr. T. H. Lister, is inserted because it refers to the appoint-
ment of Dr. Farr to the superintendence of the Statistical Department
of the General Register Office, and because it throws light upon the
history of registered causes of death. The circular address above
referred to is printed as the next extract.—EpiTor. |

With reference to the registration of Causes of Death, the following
paper was circulated in May, 18387 :—

“ We, the undersigned, President of the Royal College of Physicians»
President of the Royal College of Surgeons, and Master of the Worshipful
Society of Apothecaries, having authority from the several bodies whom
we represent, to resolve to fulfil the intentions of the Legislature in
procuring a better Registration of the Causes of Death, being convinced
that such an improved Registration cannot fail {0 lead to a more accurate
statistical account of the prevalence of particular diseases from time to
time.

We pledge ourselves, therefore, to give, in every instance which may
fall under our care, an authentic name of the fatal disease.

And we entreat all authorised practitioners throughout the country to
follow our example, and adopt the same practice, and so assist in esta-
blishing a beiter Registration, in future, throughout England ; for which
purpose we invite them to attend to the subjoined explanatory statement,
DEATHS. ] 211

in which they will see set forth the provisions of the recent statute, and
the means whereby the important object we have recommended may
most effectually be attained.
(Signed) HENRY HALFORD,
President of the Royal College of Phy sicians.
(Signed) ASTLEY COOPER,
President of the Royal College of Surgeons.
(Signed) J. HINGESTON,
Masier of the Society of Apothecaries.
lst May, 1837.

Registration of Causes of Death : Explanatory statement—The recent
Act for registering Births, Deaths, and Marriages in England, presents
an opportunity for obtaining that great desideratum in medical statistics,
a more exact statement of the causes of death, in the case of every
registered death throughout the whole of England and Wales, after the
month of June next ensuing.

The Register-Books in which all deaths are to be registered after the
last day of June, 1837, contain columns wherein may be inserted the
cause of death, in juxtaposition with those other important illustrative
circumstances, the sea, the age, and the profession or calling of the
deceased person. Each Register-Book will also be assigned to a particular
district of small extent, and will thus show in what part of the kingdom
each death has occurred. If, therefore, the cause of death be correctly
inserted, there wiil exist. thenceforward public documents, from whence
may be derived a more accurate knowledge, not only of the comparative
prevalence of various mortal diseases, as regards the whole of England
and Wales, but also of the /ocalities in which they respectively prevail,
and the sea, age, and condition of life which each principally affects.

For the attainment of this object, it is necessary to ensure, as far as it
is possible, the correct insertion of the “cause of death.” It is obvious
that on this subject the requisite information van seldom be give to the
Registrar, except by the medical attendant of the deceased person; and
that even if the Registrar be a medical practitioner (which in many
instances will be the case), yet will he often be unable to ascertain the
truth in this respect if he is to depend solely on the reports of persons
ignorant of medicine and of the names and nature of diseases; and it
cannot be expected that from his own knowledge he will be able so far
to correct their errors as to ensure a statement worthy of credit. The
requisite information must therefore be supplied either directly or in-
directly by the medical attendant of the deceased person ;—that is to
say, if such medical attendant is not applied to by the Registrar, he
must afford the requisite information to those other persons to whom the
Registrar must apply.

The persons who, according to the Act for Registering Births, Deaths,
and Marriages in England, must give information to the Registrar on
Deng requested so to do, are “some person present at the death, or in
« attendance during the last illness,” or “in case of the death, illness,
inability, or default of all such persons, the occupier of the house or
tenement ; or, if the occupier be the person who shall have died, some
inmate of the house or tenement in which such death shall have
happened.” It is also provided that, “for the purposes of this Act,
the master or keeper of every gaol, prison, or house of correction,
or workhouse, hospital, or lunatic asylum, or public or charitable
institution, shall be deemed the occupier thereof.”

It is therefore earnestly recommended that every practising member
of any branch of the medical profession who may have been present at

02

a

‘

a

‘

a

‘¢

a

‘

na

‘
212 [PART Iv.

the death, or in attendance during the last illness, of any person, shall,
immediately after such death, plece in the hands of such other persons
as were in attendance, of the occupicr of the house in which the death
occurred, or of some inmate who may probably be required to give
information, written statements of the cause of death, which such persons
may show to the Registrar, and give as their information on that subject.

Tt is desirable that such statement should be very short, the column
in the Register Book in which it is to be inserted being not more than
sufficient for the insertion of about 10 words of moderate length. It
should therefore contain only the name of the disease which was
considered to be the cause of death, and not a detailed account cither of
antecedent symptoms or of the appearances which may have presented
themselves after death. It is also desirable that such statements should
exhibit the popular or common name of the disease, in preference to such
as is known only to medical men, whenever the popular name will denote
the cause of death with sufficient precision.”

The returns procured in the first year were on the whole tolerably
satisfactory ; but, as might have been expected, some of the entries
were incorrect; the information in many instances had not. been
furnished directly by medical men, and had been furnished in ill-defined
words, such as deeline, fit, inflammation, visceral disease, cold, long
illness. Local terms were employed, which appear to denote different
diseases in different parts of the country. In many cases where inquests
were held, no attempt had been made to inquire into the direct cause of
death.

It appeared, therefore, necessary to suggest, as far as was practicable,
the use of a uniform intelligible nomenclature. The following remarks
were made in the Appendix to the First Report ; and a classification was
adopted which has been followed in the subsequent Reports :—

“The advantages of a uniform statistical nomenclature, however im-
perfect, are so obvious, that it is surprising no attention has been paid to
its enforcement in bills of mortality. Each disease has in many
instances been denoted by three or four terms, and each term has been
applied {o as many different diseases ; vague, inconvenient names have
been employed, or complications have been registered, instead of primary
diseases. The nomenclature is of as much importance in this depart-
ment of inquiry as weights and measures in the physical sciences, and
should be settled without delay.

“Tn order to render the Register as correct as possible, it is desirable
that the cause of death should be dircetly certified in every instance by
the medical attendant, who might either leave the certificate with the
informant, or give it upon application to the Registrar. When the
medical attendant is the informant, he will of course sign the register,
as directed by the Act. The certificates of the cause of death might be
in one of the subjoined forms, which present examples of some of the
more common cases.

‘The duration of the fatal disease should be stated, when known, in
hours, days, or years; which would supersede the words ‘sudden,’
‘acute, ‘chronic,’ &e., and in the end furnish many highly important
results.” /

Further experience has confirmed these remarks ; and it has been
deemed desirable to revise the nomenclature, and to make such alter-
ations and additions as the rapid progress of medical science required.—
(4th Annual Report, pp. 144-6.)

Practical Utility of Registered Causes of Death.—The registration
of births and deaths proves the connection of familie=, facilitates the
DEATHS. | 213

legal distribution of property, and answers several other public purposes
which sufficiently establish its utility; but in the performance of the
duty with which you have been pleased to intrust me, I have to examine
the registration under a different point of view, and with different
objects, which will perhaps ultimately prove of not less importance.
The deaths and causes of death are scientific facts which admit of
numerical analysis; and science has nothing to offer more inviting in
speculation than the laws of vitality, the variations of those laws in the
two sexes at different ages, and the influence olf civilization, occupation,
locality, seasons, aud other physical agencies, either in generating
diseases and inducing death, or in improving the public health.

One of the many obvious applications of the facts will be to the
promotion of practical medicine. The extent to which epidemics vary
in different localities, seasons, and classes of society, will he indicated by
the registered diseases ; and the experienced practitioner, wherever he may
be placed, will learn to administer remedies with discrimination, and with
due reference to the circumstances of the population. He will discover
that the characters of diseases change, and will not treat a pneumonia
in the same way in Whitechapel and in Westmorland, if it appear,
from the causes of death, that the diseases and constitution of the popu-
lation present striking discrepancies. The modifications in the character
of diseases, and in the medical treatment, are indicated pevhaps more
accurately by the prevailing epidemics than by either the temperature,
the hygrometricity, or any other appreciable condition of the atmo-
sphere; and it was Sydenham’s ¢octrine that the treatment of acute
diseases should lave a reference not only to the immediate symptoms,
and to the seasons, but also to the epidemic constitutions of the year and
place. A national system of Registration like the present can alone
indicate the characters of the diseases in every district; and determine
how far the practice taught in the schools, or illustrated in crowded
hospilals, and in the unhealthy parts of the metropolis, among the
destitute poor, may require modification among other classes of society,
and in other localities.

The registration of the diseases of the several districts will furnish
medical men with a series of valuable remedial agents. It will designate
the localities where disease is most rife, and where there is the least
tendency to particular classes of sickness and infirmity. In recom-
mending a residence to patients the physician will find the registered
causes of death un indispensable directory ; and the utility of a sanitary
map of the country, such as the returns will furnish, cannot fail to be
felt in England, where a part of the population is constantly migrating
from place to place in search of health. Much information has been
collected respecting the influence of the English climate ; but the facts
will bring to light many salubrious spots hitherto unknown, and disclose
the dangers which infest others unsuspected. Invalids resort to some
unhealthy places; families carry their children in the autumn into
districts where small-pox and measles arc often epidemical, or go into
parts of the country where, as the registration shows, bowel complaints
and fevers are extraordinarily fatal.

The registration of the causes of death, besides contributing to
practical medicine, will give greater precision to the principles of
physic. Medicine, like the otier natural sciences, is beginning to
abandon vague conjecture where facts can be accurately determined
by observation ; and to substitute numerical expressions for uncertain
assertions. ‘The advantages of this change are evident. The prevalence
of a disease, for instance, is expressed by the deaths in a given time
out of a given number living with as much accuracy as the temperature
214 [PART IV.

is indicated by a thermometer ; so that when the mean population of
the district is known, the rise and decline of epidemics may be traccd
exactly, and it will then be possible to solve the problem, whether
certain tribes of epidemic disorders constantly follow others, in one
determined series ov cycle. Loose phrases ave still current, for which
numerical formule will be substituted. Sydenham, one of the most
accurate of medical writers, in speaking of small-pox, employed such
terms as these: (1661) “It prevailed a little, but disappeared again.”——
(1667-9) “The small-pox was more prevalent in town for the first two
“ years of this constitution than I ever remember it to have been.’—
(1670-2) “The emall-pox arose; yielded to the dysentery; returned,”
&c., &c. These terms admit of no strict comparison with each other ;
for it is difficult to say in which year the small-pox was most fatal, and
impossible to compare Sydeuham’s experience thus expressed with the
experience of other writers in other places and other ages; for
“prevailed a little,” “raged with violence,” and similar terms, may
imply either that small-pox destroyed 1, or 2, or 5, or 10 per cent. of
the population. The superior precision of numerical expressions is
illustrated by a comparison of Sydenham’s phrases with the London
bills of mortality in the same years.

Deatrus from SMALL-Ppox in London.

 

Deaths. | Years. Deaths.

 

Years. Deaths Years. Deaths | Years.

 

 

 

|

|
1661 | 1,246 | 1666 38 1671 1,465 || 1676 359
1662 768 || 1667 1,196 | 1672 696 | 1677 1,678
1663 411 | 1668 1,987 \ 1673 1,116 || 1678 1,798
1664 1,233 1669 951 | 1674 853 | 1679 1,967
1665 655 1670 1,465 | 1675 2,507 |. 1680 689

|

 

The 1,987 deaths from small-pox in 1668, and the 951 deaths from
that disease in the year following, express the relative intensity of
small-pox in distinct terms. The method of the parish clerks, although
imperfectly carried out, was the best. Sydenham guessed the quantity
with sagacity, and called it great or small; the parish clerks measured
it, and stated the results in figures. The present Registers will furnish
medical science with an unbroken series of observations expressed
numerically.

Only a limited number of facts fall under the notice of a single
observer. His opinions, when they are the results of his own experience,
are stated in general terms, and are often adopted by others in entirely
different circumstances. Notwithstanding the constancy of nature, this
leads to serious practical errors. Hippocrates wrote his immortal
works in Asia Minor and Greece, in a particular climate, stage of
culture, and civilization ; yet all his precepts were taken for the guide
of his successors in England, France, and Germany. The therapeutic
doctrines of Sydenham, who lived in Pall Mall, and practised principally
in Westminster, spread through Enrope. The celebrated Broussais’
theory of irritation and gastro-enterite originated in the French camps.
The physicians of this country, when the causes of death are universally
recorded, and recorded accurately, will be saved from the fallacies of
partial generalization ; and, with the results of the registry before them,
will be enabled to obtain extended views of the nature, courses, and
modifications of diseases. They will have, as a basis for deduction
DEATHS, | 215

their own observations, and those of every medical practitioner in
England and Wales, in all places, and in all times; for the national
Registration goes on iu winter and summer, in spring and autumn; and
it extends to all parts of the kingdom and to all classes of society.

The works of Huxham, Haygarth, Short, Heysham, Heberden, Willan,
Bateman, and many recent medical writers, present illustrations of all
these propositions; although they rarely had access to sources more
authentic than the Bills of Mortality.

Any improvement in the treatment of disease, and any addition to
medical science, will tend ultimately to the diminution of human
suffering ; but the registration of the causes of death is calculated to
exercise a still more direct influence upon public health. Diseases are
more easily prevented than cured, and the first step to their prevention
is the discovery of their exciting causes. The Registry will show the
agency of these causes by numerical facts, and measure the intensity
of their influence. The annual rate of mortality in some districts will
be found to be 4 per cent., in others 2 per cent.; in other words, the
people in one set of circumstances live 50 years, while in another set
of circumstances, which the Registraticn will indicate, they do not live
more than 25 years. In these wretched districts, nearly 8 per cent.
are constantly sick, and the energy of the whole population is withered
to the roots. Their arms are weak, their bodies wasted, and their
sensations embittered by privation and suffering. Half the iife is
passed in infancy, sickness, and dependent helplessness. In exhibiting
the high mortality, the diseases by which it is occasioned, and the
exciting causes of disease, the abstract of the Registers will prove, that
while a part of the sickness is inevitable, and a part can only be expected
to disappear before progressive social amelioration, a considerable
proportion of the sickness and deaths may be suppressed by the general
adoption of hygienic measures which are in actual but partial operation.
It may be affirmed, without great risk of exaggeration, that it is possible
to reduce the annual deaths in England and Wales by 50,000, and to
increase the vigour (may I not add the industry and wealth?) of the
population in an equal proportion ; for diseases are the iron index of
misery, which recedes before strength, health, and happiness, as the
mortality declines.—(1st Annual Report, pp. 86-9.)

slnalysis of Causes of Death—To avoid confusion, I must state iu
what sense the term “cause of death ” is here understood. A man falls
from a height, and breaks his neck; a woman takes arsenic, which
corrodes the coats of the stomach, and in both cases death is the result.
The arsenic and the fall, or the fracture of the neck and the corrosion
of the stomach, may be viewed as the causes of death. Both should be
registered, and both may be separately considered. A person swallows
prussic acid, and although the prussic acid be discernible, no evident
material alteration of structure may be discovered. The second cause
of death cannot be ascertained. When an inflammation or a cancer
proves a cause of death, the material change in the organization is
sufficiently apparent; but there is no connexion with any external
element; or a connexion, if it exists, cannot be traced with anything
equivalent to the primary cause in the cases of violent death. Deaths
may, therefore, be divided into two classes, passing into cach other, but
as distinct as day and night; the first class comprising all that can be
referred to external violence, suffocation, poison, lightning, and fire ;
the second, such as under certain circumstances spring up spontaneously
in the organization, and are represented by inflammation, cancer, and
rheumatism. A reader, unacquainted with medicine, may conceive the
216 [Parr Iv.

nature of the latter class of causes by reflecting, that if a watch or a
machine is destroyed by dashing it upon the ground, or throwing it into
the fire, its motion may also be arrested by internal causes, having their
source in its own mechanism ; particularly if he bear in mind that there
are innumerable processes going on in the body which are not mechanical,
a change in which will destroy life, as the acid fermentation destroys
milk or wine, without any mechanical agency.

Independently of external injury, the human body has a tendency to
death ; but the tendency to life is stronger in almost every instant of
existence. Let the liability to death be expressed by the deaths cut
of 100 living a year at the ages 20-30, then the chance of dying in the
year is but 1, and the opposite tendency, or the chance of living, is 99.
The probability of living, and the probability of dying, vary at different
ages, and in different circumstances: but how much soever the two
probabilities vary in their relations, they may always be conceived as
existing.

If the human frame have in itself the principles of death, they possess
very diversified characters. Particular classes of diseases reign in
different regions and seasons, but cases appear to occur in all climates,
to demonstrate that every kind of malady can arise where man can
subsist. ‘This tendency to diseases—the morbid diathesis—is seen in
families that are surrounded by the same exicrnal circumstances ; where
some suffer from asthma, some from gout, some from insanity, some
from phthisis. There must, it is evident, be here a predisposition to
disease, or it would not be stronger in one than in another, and different
families would not be peculiarly subject to this or that form of malady,
this or that kind of death. The human race, aud every large section
of the race, may then be considered as having hereditary predispositions
to the pathological phenomena designated «liseases, in such a way that
children are not generally born with disease, but in the successive
changes which they undergo, from the first throb of life to their final
evolution, there is besides the upward, onward impulse, a principle
which draws a certain number within the sphere of disease and
mortality.

The analysis of disease is still imperfect ; and at first its multitudinous
species were, like other natural objects, ouly separated into large
groups. Plagues were the first diseases distinguished. They destroyed
a great number of lives in a short time and at uncertain intervals, and
inspired the people with wonder and terror. Neither the Jews, Greeks,
nor Romans, however, described with precision the plagues which they
witnessed. All kinds of epidemics were designated by the generic
term pestilence; and the characteristic symptoms escaped even the
classical historians. It is still undecided whether the plague of Athens,
described elaborately by Thucydides, was small-pox ; and it is absolutely
impossible to identify the numerous plagues which Livy has recorded.
This should excite little surprise. When an object falls under a writer’s
notice for the first time he seizes its striking features and effects, and
frequently overlooks the characteristic traits, which can be learned only
by a careful, frequent comparison with other kindred objects. Linneus
has defined in two lines many plants and animals, which eminent
travellers have failed to characterize in several pages of description.
By studying each kind of plague, analysing its symptoms, and noting
the order of their succession, nosologists have found that while all
plagues agree in destroying great numbers in a short time, at uncertain
intervals, they differ essentially in the symptoms, duration, and fatality ;
in the numbers and classes that they attack; and in the mode and
rapidity of their diffusion. Inquirers have succeeded, in the course of
DEATHS. | 217

several centuries, in analysing plague, and distinguishing under that
gencric designation several diseases. The early historians recorded the
occurrence of plague, painted its ravages, and in their narratives seldom
seized the characteristic symptoms. Hippocrates, Galen, and the Greek
physicians, gave accurate descriptions of several species, but confounded
or divided crroneously, or did not delineate others, partly through
ignorance of anatomy, partly from oversight, but principally from the
law which makes the analysis of diseases, like every other department
of medicine, a progressive process.

Besides plagues, the tempests of the atmosphere of life, there is
another vast, noiseless legion of diseases, marching at an even pace,
neither exhibiting aggravation, nor creating sudden desolation, but
never halting day nor night, and less under the control of external
circumstances than epidemics. They are named sporadic diseases by
medical writers, and are the ordinary maladies of every day occurrence.
It is left for the registration to decide whether they participate at all in
the fluctuations of epidemics. The line of demarcation between them
and plagues is sufficiently broad; but as epidemics approach ordinary
diseases, prevail sporadically, and only break out epidemically at
intervals, it is not unlikely that certain sporadic diseases take a colour
of the plague character.

Sporadic diseases are found to differ from each other in their
symptoms, course, termination ; and in the organs which they affect. A
part wastes (atrophy), or grows too large (hypertrophy); is infested by
a new formation (carcinoma, melanoma), or is irritated and destroyed
by a morbid deposit (tubercles). The phenomena of inflammation,
hemorrhage, dropsy, mortification, gout, rheumatism, diabetes, mark
distinct species. Again, the body is an aggregate of organs and systems,
each of which performs its offices separately, but in singular harmony
with the whole frame: the organs and functions then form another
ground of subdivision ; and as inflammations of the brain, of the lungs,
and of the kidneys, present different trains of symptoms, they are
considered separate species. ‘Two or three diseases, as thus distinguished,
may co-exist; they give place one to the other, run into various com-
plications, and present irregularities, which sometimes render the
diagnosis difficult, But this does not ordinarily happen. If the nature
of a disease be not detected at once by a practised eye, its history,
causes, and termination dissipate the obscurity.* Pathological anatomy,
chemistry, the stethoscope, and other instruments of investigation, have
greatly facilitated the analysis of diseases. They have led to the
formation of new species, and to the more accurate definition of known
species; they have also shown that symptoms of the same organic
alteration were often mistaken by the early writers for distinct diseases.
Sauvages described 3800 genera and innumerable species of diseases in
his Nosology. The interminable catalogue appears to have appalled
M. de Ratte, who exclaims, in his eulogy of Sauvages, Quel nombre
prodigieux @ennemis! The genera, in Cullen’s Nosology, amount to
151; Good has 137 genera in his Nosology, and 490 species, besides
varieties. Exclusive of malformations the species amount to 465, of
which 234 may, perhaps, be fatal at, one time or another. The diseases
enumerated in the first London Bills of Mortality did not exceed
65 in number; 199 occur in the Bill of Mortality for Philadelphia
(1836). The extent to which the analysis of diseases is carried must
depend upon circumstances; and for statistical purposes, although the

 

* Distinctionem morborum aliquando difficilem esse, fatentur omnes; possibilem
autem in plerisque, fateri etiam oportet ; nam si quis hoc negaverit, idem fecerit, ac
si nullam esse artem dixisset.—Cullen’s Synopsis Nosologie Methodice, t. 2. p. xv.
218 [PART Iv.

individuality of the facts should, as for as possible, be preserved, the
distinctions must not be too subtle or too fine, otherwise there will be
more distinctious in the tables than in the original observations. And
this should never be; for when two or three diseases are confounded
by any considerable number of observers, it is better, although they may
be distinguished by others, to refer them to one head in a statistical
table. The heart, for instance, is liable to several forms of disease ; it
may be enlarged, wasted, ulcerated, dilated, softened, or ossified ; its
valves may he destroyed or contracted ; its action may be impaired in
various ways. The practitioner and the scientific writer endeavour to
seize all these distinctions ; but in the present state of medicine many
heart diseases are necessarily confounded, so that it is useless to separate
them in a tabular analysis.—(1st Annual Report, pp. 89-92.)

Registration of Causes of Death; Defects and Imperfections.—
Registered causes of death are subject to two kinds of imperfection,
which it is necessary to distinguish.

The first. is the consequence of the imperfection of medical science
itself, and will only diminish as that science advances. And the second
arises from the imperfect practical application of existing science: only
a portion of the population has the advantage of consulting the most
skilful physicians or surgeons of the day, who are conversant with the
newest discoveries in physic; and in the remoter parts of Wales, as
well as in some English counties, the medical man lives so remote
as to be absolutely beyond the reach of large numbers of the people ;
many young children, many long afflicted men and women, many old
people, die without being seen for weeks before death by a surgeon.
Many men die of hernia, many women in childbed, who might be saved
by surgical skill. Yet the medical attendance of the population is, I
believe, better in England than it is in any other state of Europe; and
the Poor Law does much to extend its advantages to the lowest classes.
Where surgeons are not found in attendance on the sick they should
be supplied in some way; and if this were done, science might well
be employed to inquire into the causes of deaths which it had endeavoured
to prevent.

To resume : thousands of deaths occur without any scientific inquiry
into the cause of death ; and in thousands of other cases medical science
seeks in vain to unravel the mystery which enshrouds the extinction
of life.

The coroner often simply returns “natural death.” As one of the
great ends of Government is the protection of life, the inquiry, however,
in such cases is not without its use, as the negative finding of a jury is
a satisfaction to the public mind, and suffices sometimes to relieve the
innocent from suspicion. At the same time it often deters the tempted
man from crimes which he feels are likely to be discovered.

In the earliest dawn of the nation the English inquired into the
causes of death with a view to discovery and prevention. The protection
of life was a fundamental principle of their laws. It was as much an
object of their political organization as national defence or war. And
the dead body, it was held, called for the coroner’s inquest whenever
death was sudden or violent or in prison; that is, whenever it was the
result, or appeared to be the result, of any discoverable cause. The
plagues of the sixteenth century proved that human ‘life is exposed to
invisible enemies more deadly than the mechanical forces of nature,
the ferocity of animals, or the malignity of manslayers ; aud towards
the end of Queen Elizabeth’s reign the London Bills of Mortality were
commenced (1592). It was part of the general measures of her able
government, by which abstracts of burials, haptisms, and marriages
DEATHS. | 219

were directed to be compiled ineach parish ; and persons were appointed
to view the bodies of all that died before they were suffered to be
buried, and to certify of what probable disease each individual died, in
statements of which it was the duty of the minister to make a weekly
return, The deaths by plague and by all other diseases in the age¢regate
were published in the London bills so early as 1603; and in 1629 the
several casualties were set forth weekly. Graunt gives a complete
return for the year 1632 of the causes of 9,535 deaths in London,
whereof 8 were of the plague.* He says, that though not published,
“the original entries in the //all-books were as exact in the very first
“year as to all particulars as now; and the specifying of casualties and
‘“* diseases was probably more.”

Graunt thus describes the mechanism by which the observations in
this remarkable series of Tables were collected :—-

“ When any one dies, then, either by tolling or ringing of a bell, or by bespeaking
of a grave of the sexton, the same is known to the searchers, corresponding with
the said sexton.

“The searchers hereupon (who are ancient matrons sworn to their office) repair
to the place where the dead corpse lies, and by view of the same, and by other
enquiries, they examine by what disease or casualty the corpse died. Hercupon they
make their report to the parish clerk, and he, every Tucsday night, carries in an
accompt of all the burials and christenings happening that week to the Clerk of the
Hall. On Wednesday the general accompt is made up and printed, and on
Thursday published and dispersed to the several families who will pay four shillings
per annum for it.”

Graunt discusses the value of the bills, and shows what “ corrections
“ upon the, perhaps, ignorant and careless searchers’ reports,” were
required; at the same time he says, as “many of the casualties were
“ but matter of sense,” the searchers’ reports might be sufficient in
such cases. In many of the more intricate cases “the searchers are
“ able’to report the opinion of the physician who was with the patient,
“ as they receive the same from the friends of the defunct ;” and in
very many cases, such as drowning, small-pox, dropsy, falling sickness,
palsy, ague, rickets, their own senses were, in his opinion, sufficient.

Many of Graunt’s judicious observations on the casualties of the bills
are applicable to the’ reported casualties of the remotest parts of the
country in the present day; for some districts still represent the
ignorance of the cities of ages gone by. And Graunt was essentially
right, for there can be no doubt of the value of even the imperfect
reports of facts in the early bills directly concerning the life and death
of Englishmen. They had on them in Graunt’s book the approving
stamp cf the Royal Society. Sydenham, it is evident, had the London
bills before him in writing his imperishable commentaries. Arbuthnot
used them in an argument on Divine Providence and in the interests
of morality.| Heberden in a masterly paper illustrated the use of the
weekly observations, and deduced from them an important law.t
Simpson and Price constructed life tables from the London bills.

The parish clerks of London deserve our gratitude for their perse-
verance in publishing the bills, which the citizens took in weekly for
“no other reason” that Graunt could discover than curiosity about

 

* Natural and political observations upon the London Bills of Mortality. By
Capt. John Graunt, Fellow of the Royal Society. Tuesday, June 20, 1665. Ata
meeting of the Council of the Royal Society ordered to be printed. 5th ed. 1676.

¢ An argument for Divine Providence taken from the constant regularity in the
births of both sexes. By Dr. John Arbuthnot, Trans. of Royal Society. Vol. xxvii.
p. 186. He shows by the London bills that males always exceed females in the
yearly births, but that external accidents make a great havoc among males. He
concludes that “ Polygamy is contrary to the law of nature and justice.”

t See Influence of Cold upon Health. By W. Heberden, junior, M.D., Phil.
Trans., 1796, p. 279.
220 [PART Iv.

increase and decrease of burials or rare casualties, ‘so as they might
“take the same as a text to talk upon in the next company ;” and
in the plague-time, “that so the rich might judge of the necessity of
“ their removal, and that tradesmen might conjecture what doings they
“were like to have in their respective dealings.” Similar bills were
commenced in some other English and continental cities, but they were
allowed to drop, leaving the series incomplete.

While medical science advanced, the weekly bills remained stationary ;
their interest was not kept up by eruptions of plague; Dissenters’
burials were not included; and the clerks of many parishes made no
returns, or only made them irregularly. And even when complete, the
bills gave no information about the population of the towns and counties
ol the whole kingdom.

It was only in 1887, five years after the first epidemic of cholera, that
under the Registration Act provision was made for the inquiry into the
cause of nearly every person’s death. The column of the schedule
headed “Cause of Death” was introduced in the House of Lords.
There have then since July Ist, 1837, been two kinds of inquests into
the cause of death,—the Coroner’s Inquest and Registration Inquiry.

The latter measure appears to have been looked upon as experi-
mental. There was no view of the body, no arrangement for obtaining
evidence, no machinery for instituting inquiry; and where there had
been no niedical attendant, or where the medical attendant refused to
supply the information in his possession, no means of getting the
required facts, except by making the medical man the legal informant.
The imperfect information of the coroners was expressed in rude,
vague, antiquated language, and was less satisfactory than that supplied
from other sources. The heads of the medical profession supported
the Registrar General’s efforts to overcome the first difficulties; you
circulated medical certificate books with a Nosology freely among the
profession all over the country. You addressed coroners, and since the
office has been strengthened by the Act authorising the payment of
medical witnesses, their information is much more valuable than it ever
was before. The result is apparent in the returns of the present year.
You succeeded in providing in medical men frequent substitutes for
uninstruected jurymen and “ancient matrons sworn.” Under the present
administrative arrangements little further progress can be made.

It is notorious that the registration of the cause of death in its
present form has contributed to bring crime to light, and has facilitated
the conviction of the guilty. The trials of Palmer, Pritchard, and
other criminals afford illustrations. Enough has been done since the
passing of the Registration Act to establish the utility of general inquiry
into the causes of all deaths, and to justify the employment of the
machinery necessary to make the inquiry as complete as possible for
accuracy of record, for protection of life, and for the furtherance of
medical science.

It will be Lorne in mind that the coroner and his jury can only
conduct the inquiry on view of the body (super visum corporis) ; by the
first statute (4 Hd. 1, stat. 2. A.D. 1276) it is enacted, that on being
commanded by the King’s bailiff or other honest men of the country
the coroner of our Lord the King “ shall go to the puaces where any
“ be slain, or suddenly dead or wounded * * * and shall forth-
“ with command four of the next towns, or five or six, to appear before
“him in such a place.” The coroner inquired upon oath, and his
information was based upon actual examination of the body, the place,
and the surrounding persons. ‘The searchers of the London bills were
also instructed “ to repair to éhe place where the dead corpse lies, and
DEATHS. | 221

“ by view of the same, and by other inquiries, to examine by what
“ disease or casualty death was caused.” The registry of burial in the
Established Church is a public act; the coffin and several witnesses are
before the clerical registrar; but the identification of the body in the
place of death is lost. And in a large city anybody may be buried
under any name. By the Code Napoleon the Registrar is bound to see
the body, and to register the death on the information of two men of
full age (21), and without his certificate the body cannot be interred.
(Code Civil, Livre I. tit. I. s. 77.)

S. 77. “ Aucune inhumation ne sera faite sans une autorisation, sur
papier libre et sans frais, de Vofficier de Pétat civil, qui ne pourra la
délivrer qu’aprés s’étre transporté auprés de la personne décédée, pour
sassurer du décés, et que vinet-quatre heures aprés le décés, hors les
cas prévus par les réglemens de police.” See also s. 37.

Should any signs of death by violence be discovered, or any suspicions
be aroused, the body can only be buried after the circumstances of the
death have been inquired into and reported on by a police officer, aided
by a physician or surgeon. (s. 81.)

This is the spirit of the registration law on the continent. The
inspector of the dead in Austria is called T'odbeschauer. In Brussels
notice of every death is sent to the Town Hall, with the address, and
a medical inspector inquires into the circumstances and registers every
death.*

In England, under the Act 6 & 7 Will. 4. ¢. 86. death registration is
a simpler process. A person presené at the death, or in attendance
during the last illness, of the deceased person, goes to or sends for the
Registrar of the district in which the death happens, gives the requisite
information,{ and signs the register book as the informant either in
writing or by mark. The qualification implies that the informant has
seen the deceased person alive during the last illness, but beyond that
there is no restriction in the act as to capacity, character, sex, or age.

The informant and the Registrar are usually alone during the act of
registration; no witness is required; and, if present, no witness is
allowed to sign the book.{ If the persons qualified to give information
do not come to the Registrar, he is directed to go to the house where
the death occurred, “ or wherever such person gualified to give informa-
“tion can be found, and ask for it.’ When found, informants “ by
“yefusal to give information, and to sign the register books, render
“‘ themselves liable to be indicted for a misdemeanor.” The inducement
to take the initiative turns on the use of the Registrar’s certificate, which
given after registration is authority for the burial of the body. Any
person burying a dead body without the certificate of the Registrar or
the Coroner, and neglecting to give notice of the burial within seven
days, incurs a penalty not exceeding 10/. for every such offence.

Registration is thus performed without any expense to the parties,
and with as little trouble and expense to the public as possible. Copies
of the entries in the register books made by the Registrars, and verified

 

* Early one morning, after the annual fétes in which the Belgians so much
delight, I accompanied Dr. Verstraten on his pilgrimage to the chambers of the
dead scattered over the city, and it was a very striking and varied spectacle. At
one hour we stood in the midst of lights and incense by the body of a lady of rank,
at ancther in a wretched attic by the corpse of « father of a family of sleeping
children, and finally, after traversing many streets, finished our course at the
Lying-in-Hospital. He inquired into the circumstances and causes of every death.

+ In default of the qualified informants as above described, it is incumbent on the
occupiér of the house to give information, upon being requested so to “do by the
Registrar. Of the oceupier’s death an inmate may be the informant,

tf See Kegulation for Duties of Registrars, and Act 6 & 7 Will. 4, c. 86. 1836.
222 [Parr Iv,

by the Superintendent Registrars, are sent every three months to the
General Register Office, where they serve for statistical and other
important purposes. A certified copy of an entry, sealed at the General
Register Office, says the Act, shall be received as evidence of the
death to which the same relates, without any further or other proof of
such entry.

The Registrars, appointed generally by Boards of Guardians, before
their appointment is confirmed, answer questions in writing, and their
competency is proved by their copies sent to the office, and by the
state of their registers which are periodically examined by Inspectors.
The Registrars are a highly respectable body of men of all the various
classes of society, and as they are only paid small fees they are neces-
sarily engaged in other professions, in trades, or in some branch or
other of industry. The work requires integrity, accuracy, sound sense,
good writing, and close attention to all the minute provisions of the
Act and of the Regulations. The clerical part of their duty is checked
by the Inspectors, by the Superintendents, and by the central Record
department; but there is at present no means of checking the registered
facts, or of determining the degrec of accuracy with which informants
report and Registrars record the particulars of each entry. Where
the informant is educated and interested, he naturally reads before
signing the entry, and thus to some extent checks the work. Unfor-
tunately it happens that in a large proportion of cases the Informants
sign by a mark, and as they cannot write their names they cannot read
the record which they sign alone in the presence of the Registrar.
They cannot check the record. This has given occasion to cases of
fraud which could scarcely have been anticipated. In the course of
twenty-nine years, out of a body of 2,200 officers, four, for the sake
of the shilling an entry, inserted long series of fictitious entries of deaths
which never occurred. They invented all the particulars of hundreds
of deaths. The first case was that of a Registrar of All Souls, Mary-
lebone, who died before the discovery; he served under a most acute
Superintendent Registrar. The second case was that of a Registrar
of Howard Street Sub-district, Liverpool, of respectable connexions,

-who for fictitious entries was dismissed, convicted of felony, and
sentenced to six months imprisonment with hard labour. ‘These two
cases, and another at South Shields, are referred to in the 9th and
13th Annual Reports,* and the required corrections are made in the
calculations of the mortality of Marylebone, of South Shields, and of
Liverpool. This offence, it may be mentioned, was first distinctly
defined in the Forgery Act of 1861 (24th & 25th Victoria), under
which the wilful insertion of any “false entry of any matter relating
“to any death” renders the offender liable, on conviction, to penal
servitude for life (s. 36.); yet a Registrar of Howden, who began
registering fictitious entries about ten years ago, continued the practice
up to a recent date under the eye of his Superintendent, and subject
to the pericdical visitation of intelligent Inspectors. The causes of
death were copied, with slight variations, from medical certificates, and
his imaginary informants were represented as signing with marks. This
a man of ordinary capacity dared and was able to do, because while
there is a check on the handwriting and the form of entry, there is
no check whatever on the accuracy of record, or on the veracity of
informants. The facility of signing with marks of single informants
tempted four men into the commission of these extraordinary crimes for

 

* See Report IX., pp. 177 and 258-9. Report XIII, p. 294.
DEATHS. | 223

the sake of small sums of money. For money the same criminals
might, it is to be feared, with the hope of impunity before them, have
falsified the record of important facts affecting vast amounts of property
in insurances and successions. Fictitious entries embarrass statistical
inquirers, and they were first brought to light in this office by the
exorbitancy of the results. The Howden fraud was kept within
narrower limits; it was discovered through the clergyman of a parish
where the mortality was exaggerated.

It is ceplorable that a single case of fictitious entry by a Registrar, or
of deliberate fraud by informants, should have occurred during twenty-
seven years; but it must be borne in mind that few registrars among
many thousands, and few informants among many millions exposed to
temptation, have criminally falsified the public records. The wilful
falsifications are insignificant in number in comparison with the errors
in 11,011,291 entries on the death registers.

I have referred to such defects of Registration as vitiate the evidence
that the registers afford affecting property, and the use of the records
for scientific induction. I have now to refer to the imperfect
security afforded by incomplete as compared with complete registra-
tion against murder and attempts on life. The following death was thus
registered :—

“ Died 11th June 1848 at Wix (Manningtree) William Constable,
aged 38 years, labourer, decline (3 months), Nod certified.
“ x The mark of Mary Faint, present at the death, Wix.”

Cs

This was one of the Essex poisonings. The man it was afterwards
discovered, was poisoned with arsenic by his half-sister Mary May,
aged 28. She was tried at Chelmsford, found guilty, and executed.

The facility of registration in this easy way does not discourage the
criminals. They go on with greater confidence. And this was only
the first discovered case of a series of similar murders of husbands
and children by wives and others, who could make their marks and
administer arsenic in the Essex villages of Wix, Bradfield, Ramsay,
Dovercourt, Tendring, Thorpe, Kirby, Mistley, Great Oakley, and
Great Holland.* Sir James Graham in the House of Commons, in
June 1846, referring to another series—the Norfolk poisonings,—said :
“ There wos reason to believe that in the county ot Norfolk no fewer
“ than twenty persons had died from poison administered by one
“ individual, and in none of these cases had an inquest been held.” I
may cite other instances.f One murder successfully registered without
detection led to the commission of more murders, and murder became
epidemic by imilation. It is probable that the number of’ such cases
was exaggerated, but the terror they inspire is in itself an evil, and
by crimes of the kind the country is dishonoured in the eyes of the
world.

 

* These cases are well described in the letter of a barrister in the Morning
Chronicle, April 11th, 1849.

+ In one case it happened that Mr. Hitchins, who was coroner for Kesteven and
Parts of Lindsey, was also a Registrar of Deaths in Lincoln. He assigned the
following reasons for wishing to retain the latter office :—‘« My object in desiring to
“ yetain office is not for the emolument, but because I have found it to assist me
“ essentially in my office of coroner. By its means of information three murderers,
and one for manslaughter, have been transported ; and at the present time two
murderers, and one for manslaughter, are for trial at the next assizes, from being
unable to obtain certificates.”— Letter, dated Lincoln, 3d February 1849. ‘The
murderers in another district might have escaped, as the deaths might have been
registered without a certificate,

«

‘

«
224 [PART IV.

These deaths occurred in country villages among ignorant people, but
in towns the detection of crime is rendered in certain cases much more
difficult than it is in the country. The body can be buried in any
churchyard or cemetery without a Registrar’s certificate; and the
clergyman or burying officer, though bound to give the Registrar notice
(which he sometimes forgets), can only give such particulars as the
parties conducting the funeral supply. The notice, if written, may be
addressed to the wrong Registrar, or be so vague or perhaps erroneous
that the Registrar of a large district, like Islington in London, cannot
find the house in which the death occurred. Bodies are sometimes
removed unregistered to other districts for burial, and all traces of them
are lost. As still-born children are not registered at all, and are buried
with little ditficulty, there is a great temptation to inter the bodies of
children living only a short time as still-born. This opens another gate
to crime.

By forbidding, as in France, the burial of any body without the
Registrar’s certificate, the latter class of evils will be obviated;
and although inconvenience must occasionally arise from the absolute
prohibition of the burial of the uncertified dead, that inconvenience
should be encountered for the sake of many compensating advantages.

There is another defect in the Act: some old women and men, like
hermits of old, live in solitary dwellings; in their last illness
terminating suddenly they may have no person in attendance, and
no witness present at their death. In these cases there is no
legally qualified informant, and the deaths are not registered; the
causes of death remain for ever unknown. The coroners are now
paid by fixed salaries, and in many cases of violent deaths they do not
hold inquests, unless they are led to suspect crime. ‘This saves the
county expense, but it has resulted in the absolute non-registration of
deaths.

Such are some of the defects by which the registration of the
causes of deaths, and of the fact of death itself, is rendered less
useful than it might be made for the purposes of science, for sanitary
administration, for evidence affecting successions of property, and for
the protection of life. To remedy these defects, amendments of the
Act are required; families must take more trouble to find qualified
informants, and the country must consent to pay the necessary expenses
of fuller inquiry.

It is now sufficient to send to the register office one informant,
such as a nurse, and although a medical certificate is asked for, it
is not indispensable by law, and is often not produced. That is all
the trouble families are put to in registering their dead; and the
Registrar gets a shilling from the poor rate for recording, and making
copies of the entry to be transmitted to the central office. The Super-
intendent Registrar gets 2d. for examining the copy of the entry with
the original entry. Each death costs the country twenty pence for
registration, including pay of officers, cost of books, ink, copying,
custody of records (which it is expected will last for centuries), indexing,
analysing statistically, and administration.

The inquiry into the cause of death might be made sufficient for all
its great and useful purposes by a simple extension of the system of
medical certificates which you introduced, and which has for many years
been in partial use. And as Iam not disposed, in imitation of foreign
practice, to relinquish the principle of confidence in the medical
attendants on families, I submit that having been in attendance up to
the date of death, their certificates should still be received, provided
they have seen the deceased on the day of death, or have seen the body
DEATHS. | 225

subsequently for identification. It would be undesirable to enforce the
grant of the certificate by any penalty ; and under this arrangement the
medical attendant should charge the family a fee in proportion to his
ordinary charges. For pauper patients the Poor Law medical officer
should be entitled for the certificate of death to a fee fixed by the
Commissioners.

Under these circumstances many deaths which are now “ certified ”
would be “ uncertified” by medical attendants, as the friends of out-
patients of hospitals and dispensaries, as well as others often get
certificates to which they are not entitled through the kindness of the
medical officers, who have sometimes no means of identification or
verification. In all such cases, und in every case of death without
medical attendance up to the date of death in which the certificate
could not be obtained from a legally qualified medical attendant,—an
informant, or the oceupier of the house, or in his default an inmate,
should be bound to give notice to a medical officer specially appointed
for the duty in each of the districts of the kingdom, This registration
medical officer would thereupon visit the body, and if all was clear,
and admitted of satisfactory determination, send his medical certificate
of the probable cause of death by the informant or by post to the
Registrar, who would upon its receipt register the death, and issue his
certificate for burial in the usual course. The registration medical
officer would, if the case was enveloped in any suspicion or obscurity,
refuse his certificate until an inquest had been held or refused by the
Coroner, whose inquiry should by no means be superseded. The
registration medical officer should be specially qualificd to conduct
post mortem examination, and, on being summoned, might appear as the
medical witness at the inquest. By practice he would acquire aptitude
in the investigation of the obscurer causes of death, and in the detection
of crime. Under this system every death, and the cause of every
death, would be certified; and poisonings and criminal attempts on the
life of children or adults would be less frequent, as they would with
difficulty eseape detection. Expected impunity would not invite men or
women into the commission of fearful crimes. And haman life would
be under a new safeguard.

The Registrar should invariably write ‘certified by ” in his Register
Book, adding the name and title, and if out of the district the address
of the medical attendant or of the registration medical officer, as the
case may be. The Registrar to file the certificates, and to produce
them for examination with the certified copies by the Superintendent
Registrar, who would certify the uccuracy of the copied entry of the
cause of death.

It would increase the value of the evidence if the certifying physician
himself signed the entry in the register. But this would be a complica-
tion ; it would increase the expense, give much trouble, and produce
delay, so that I do not propose it. It was tried in the case of the
coroners, and failed.

The advantages of the proposed amendments may be briefly
enumerated :

(1.) The cause of death would in all cases be certified by one pro-
fessional witness, and would be recorded as correctly as is practicable in
the present state of science.

(2.) The fact that a given person died at a given place would be
attested by the informant as at present, and the evidence would be
enormously strengthened by an educated witness. While so large a
portion of our informants cannot even write their names, this is of
great importance.

P
226 [PART IV.

(3.) Secret murders and attempts on life, and deaths of children, or
of old people, from neglect, could rarely escape detection ; they would,
other things being equal, be less frequent than they have been in past
times, Life would become more secure. The public solicitude, like a
Providence watching over all, would cherish the reverence of all classes
for human life.

(4.) The frands of informants would be less common, and no Registrar
would again manufacture fictitious entries, thereby throwing discredit
on the whole of the xational registers.

(5.) Much trouble would be saved to the public, who are now put to
expense in getting corroborative certificates, as it is felt that the present
certified copy of an entry is most imperfect evidence of the death and
identity of deceased persons.

(6.) The registration medical officer visiting the dwellings of people
in ‘unfavourable sanitary conditions would discover and point out the
consequences of those conditions to the families themselves, and to the
authorities in seasons of cholera, of fever, or other epidemics. The
authorities would find it convenient to make him the health officer of the
district ; and often where such an officer alrendy exists, he might
discharge the medical registration duties. ‘The Post Office would employ
the registration medical officer in insurance business, and so would
insurance offices, to whom he could render essential service in putting
a stop to the numerous frauds which are every day committed at their
expense.

Two Inspectors are appointed with great advantage, as they instruct
Registrars, and inspect the books on the spot in periodical visits. But
they proceed no further than the books; and, unless the books them-
selves supply evidence of inaccuracy, no inaccuracy is discovered.
They do not institute any comparison between the actual or the
ascertainable facts and the records of those facts. Here many errors
must occur. At this office no important work is allowed to pass
unchecked ; and after selecting the clearest headed men, the calculations
are all made in duplicate, and carefully compared. Experience has
shown that this is necessary to ensure accuracy. It provides against
errors of human fallibility, and errors of negligence. Now the registra-
tion records need not be made in duplicate by two separate officers and
compared ; but by periodical inquiries into the actual facts of cases
where the informants sign with marks every Registrar woulil work under a
sense of responsibility, and would do his work better than he does it now.
I beg to suggest that an Inspector should be appointed for special
employment on this duty, and a Medical Inspector should be especially
employed in looking after the registration of the causes of deaths,

Medical men have to learn the difficult duty of returning fatal diseases
on a uniform system and under the same names. ‘Their attention might
be called to any imperfections in their returns.* This is found to work
well in Geneva, where it was performed for many years by my friend
Dr, Mare d’Espine with the best possible result, both in the interests
of science and of justice.

This improvement in our system of registration would be quite in
accordance with Knglish habits, which must ever be religiously
respected in a matter so solemn as death. ‘The public medical officer
would only intervene when the family had no physician in attendance,
and wherever he attended it would be confidentially, for the comfort and
satisfaction alike of friends and of the community,

 

* Cireular letters are now addressed to certifying medical practitioners whose
certificates do not supply the necessary information for satisfactory classification —
Epiror.
DEATHS. | 227

This system, I submit, would be more efficacious than the registration
now in use in France, where the death can be registered by declaration,
without assigning the cause of death. The inspection of the body by
the Officier de Vétat civil would be superseded by the certificate of the
medical attendant, or of the registration medical officer; the inquiry
into the cause of death would be universal; and the evidence of the
certificate of registry would be valid. The French explicitly reject
women as informants,* and thus must in many cases forego the best
possible testimony. Women are almost always, except on the field
of battle, in attendance or present at death. The wife does not forsake
the husband, the mother the child, in the last moments. In marriage
and in birth, the two great acts of registration, the woman is indis-
solubly associated with the other sex, and from men in death they are
not divided. On what ground then is the woman rejected peremptorily
as a witness? ‘The French principle is inapplicable to English women.
But in England we may well avoid rushing to the other extreme.
Why should a majority of the informants of some districts be
ignorant women who sign the registers with marks, and cannot:
read and check the entry to which their signature is attached in the
national records? The medical certificate ix indispensable under such
circumstances,

 

* Code Civil, livre 1. sec. 37. : Les témoins produits aux actes de I’état civil ne
pourront étre que du sexe masculin agés de vingt-un au moins et ils seront choisis
par les personnes interessées.

{+ Nomprr and Proportions per Cent. of Persons who were Informants of
Deaths, and of Persons married, who signed the Register with Marks, in eleven
Districts or Snb-Districts of England and Wales in a portion of the Year 1864.

 

 

 

 

IyrormantTs at Deati
(exclusive of Coroners and Persons Marriep.
Informants in Institutions).
Total |Informants cae a Number ice aacle
Number | signing re a ‘| Total | signing Fe ent
of with othe |Number.| with eae
Deaths. | Marks. Marks: Marks. Marks,
Persons - | 3,196 1,537 48 10,864 2,902 27
Males 1,208 319 | 26 5,432 | 1,142 21
Females 1,988 1,225 62 5,432 1,760 32

 

 

 

 

 

 

 

The facts are compiled from the Registers of the districts of Chelsea, Reading,
Peterborough, Romford, Highworth, Rugby, Derby, Halifax, Durham, and Carnarvon,
and the sub-district of St. Martin, Liverpool.

Of 100 informants 38 were males and 62 were females.

Norr.—Exclusive of coroners and informants of institutions, of 1,217 informants
at death in the county of Northampton 181 were men of whom 52 signed with marks,
and 1,036 were women of whom 784 signed with marks. Of 1,843 persons marvied
447 men and 499 women signed with marks, or of 100 informants at death 69 signed
with marks, and of 100 persons married 26 signed with marks. The ignorance of
the informants at death was to the ignorance of the ordinary run of people marrying
: Sor raripienenite as 69 to 26. Of 100 informants 15 were males and 85 were
emales.

P2
228 [PART Iv.

The improvements in registration cannot be carried out without
expense. The medical certificate will cost the public from @ florin to a
guinea «nm entry; only the portion of the pay for the registration
medical officer and for inspectors will come out of poor rate and out of
consolidated fund. It is desirable to make the fee of the registration
officer sufficiently high to command the services of a good class of
the profession ; and the tariff must, therefore, necessarily vary in
country and town districts with the distances to be travelled, and the
variable local medical charges, The fixing of the fee might he left to
you, subject to the approval of the Treasury. The cost of registration
medical officers and of inspectors would not exceed in the aggregate
50,0001.*

If we compare this sum, and the value of the services for which it-is
to be paid, with the cost of inquests and the cost of funerals, it does
not appear to be great or extravagant.

The cost of registering the particulars and the causes of the deaths of
the 495,531 persons who died in England and Wales was about 41,350/.
in the year 1864; in 1867 under the improved plan it would be about
91,3502. Tustead of 20d. it would be about 44d. on each death. This
sum would be amply recouped in the additional security to life and
property. It is computed from the legacy duty returns on 495,531
deaths that about 93,500,000/. passes by death to successors, On this
sum 92,000/. is less than a farthing in the 12.

The coroners of counties and boroughs held inquests on 24,787 bodies
at a total cost, including coroners’ salaries, travelling expenses, and
medical witnesses, of 72,5987. This sum is paid out of the rates. It
amounts on an average to 21, 18s. 7d. on each inquest. The jurymen
are not paid for their services, but they are summoned, and if they do
not attend render themselves liable to a penalty. The vaiue of their
time cannot be estimated at less than 25s. 5d. This will make the
cost of an inquest 4 guineas, or 24,787 inquests cost 104,105/. in the
year. The value of this ancient institution cannot be questioned, but
the inconvenience and cost to families left out of account in this estimate
is not inconsiderable.

If the inquiry by inquest had been extended to the whole of the
deaths, the cost in coroners and in medical witnesses only in the year
1864 would have amounted to 1,451,345/., without allowing anything
for the time lost by jurymen, and for the inconvenience of families.

The cost of 66,748 funerals in the metropolis was estimated by
Mr. Chadwickt for the year 1839 at 626,604/.; and his “ proximate
“* estimate of the expense for the total number of funerals in England
‘and Wales,” was 4,871,4932. He shows that the expense of pauper
funerals in London was 13s., of artizans 5/., tradesmen of second class
&c., 271. 10s., tradesmen of Ist class 502, gentry and the higher classes
of people 1002. ; while the expenditure on the funerals of children under
10 years of age of the corresponding classes, excluding paupers, ranged
from 30s. to 307. The average cost of funerals of persons of every rank
above paupers in London he takes at 14/7. 19s. 9d., and including paupers
at rather less than 10/. J am aware that the cost of funerals of persons
of rank runs up to 1,000/. or 1,500/., and that workmen’s clubs pay
commonly 10/. tor burial, but T am disposed to think that Mr. Chadwick’s

 

* Take the annual deaths at 500,000, and the uncertified cases in the propor-
tions above given as 17 per cent., then 85,000 cases would be visited annually.
The cases would be almost exclusively in the poorer classes, and at 10s. each the cost
would be 42,500/.

ft Supplementary Report on the Results of a Special Inquiry into the Practice of
Interment in Towns, by Edwin Chadwick, C.B., pp. 70-1.
DEATHS. | 929

estimate is too high for the whole population, in town and country.
Instead of his figures I take the average cost at 6/., and then the
amount that the nation expends annually ou the burial of its dead is
2,978,1862. This includes only expenses that figure in undertakers’
bills. It neither comprises the extra cost of mourning, nor the expen-
diture in memory of the dead on monuments, or friable stones, which
will be obliterated or crumbled into dust long ere the national lists of
the dead in the custody of the State have perished.

It is well to attach solemnity to funerals, but no one can doubt that it
would be wiser on the part of the nation to give a florin or a guinea as
a fee to a registration medical officer for the benefit of the living and of
generations to come than to squander guineas lavishly on stones, or on
lids of feathers, rich silk bands, porters, pages, feathermen, and mutes.

The registration medical officer would stand in nearly the same
relation to the Registrar-Geueral, who directs the inquiry into the
cause of death for the purposes of registration, as the medical witness
stands (under 6 & 7 Will 4. c. 89.) to the coroner, but it might be
desirable to leave his first appointment and pay to the same bodies as
appoint the Registrars and Superintendent Registrars.

Satisfaction in good work was pronounced by the inventor of the
word “statistics” to be characteristic of the English workman,* and I
trust that I may without presumption say that while the department of
which you are the chief shares the feeling it is anxious to deserve
Achenwall’s praise of the English workman.

The following is an analysis of the particulars of which evidence
is found in the death registers. I take the example given in the
schedule :

1. That a person is dead.

2. That the name of that person is—William Green.

3. That the said person died at a certain date,—at 5 o’clock

4th February 1865.

4, That the said person died in a certain place,—31 Strand, London.

5. That the said person was by profession—a carpenter.

Note.—All these particulars are recorded on the evidence of the
informant, who, if he has witnessed the death, bears direct testimony to
particulars 1,3, 4; the testimony as to 2 and 5 may be direct or indirect.
If he was merely in attendance, and has not seen the body, all the evidence
is indirect. He gets it at second hand.

6. That the said person was a male or female—J/ale.

7. That the said person was of the age—43.

Of the sex and age the evidence is always indirect ; it would be
strengthened, as would all the other evidence, by the production of the
certificate of birth at the time of the registry of death.

8. That the cause of death of said person was small-pox.

Note.—Sometimes the cause of death is easily distinguished by unskilled
observers ; in others it can be discovered after death by a skilful inspector
from the testimony of surrounding persons; in others it can only be
distinguished by medical men who have observed the symptoms during
life. In many obscure cases inspection of internal organs (autopsy) and

 

* «The Englishman is the best workman in the world, for he works so as to
satisfy his own mind, and always gives his work that degree of perfection which he
has once learnt to appreciate and attain; and as the Frenchman seeks to enhance
the value of his manufactures by all kinds of external ornament, so the Englishman
seeks to give his productions in exactitude, usefulness, and durability a less
fleeting worth.” (Statsverfassung der heutigen vornehmsten Europiischen Reiche
und Volker im Grundrisse von Gottfried Achenwall Weyland Hofrath und Professor
der Rechte und der Politik zu Gottingen. 1781. p. 824.)
230 [earr Iv,

chemical analysis are required to enable the medical expert to divine the
cause of death. In some cases, particularly of infants and old people, the
cause of death cannot be discovered in the present state of medical
science.
9. That the signature, description, and residence of informant was—
Rebecca Green, Widow, 17 North Street, Marylebone.
Nole.—Under “ Description,” when in attendance is added, it would he
well to add “nurse,” wife,” “mother,” &c. &c., and the profession of
informant. So also when “present at death.” This concludes the
information ; the two other columns relate to the Registrar,
10. That the Registrar registered the said particulars on a given day
—ith February.
11. Witness, his vame and title, John Cox, Registrar.

I found on trial that in London many particulars respecting the great
majority of the deceased, except in public institutions, are known to
the people around them at death.” The following is one among many
instances. It isa specimen of what I held then and still think would
be a complete schedule. If it be ever adopted it will be necessary to
pay the Registrar 1s. 6d. instead of 1s, Od. an entry, aud the Superin-
tendent 3d. instead of 2d. for examination, as the labour will be
increased. It is evident that the additional particulars as to birth-
place, residence in district, parents’ names, marriage, and issue would
have the same value as some of the particulars now registered ; they
would depend on indirect evidence, and, if required, every year such
evidence would increase in value :—

District, Poplar.— William Canty, male, age 62, died 2th February,
at half-past six o'clock a.m., at 10 Cottage Row, of pneumonia, 2 months,
as certified by H. Bloomfield, M.D, ; born in Cork, Ireland ; 36 years
in Poplar ; father Timothy Canty, deceascd, mother Mary Canty,
maiden name Nicolas, deceased; marricd in Scrill parish, Ireland, at
age 22, to Honora M‘Carty ; left issue Timothy, age 31, William 30,
Mary 20, John deceased, aged 27 in (846, Catherine deceased, aged
/ in 1820, Stephen 21; witness, Honora Canty her x mark, widow,
Informant ; Mary Canty, daughter, witness ; 7. IF. Gagen, Registrar,
March 3, 1847.

I do not venture to complicate the proposal as to the medical regis-
tration certificate with these or any other alterations of the schedule
and the Act.

To secure the registration of the causes of death it would be necessary
to alter some clauses of the Act (6 & 7 W. 4. ¢. 86.), and to insert a
new clause to the following effect. It is slightly altered from the
Registration Act for Ireland (26 Vict. ¢, 11. s. 46.)

“Medical Certificate of Death.

“ Whereas it is expedient to establish an authentic registration of the
causes of death : Be it therefore enacted, the Registrar shall furnish
from time to time, gratis, to every duly qualified medical practitioner
within his district the necessary forms of certificates of death in the
form (—) hereunto annexed, which certificates the Registrar General
shall cause to be printed and forwarded from time to time to every
Registrar for that purpose; and the medical practitioner who shall
have been in attendance during the last illness and until the death of
any person dying after the 31st December 1866 shall within three
days after the death of such person transmit to the Registrar of the

* See Jonrnal of Statistical Society, Vol. XI., ‘Report of Registration Committee
“ to the Council of the Statistical Society,” pp. 282-5.

a

oe

‘

 
DEATHS. ] 231

district in which the death occurred, or deliver to the relatives of the
“ deceased, or to a person legally qualified to sign the Register as
informant of the death, a certificate of the cause of death in the form
mentioned, the particulars of which shall be entered by the Registrar
in the register. In case such certificate shall not be so transmitted
or delivered, the Registrar shall give notice of the death to the
registration medical officer, who sliul within two days after the receipt
thereof return a certificate duly filled up to such Registrar, who shall
enter the particulars relating to the cause of death in the proper
column of the death register ; provided that the registration medical
officer shall, if he see fit, refuse to give his certificate until an inquest
has been held.”

ae SR RH BR HK
ne ow oe Boe A

.

Certain amendments would be required in the Act to secure the
complete registration of deaths. The task of giving notice of death to
the Registrar, and in the case of deaths without medical attendance to
the registration medical officer, should be enforced by penalty (see
sect. 38 of 17 & 18 Vict. cap. 8U., Scotch Act,) so as to make it the
duty of the parties concerned to procure from the medical attendant, or
in his default forthwith from the registration medical officer, the
certificate of the cause of death authorizing the issue of the burial
certificate by the Registrar. It is evident that if the body can be
interred before the inquiry it will open a door to crime by rendering
detection difficult if not impossible. The body is seen at once and “is
often buried in France on the second day; in England the people cling
to the presence of their dead, and thus inquiry is easier. Decent
dead-houses should be provided for poor familizs in towns.

Still-born children should be seen by the registration medical officer,
whose certificate to the effect that they were still-born would authorize
their burial without funcral rights, They would be entered in his
books, and would not appear in the Registrar’s accounts, which should
embrace only all those born alive-—(27th Annual Report, pp. 175-191.)

[Many of the imperfections and defects in the English Registration
system, here pointed out by Dr. Farr, were removed by the Births and
Deaths Registration Act of 1874, which came into operation nearly ten
years after the 27th Annual Report was written. The suggestions,
however, as they were written, form an interesting contribution to the
history of Civil Registration, and some of them, notably that relating to
the appointment of a registration medical officer for inquiry concerning
uncertified and unsatisfactory causes of death, are still under discussion,
—Eprror. ]

Statistical Nosology —sSeveral Nosologies have been framed, and
partially adopted. The Nosologia Methodica of Sauvages was the first
important work of the kind ; his successors, Linnwus, Vogel, Sagar,
Selle, Ploquet, Crichton, Macbride, and Darwin, either made few in-
novations ov few improvements, and the system of Sauvages would
perhaps have continued current, if Cullen had not offered a Nosology,
which his popularity as_a teacher and a writer, as well ag its simplicity
and its merits, contributed to establish in Great Britain. The
principal modern Nosologies ave by Pinel, Richerand, Bichat, Parr,
Young, and Mason Good. Diseases may be classified anatomically, or
according to the parts affected; and the anatomical arrangement may be
founded upon the locality proceeding a capite ad calcem; upon the
organs and systems of organs; or upon the different tissues, whether
serous, mucous, adipose, muscular, nervous, bony, or parenchymatous.
The anatomical arrangement is followed by some London Jecturers,
232 [PART Iv.

Vicq-d’Azyr, Richerand, Bichat, and Mason Good classified diseases
physiologically, or after the fictions involved in disease. Mason Good
divided diseases into six classes; those affecting the digestive, the
respiratory, the sanguineous, the nervous, the sexual, and the excernent
functions; and a seventh class of fortuitous lesions and deformities. By
writers upon diagnosis diseases have generally been considered topo-
graphically ; for the purposes of prognosis they have been divided into
acute and chronic, slight and fatal: and in practical therapeutics a
division exists into medical and surgical diseases. Diseases have also
been divided into diseases of children, adults and old people. Dupuytren
remarked at the beginning of the present century, that such classifications
are not founded upon the essential nature of the pathological processes
ov products themselves ; and considered abstractedly, they are inferior to
the symptomatological classifications. A classification founded upon the
elementary phenomena, and the products of disease, such as has heen
indicated by Professor Carswell,* would probably lead to important
numerical results, if it could be realised in the present state of medical
observation. If the relative frequency of inflammation, tubercles,
carcinoma, &e., and the organs which they especially affect at different
ages and in different circumstances, were determined by direct observa~
tion, and expressed numerically, it could not fail to throw light on
medicine. This has been attempted in an arrangement of fatal diseases
oceurring in the Equitable Society, at Carlisle, and in Philadephia.
The same diseases have also been classified according to the organs
affected at different ages.| Dr. Heysham classed the Carlisle observa-
tions according to Cullen’s Nosology. In the London, Swedish,
Philadelphian, and other tables of mortality, the causes of death are
arranged alphabetically. Cullen’s Nosology is in general use in the
public services ; but pathological anatomy has made great progress since
the time of Cullen, and his Nosology no longer presents diseases in their
presumed natural relations. It is not suited to statistical purposes, and
has been properly abandoned in the statistical report on the diseases of
the army, although Cullen’s Nosology has been used in the army medical
returns down to a late period.

The primary divisions of a Statistical Nosology should evidently be
founded upon the mode in which diseases affect the population: whether
they are generated and prevail only in particular localities (endemics),
extend like cholera over uations (epidemics), or are propagated by
contagion ; whether they arise in an isolated manner (sporadically) from
ordinary causes, and sources existing in the organization itself; or
whether they are caused by violent means. The first class will embrace
all diseases, like ague, fever, small-pox, and cholera, that prevail
endemically or epidemically, together with hydrophobia and such maladies
as are communicated by inoculation. This great class of maladies is the
index of salubrity ; it is this class which varies to the greatest extent in
different climates and seasons; it is this class that has latterly been so
much diminished in England, and that constitutes the principal difference
between the health of different populations and different periods; for
fearful and destructive as epidemics are in their strength, sweeping
mankind of every age before them, like an irresistible conflagration,
they can be controlled and almost always admit of prevention or mitiga-
tion. Of the utility of keeping this class of diseases distinct in a
practical sanitary report there can be no question. The ancient
division of plagues and sporadic diseases has therefore been retained.

 

* Illustrations of the Elementary Forms of Disease.
¢ Art., Vital Statistics, MacCulloch’s Statistics of the British Empire.
DEATHS. | 233

Classification is another name for generalization, and successive
generalizations constitute the laws of the natural sciences. But it is
obvious that the classification must depend not absolutely upon the facts
considered in their essential nature, but also upon the form, character,
and accuracy of the observations. And this renders necessary a brief
reference to the mode in which the causes of death have been recorded.

Diseases are not always easily distinguished: the symptoms of dif-
ferent species appear simultaneously and are confounded; the nature of
the affection is sometimes known, while many of the organs involved are
concealed ; or the part affected is recognised when the precise nature of
the lesion can only be discovered by post mortem examination. These
obstacles to the accurate determination of disease are inherent in the
subject; other sources of inaccuracy may be traced to the incompetency
and negligence of the observers. The result so far as it affects the
registration is the same. It is generally less difficult, however, to
determine from the external symptoms the part affected, whether it be
the brain, lungs, heart, or intestines, than to ascertain whether the
lesion be inflammation, tubercles, carcinoma, or ulcer; and there are
consequently in the returns numerous entries, such as ‘disease of the
“heart,” “ disease of the chest,” “ disease of the brain,” “ disease of the
“ liver,” the nature of the disease having been apparently unknown and
unspecified. To classify these entries, which may be reduced, but are
in the present state of medical science and of the registration inevitable,
—sporadic diseases have been grouped according to the systems and
organs affected. The first group of diseases of the brain, spinal marrow,
and nerves, shows that this classification possesses several advantages ;
bringing together diseases which have considerable affinity, and which
are easily confounded with or run into each other, and so correcting
errors and discrepancies in nomenclature, besides reducing the pheno-
mena of fatal diseases to natural families. In fixing the tabular list of
diseases the following principles have been attended to :—

1. Diseases distinctly specified in the returns, although not of frequent
occurrence, like diahetes, have each a place in the tabular form; so that
the facts thus fully laid before the public may be separately compared,
and classified in any way likely to lead to useful results. Where a
particular disease occurred very rarely, it was classed under a general
head, and referred to in notes.

2. The number of groups has, however, been diminished, because no
general principles can be deduced from small numbers, accidental
irregularities destroying the results, according to the well-known doctrines
of probabilities. Besides it was useless to keep up distinct heads,
which, although distinguished in some, were confounded in other
returns.

3. When after whooping-cough it was stated that the patient died of
pneumonia, the case has been referred to the primary disease ; and the
same principle has been adhered to in similar instances,

4. The list of diseases has been drawn up with direct reference to

the returns. It was, however, necessarily fixed before the Abstract was
made.

Objections will perhaps be brought against the condensation of the
list in the abstract, and the confusion of diseases essentially distinct in
their nature and seat; but a more extended catalogue in’ the present
stage of registration would Jead to deceptive results, and present an
air of minute exactness which has not been obtained. Several of the

groups may be subdivided at a future time, if it should be deemed
advantageous.
234 [PART 1V,

The tabular arrangement exhibits the greater number of the causes of
death under names which will be found convenient in practice, aud
sufficiently precise for statistical purposes. The common English name
has always been adopted, except in a few obvious instances ; but where
no ove English name existed, and where the dixscase is popularly cx-
pressed by periphrasis, the common medical term has been adopted.
Pneumonia is used, for instance, and not inflammation of the lungs.
The Latin or English synonyme will render the tables intelligible on the
one hand to foreigners, and on the other to the general reader. If the
causes of death were uniformly registered under the same names, and
each cause of death designated by one word, it would increase the
accuracy of the Abstract, and diminish the labour of framing it very
considerably, perhaps one-half, as much time is necessarily lost in calling
over three or four hundred thousand long words, such as, * inflammation
“ of the membranes of the brain,” and still more in determining
precisely what many of the equivocal local terms mean.

In ditferent circumstances, and in other countries, it would be neces-
sary to havea distinct head for remittent fever, yellow fever, plague,
&e.; but it will he found that if they occurred, they produced so few
deaths as scarcely to affect the high mortality from typhus in England.
The same remark applies to other heads, including distinct diseases.

The advantages of u uniform statistical nomenclature, however im-
perfect, are so obvious, that it is surprising no attention has been paid
to its enforcement in Bills of Mortality. Each disease has in many
instances been denoted by three or four terms, and cach term has becn
applied to as many different diseases; vague, inconvenient names have
been employed, or complications have been registered instead of primary
diseases. The nomenclature is of as much importance in this depart-
ment of inquiry as weights and measures in the physical sciences, and
should he settled without delay. (1st Annual Report, pp. 92-5.)

-lnalysis of Morbid Phenomena—Nomenclature.*—It will be observed
that the Alphabetical List contains more diseases than the Nosology, and
the Nosology more than the Abstracts ; to explain this, and to show how
the list of the causes of death may be legitimately extended or contracted,
it will be useful to inquire how diseases have been named, or upon what
principles morbid phenomena have been grouped and subdivided. I
shall therefore pass rapidly in review the elementary phenomena of
discase, and consider more particularly how the numerous and in some
instances apparently avbitrary species have been distinguished by
original and systematic writers; for without admitting the assertion
repeated by Crulen, that “species are created by nature, genera by the
human mind,’ t—as our ideas both of species and genera are creations of
external nature ard of the percipient mind,—the determination of these
primary elements of generalization is unquestionably more important
than the subsequent steps in the process, because an error here will be
irreparable. The species in the statistical Nosology occur in the registers
as well as in all the systematic medical works ; and my object ix not so
much to propose anything new, either in the names or the species, (it

 

* The medical readcr who takes an interest in this subject, is requested to refer to
the article “ Nosology” in the Appendix to the First Report. I say “medical ”
reader, because it is impossible to discuss a subject so purely technical as Nosology
without assuming a knowledge of facts and principles which can only be familiar
to medical men ; who it is quite certain will be called upon to exercise all their pro-
fessional sagacity in returning the “causes of death” with the necessary degree of
accuracy.

+ A natura vero, species solum date sunt; ct generum constitulio est mentis
humane excogitatio.— Cullen—Synopsis Noso]. Meth. Even in natural history it
would perhaps be more correct to say “individuals ” than species.
DEATHS. | 235

beiug the very nature of an arrangement of the facts observed by all the
practitioners of a country to follow, as the observers themselves follow,
the discoveries of pathology), as to point out some of the principles
which have guided us in the distinction of species, and in the formation
of the other divisions of the classification.

The human body consists of atoms of various kinds in certain degrees
of proximity—in a polarity—and in relative positions—which prebably
determine the properties of the organization, considered in reference to
its various parts, and to the external world ; from which it ix constantly
receiving, and to which it is incessantly rendering, its elements. The
constituent atoms of oxygen, hydrogen, carbon, nitrogen, phosphorus,
sulphur, iron, calcium, magnesium, potassium, and sodium, exist in fluid
or solid compounds—the result of a long series of metamorphoses in the
earth, atmosphere, plants, and inferior animals. The fluid compounds
ave blood. The solids, which, according to a recent theory, consist of
cells, may be divided into cellular, mucous, fibrous, horny, cartilaginous,
osseous, muscular, vascular, nervous tissues; and the blood, apparently
« homogeneous liquid, perpetually undergoing transformations, readily
separates out of the vessels into a clot of fibrine entangling globules, and
into serum, containing dissolved albumen, with carbonates, phosphates,
muriates, and sulphates of potash and soda in solution. Fibrin and
albumen contain the same elements in the same proportions; with a red
colouring compound of iron they form the globules. The blood also
contains peculiar fatty bodies, and the earth of boue in small quantities.
All the ¢isswes are formed out of the blood, and they form the parts,
organs, and systems of which the aggregate is the organization.

The Jody in the whole, and in its parts, undergoes innumerable
alterations, but these deviations from the normal type may be reduced to
certain gencral heads :—(1.) increase or diminution of density, weight,
volume, cohesion, elasticity, colour, number (of parts),—of which the
following are examples—iuduration, softening, dilatation, contraction,
atrophy, hypertrophy, anemia, plethora, albinism, fracture, hemorrhage :
(2.) displacement ; examples—transposition of viscera, hernia, disloca-
tions, passive congestion, dropsy : (8) heterologous* products; examples
—pus, tubercle, cancer, melanosis: (4.) disorganization ; examples—
ulceration, mortification. The secretions—the products of transform-
ations of the blood and tissues—saliva, intestinal juice, pancreatic fluid,
bile (poured into the intestinal canal), milk, urine (liquids), perspiration,
breath (generally in a state of vapour)—may all be excessive (flux),
altered in composition (discharge), or deficient (suppression) ; examples
—diuresis, ischuria, diabetes, albuminuria, stone (of uric acid, oxalate of
lime, phosphate of lime, the triple phosphates). As the urine, which
affords peculiar facilities for chemical investigation, has been found to
vary in all its constituents, and to contain either matters derived from
the blood, as albumen—or, as in jaundice, secreted by remote organs—or
new (heterologous) compounds, such as diabetic sugar, oxalate of lime,
free uric acid,—the existence of similar changes may be inferred in the
other secretions, and in the blood.

Besides the pbysical and chemical alterations which may be detected
after as well as before death, derangements of the dynamic phenomena
of life are observed, which may be referred to the heads of heat, refrigera-
tion, spasm, paralysis, pain, coma, mania, amentia; as we see them, for
instance, in ague, the exanthemata, typhus, inflammation, cholera,
tetanus, epilepsy, palpitation, paraplegia, gastrodynia, apoplexy,
insanity.

 

ee Lennec proposed to call tubercle, melanosis, and cancer, which have no analocues
in the organization, heterologous products. .
236 [PART Iv.

The elementary phenomena of disease admit of infinite combinations :
and none is of more frequent occurrence, or of greater importance, than
inflammation; the symptoms of which are “redness and swelling, with
heat and pain.”* The redness and swelling denote an excess of blood in
the part ; the heat a chemical reaction of the blood and tissue, the result of
which is interruption of the function, and generally the effusion of lymph,
the formation of pus, or gangrene. Ifthe hypothesis be adopted, that beat is
formed hy the combustion of organic matter, and is proportional to the
amount of oxygen consumed, we can easily understand how heat. is
generated, and becomes sensible in inflammation. ‘Lhe heat, accompanied
by quick pulse (increased action of the heart), is called inflammatory
fever ; but fever itself is the result of « great variety of morbid processes,
in which the disengagement of heat and the waste of flesh is rapid.

If we now inquire how the species of disease have been distinguished,
and whence their characters have been derived, it will be found to have
been generally from the morbid processes or products, the parts affected,
the pain, the perceptibility of phenomena, their duration, their
individuality, frequency, and fatality.

The parts affected, and their functions, stand next in importance to
the morbid processes, actions, or products. The body is an aggregate of
organs, each consisting of a variety of tissues, and performing special
offices. The eye, for instance, is an organ consisting of a lens, of
humours, membranes, blood-vessels, muscles, nerves, the optic nerve : its
function is vision; and though all the deviations of its apparatus from
the normal state are morbid, interference with vision stamps them with
importance, and entitles them to names. The most important organs
are the brain, spinal marrow, nerves, senses, constituting the nervous
system; function—-sensation, volition, motion : the heart, arteries, veins,
—the vascular system ; function—circulation of the blood. The nervous
and vascular systems pervade, and their derangement may directly
disturb, aJl the parts of the body. The functions of the absorbent,
respiratory, digestive, urinary, generative, locomotive, integumentary,
and cellular systems, will be denoted by their names. Each system is
composed of many parts, forming subordinate organs; thus, the hand is
an organ of prehension, the mouth of mastication, the pharynx of
deglutition. ‘Some parts are more easily observed than others, and will
be found to have not perhaps more disease, but a greater number of
specified diseases. The influence of function and of perceptibility on
nosological nomenclature will be seen by comparing in systematic works
the diseases of the ear and hand with the long list of diseases of the
eye ; the diseases of the mucous membrane with the diseases of the
skin ; the inflammations distinguished by the ancients, with the serous,
mucous, parenchymatous inflammations of modern pathologists, armed
with new instruments of diagnosis, and facilities for examining bodies
after death. Where particular parts of organs are liable to attacks, and
present, characteristic symptoms under the attack, or where the products
of pathological processes are distinct; wherever, in fact, important patho-
logical states and phenomena are isolated, and can be individualized,
they have been made species of disease. Pleurisy, pneumonia, and
catarrh (bronchitis), were distinguished at an early period, and their
independent existence has heen confirmed by pathological anatomists ;
they differ in the symptoms, site, and fatality; and occurring together,
but often alone, are examples of the way in which diseases of different
parts of an organ have been divided into species.

 

a Note vero inflammationis sunt quatuor, rubor et tumor cum calore et dolore.
Celsus, lib. 3, sect. 10.
DEATHS. | 237

In the constitution of species, more attention is now justly paid to
structural than to functional changes; the former are often the proxi-
mate causes of the latter, but some pathologists, led astray by a principle
of classification applicable to natural history,* or pre-occupied by their
anatomical studies, and the recent discoveries in morbid anatomy, have
denied the existence of dynamic disease, and, by a violent and improba-
ble hypothesis, have assumed that every case, for instance, of insanity,
convulsion, or syncope, is the symptom of a congestion, inflammation, or
some other evident anatomical lesion. Tt would be as reasonable to
assume that the needle of the mariner’s compass never loses its magnetic
properties but by evident oxidation.

Upon an examination of the registers of the fatal diseases in the first
years of registration, made, as is evident, from the instructions, without
any preconceived notions on classification, it was found that, exclusive of
epidemic diseases, a majority of the cases had been referred to particular
organs, which were named or unequivocally indicated by the nature of
the lesion. In other cases, such as haemorrhage, dropsy, abscess, morti-
fication, and cancer, the seat of the disease was seldom mentioned. The
first class was arranged in groups, as sporadic diseases of the nervous,
circulating, respiratory, digestive, urinary, generative, locomotive, and
integumentary systems; the second as diseases of uncertain seat (de
incertis sedibus).} This mode of viewing the facts is common in England ;
it has been adopted in the treatises on the practice of physic which are
most generally in the hands of practitioners, and, what is of more im-
portance, by the authors who have devoted themselves successfully to
research, and have naturally contributed most to the formation of the
reigning medical opinions. The Library of Practical Medicine has fol-
lowed this arrangement, and we have the original works of Abercrombie
and Marshall Hall, on the Diseases of the Nervous System; Hope, on
the Diseases of the Circulating System ; Williams, on the Diseases of the
Chest ; Abercrombie, on Diseases of the Stomach and Intestines ; Prout
and Sir Benjamin Brodie, on the Diseases of the Urinary Organs;
Willan and Bateman, on Cutaneous Diseases, not to mention others, and
the treatises on midwifery, or the surgical treatises on the diseases of the
joints and bones. Upon the other hand, there are essays and papers by
Carswell, Watson, Sir James Clark, Mueller, Carmichael, and Walshe,
on hemorrhage, dropsy, tubercle, cancer, with a subordinate reference to
the parts affected. The French writers, Lannec, Andral, Chomel,
Rostan, Lallemand, and Louis, from whom we derived so much, have
cast their practical works in the same mould. This mode of grouping
and considering the different types of sporadic disease appears to be
practically the best—to involve few errors in carrying it ont, to lead to
useful results, and to be in conformity with the general principles upon
which diseases have been constituted and named.

Tt will be observed that the different heads in the statistical N osology
are numbered and sometimes subdivided. They may he called species,

 

* Pour que chaque étre puisse toujours se reconnaitre dans ce catalogue, il faut
qw il porte son caractére avec lai: on ne peut done prendre les earactéres dans des
propriétés ou dans des habitudes dont Vexercice soit momentanée mais ils doivent
étre tirés de la conformation : Curvier—-Régne Animal, tome i. p. 7. The problem
in natural history is or was—Given one of many thousands or millions of individuals,
what is its name and place in the “catalogue ?” As the specimen is often dead, or
as in fossils, has been only partially preserved, the superior importance of characters
derived from the most permanent structures of the organisation is obvious. Recogni-
tion is not a main object of any classification of diseases; and the most expert
anatomist would, in nuinberless instances, find it is impossible to divine from the
after-death appearances the previous pathological phenomena.

t Celsus.
238 [PART Iv.

provided the term be not understood in the strict sense it bears in natural
history,* with the technicalities of which medical science should not be
encumbered, as it has principles of its own, and can derive more advan-
tage from the methods of chemistry and natural philosophy.

To commence with the diseases of uncertain or variable seat.
Hemorrhage is essentially the loss of blood; blood may escape from
any of the vessels in any part; and the difference and susceptibility of
the part has given eight names to the affection. Hemorrhage is
periodical in females, and hereditary in some families; epistaxis is a
type of simple hemorrhage. ‘The extensive loss of blood in phthisis,
stone, cancer, ulcer, wounds, &¢., is an important and sometimes fatal
complication, but the combination of lesions may be described (‘ phthisis,
hemoptysis,” &c.), and does not require a name. Hemorrhage in the
brain is one of the causes of apoplexy ; in the lungs, one of the causes of
asphyxia. Dropsy, the effusion of serum in the cellular tissue, the brain,
chest, pericardium, peritoneum, tunica albuginea, las received distinct
names, It is frequently an effect of retarded circulation, is a sequela of
searlatina, is observed in famines, and is the cvuse, consequence, or von-
comitant of Bright’s disease of the kidneys (nephria). Abscess, or
purulent deposit, is a secondary disease ; psoas abscess (almost invariably
scrofulous) has been distinguished, ulcer is generally scrofulous, scor-
butic, syphilitic, cancerous, or varicose, and is further described by the
addition of the part affected. Scrofula, characterized by the deposit of a
matter allied to, if not identical with, the tuberculous matter of phthisis,
so frequently affects the lymphatic glands, that their chronic enlargement
or inflammation (adenitis) is almost always considered scrofulous ; the
deposit of tuberculous matter in the mesenteric glands has a name (¢abes
mesenterica), asit is frequent in children. ‘Tubercle may be deposited in
every part, and is found in the bodies of those who die of other diseases,
it atfects the glands and brain chiefly in children, the lungs in adults.
Cancer differs from tuberculous matter in its tendency to assume an im-
pertect form of organization, it presents several varieties, but as it invades
many parts simultaneously or successively, it has not received special
names from the organs notwithstanding the variety of specific symptoms
to which it gives rise. It is unnecessary to extend these remarks; they
will apply with little variation to all the diseases in the class. By
following all the possible combinations of the few elementary lesions here
fixed upon, through all the organs, considering each a separate disease,
and giving it a name, the number of species would become very great,
but the number has been limited by their infrequency, imperceptibility,
indistinetness, or indestructiveness.

If it were agreed to use the prefixes—hem-a, hydr-o, py-o, hele-o,
choir-a, carcin-o, necr-o, hyper, par—to designate the ten principal
lesions in the class, by prefixing them to only ten of the principal parts
(and they may be prefixed to a hundred), 100 species would be formed.
Thus, as we have hydro-cephalus, serum infused in the brain (inclading
its membranes) ; we should have hemencephalus, blood effused in the
brain ; pyencephalus, pus (abscess) in the brain; helcencephalus, ulcer:
ation of the brain; choirencephalus, tubercles in the brain; necren-
cephalus, ramolissement of the brain; hyperencephalus, hypertrophy of
the brain; péarencephalus, malformation of the brain; and earcinen-

 

* La génération étant le seul moyen de connaitre les limites auxquelles les variétés
peuvent s’étendre, on doit détinir l’espece la réunion des individus déscendus Pun de
Vautre ou de parents communs, et de ceux qui leur ressemblent autant qwils se
ressemblent entre ¢ux.—Curver, R.A., tome i. p. 17. With this definition before
our eyes, we cannot confound the species and genera of natural history with those of
diseases. :
DEATHS. |] 239

cephalus, cancer of the brain ; carcinocardia, cancer of the heart;
carcinopneumon, cancer of the lung ; carcinohepar, cancer of the liver ;
carcinogaster, cancer of the stomach; carcinentera, cancer of the
intestines ; carcinephrus, cancer of the kidney ; careinocystis, cancer of
the bladder ; carcinohystera, cancer of the uterus; earcimamma, cancer
of the breast. Carcinosteon is designated osteosarcoma in surgical
works. All these lesions are the source of special phenomena ; (hamen-
cephalus, carcinencephalus, and carcimamma, for example, are attended
by very different effects) ; and they have been enumerated because a
comparison of these and other possible combinations of lesions and
symptoms affords a good illustration of the way in which diseases
have been constituted; but the new names have not been introduced
into the Nosology, because it could have led to uniformity only at the
expense of old names,* and because the primary fatal diseases of
several in the class are not numerous, and others, as has been already
stated, in which there are organised or unorganised deposits, affect
several organs before they prove fatal. Hemencephalus, necren-
cephalus, hyperencephalus, hypercardia, may however be advantage-
ously adopted. In other cases it will be simpler to write, as has been
recommended in the Nosology, “cancer of the breast, liver, brain,”
than three compound names; and more convenient to describe the
disease by the addition of the locality affected, as cancer of the tongue,”
“esophagus,” “stomach,” “colon,” &c., than to invent specific names,
which are only required in the place of descriptions when the things or
facts have to be frequently considered and mentioned,

Redness, swelling, heat, and pain are diagnostic symptoms of inflam-
mation, but they cannot be satisfactorily observed except in external
parts; the fever is common to all acute inflammations; though the
vascular injection, and other traces of inflammation might be found after
death, they are rarely observed, as the internal parts are seldom inspected ;
so that practically the perversion or abolition of function is the most
striking phenomenon in the inflammations of the organs which are
considered sufficiently important to form distinct diseases. Hence
the parts affected, with the suffix “ itis,” gives names to thirty or forty
diseases; a subdivision of phenomena which, if it is not always justified,
and is unnecessary for statistical purposes, admits of explanation, and
throws light upon the principles already advanced. Inflammation may
exist wherever there are blood and capillaries; its species are limited
by the importance of the parts affected. Inflammation of the mem-
branes and medullary matter of the brain have been designated
meningitis and encephalitis ; of the spinal marrow and its membranes,
myelitis. Besides these inflammations, which sometimes exist apart, and
can sometimes be distinguished during life, writers have described
arachnitis, cerebritis, cerebellitis, &c., from the appearances after death.
Cullen designated by the old term phrenitis the inflammations of the
brain, spinal marrow, and membranes; and although the chief
distinctions of modern pathologists should be attended to, where it is
practicable, in assigning the causes of death, it would be unwise to carry
the division further, or to preserve more than the one head, cephalitis, in
the abstracts. Ophthalmia is now subdivided, and minute oculists
describe ‘‘ conjunctivitis, sclerotitis, iritis, choroiditis, retinitis, and
“ hyaloiditis.” Auscultation has facilitated the diagnosis of affec-
tions of the chest; and the inflammations of the internal and
external membranes have been separated from those of the parenchyma

 

* Heleosteon and chirosteon for caries, psoas abscess, and white-swelling ;
necrosteon for necrosis, hyperosteon for exostosis and node, choirentera for tabes
mesenterica, hementera for melzna, hemahystera for menorrhagia, hydroperitoneum
for ascites, &c.
240 [PART Iv.

of the heart and lungs; besides pleuritis, bronchitis, and pneumonitis,
practical writers now treat of pericariditis, endocarditis, carditis. The
inflammations of the two surfaces and parenchyma of other organs are
generally designated by one word—glossitis, parotitis, hepatitis, pan-
creatitis, splenitis, nephritis, cystitis, orchitis. If it were of the least
utility, the triple subdivision might be extended to these organs ;
and hepatitis, for example, might be made choledocitis, perihepatitis,
hepatitis. Inflammation of the intestinal tract has received several
names; stomatitis, tonsillitis, pharyngitis, cesophagitis, gastritis, enteritis,
(under which term I include duodenitis, jejunitis, ileitis, ccecitis, colitis,
rectitis, proctitis), These terms are held to designate especially inflam-
mation of the mucous and submucous coats of the canal; which is
invested after it enters the abdomen by the peritoneum: inflammation of
this serous membrane is named peritonitis. A question has arisen
whether inflammation of the part of the peritoneum, investing the
stomach, small and large intestine, liver, uterus, bladder &c., should net
be specifically designated gastritis, hepatitis, @e.? It will be much
more convenient to designate inflammation of every part of the peri-
toneum—peritonitis : but the serous and subserous coats of the peritoneum
derive blood from the vessels of the subjacent organs; and, when
secondarily involved, their inflammation is necessarily included in’ our
idea of inflammation of those organs. Inflammation of the liver, causing
adhesions of the peritoneum, is essentially hepatitis; the inflam-
mation, from perforation of the intestine, of the investing membrane of
the liver, and of the other viscera, although their functions are all
violently deranged, is essentially peritonitis. Tleus is ascribed to inflam-
mation of the muscular coat of the intestine by Dr. Abercrombie, who
considers it “ established that a result of inflammation in muscular fibre
“ is gangrene.”* Dothinenteritis has been applied to inflammation of
the mucous follicles. ‘The inflammations of the respiratory tract are—
coryza (schneideritis ?), laryngitis, tracheitis, bronchitis, pneumonitis ;
of the urinary tract—urethritis, cystitis, ureteritis, pyelitis. ‘The bones,
ligaments, joints, (synovial membranes), burse, tendons, muscles, nerves,
veins, arteries, lymyhatics, and glands, described by anatomists, are very
numerous; the bones, for instance, are reckoned at 246, and every one
may be the seat of inflammation, similar in its kind, however different in
its effects ; so to avoid an endless multiplication of names, which would
be rarely or never used, inflammation of the veins (of one or of all) has
been called phlebitis, and the inflammations of the other parts have been
named in the same way, arteritis, adenitis, neuritis, myositis, arthritis
(synovitis, chondritis, syndesmitis), ostitis, (endostitis, periostitis,)
fascitis, tendinitis. 1n registering this class of cases it will be most
convenient to write “Inflammation of ——,” the particular part; or
“ Arthritis (knee),” &c.

Inflammations are acute or chronic; but the duration may be more
accurately expressed by the ordinary measures of time.

Inflammations may be divided into pure inflammations—idio-inflam-
mations—or those which supervene in a normal state of the blood and
tissue ; and inflammations which are developed in cachexies, and in the
course of other diseases. The distinction is of such fundamental
importance, that it should be explicitly expressed in the names; which
might be effected by restricting the use of the termination “itis” to
idio inflammations, and applying the termination “ia” to complicated
inflammations. Simple inflammation of the lungs would be designated

 

 

* Researches on the Diseases of the Stomach, the Intestinal Canal, the Liver,
and other Viscera of the Abdomen, By J. Abercrombie, M.D., &c. Third edition,

p. 6.
DEATHS. | 241

pneumonitis; the inflammation of the lungs occurring in small-pox
“pneumonia.” Upon the same principle ophthalmitis ; and purulent
ophthalmia, may be distinguished ; the visceral inflammations in typhus
and remittent fever would not be cephaliés, &c., but cephalia, pulmonia,
gasteria, enteria, hepatia. The inflammation of the brain in scrofulous
children has a specific name—hydrocephalus; and_ peritonitis, with
tubercular deposition, is qualified by “tubercular;” the adoption of
the two termirations would be a useful extension of the analogy, with
which dysenterza is in strict conformity.

The systems of organs in the body are liable to functional derange-
ments which cannot be ascribed to inflammations. Neither the inflam-
mation nor the dynamic derangement exists independently of the organs ;
the two series of phenomena often co-exist ; and it is not clear that they
can be advantageously separated in statistical abstracts of the causes of
death. They were grouped together under the principal systems in the
first abstracts, and the arrangement has been retained: for the organ
determines the character of the disease, as the grafted branch determines
the quality of the fruit.

The brain, spinal marrow, and nerves are the organs of sensation,
volition, and (with the muscles) of motion. The muscles are of two
kinds ; (1) the voluntary muscles, which are attached to the bony levers
of the skeleton, and by contracting at the bidding of the will, produce
the various movements which we witness of the whole or a part of the
body; and (2) the involuntary muscles of the hollow organs, for the
retention, circulation, ingestion, and expulsion of fluids; some of which
such as the heart and intestinal canal, are independent of the wili, while
others, like the respiratory muscles, are excited by the brain and by the
spinal marrow—by the stimulus of volition and of contact—reflected
along the nerves. Spasm is in general the excess, paralysis the abolition
or diminution, of muscular action; the voluntary muscles, in spasm,
contract spontaneously, despite of the will; in paralysis the will has no
effect upon them, or does not produce harmonized contractions; the
involuotary muscles in the same circumstances contract violently and
irregularly, or cease to contract upon the application of the accustomed
stimuli. As volition implies consciousness, the muscles which are
exclusively excited by volition are inactive (paralysed ?) in sleep, coma,
and apoplexy—which, in its simple form, appears to be a modification of
deep sleep. In tetanus, croup, epilepsy, catalepsy, hysterics, convulsions,
chorea, tremor, paralysis, apoplexy, the voluntary and partly voluntary
motor system is principally deranged, with or without loss of conscious-
ness; but the spasms or paralysis may originate in the muscles, the
nerves, or the spinal marrow: and after Dr. Marshall Fall’s ingenious
hypothesis, supported by many facts and experiments, the true spinal
system, in this sense, may be considered the seat of the spasm, which, as
well as paralysis, may affect any muscle to which motor nerves are
distributed, as pain may be felt in any part from which sentient nerves
proceed. Pain accompanies nearly all diseases; when it is the sole or
principal phenomena, it has been designated neuralgia—or cephalalgia,
odontalgia, cardialgia, gastralgia, enteralgia, &c., by suffixing algia, from
adyos, pain. Odynia is used precisely in the same sense (as in gastro-
dynia) ; and headache, toothache, heartache, bellyache, stomachache, are
translations of the Greek compounds. Tic douloureux is a convulsive pain.
The spasms and paralysis of parts may be designated in the same manner
as their pains, by terminations (cardiasm may denote spasm, cardialysis
paralysis of the heart) : hemiplegia and paraplegia are in general use;
trismus, opisthotonos, emprosthotonos, pleurosthotonos, are scarcely
required to denote transitory forms of tetanus. The modifications of

 

Q
242 [PART Iv.

muscular force, contraction, and rhythm, as well as their combinations
with pain, loss of consciousness, and functional derangements, are
numberless; it will be sufficient to mention a few from the Nosologies, as
as they are either physiological, and not primary independent affections,
or seldom shorten life: trembling, shivering, languor, Jassitude, hiccup,
sobbing, sneezing, coughing, puffing, snoring, yawning, twitching,
twinkling, squinting, stammering. (Linneus, Mason Good, &c.)

The modifications of the senses, aud of their organs, are equally
numerous: the names of disorders of the feelings, passions, intellect,
occupy no inconsiderable space in the lexicons of all languages. Mania,
monomania, and dementia—a termination of mania—may be dis-
tinguished in the registers.

When the brain, spinal marrow, and nerves of persons affected with
the lesions that have been called dynamic are examined after death,
traces of inflammation are often found: congestion, softening, effusion of
serum, hemorrhage, tubercles, tumours, produce paralysis or apoplexy.
The connexion between the anatomical lesions and derangements of
function requires further investigation; it is not constant.

It was necessary to point out the dependence of visceral pains,
spasms, and paralysis on the brain and spinal marrow; which, in their
various states of excitement, depression or derangement, influence even
the involuntary muscles. ‘The heart, for instance, beats violently or
intermittingly under varions states of mental excitement, and beats
heavily and slowly in apoplexy: but as palpitation, spasm, fainting,
cardialgia, &c., are frequent symptons of heart disease, and as their
source in idiopathic cases may be in the heart itself, they have been
classed with its inflammations and organic diseases. The same prin-
ciple has been acted on in dealing with the neuroses of other organs,
and with affections of the brain originating in the diseases of the heart
and kidneys. The organic diseases of the vascular system—hyper-
trophy, atrophy, ossification, diseased valves, aneurism—which are
now detected by auscultation, can often, but not always, be traced to
inflammation.

Laryngismus stridulus, and asthma, appear to be the only neuroses
of ithe respiratory system which require a separate head in a classifi-
cation of fatal diseases. Deposits of tubercle have so frequently their
seat in the lungs, that the phenomena to which they give rise have
been called phthisis pulmonalis; and on this ground, as well as the
supposed uncertainty of diagnosis, where auscultation is not used,
phthisis was classed with the diseases of the lungs in the first Abstracts.
It does not, however, appear to be governed by the same laws as the
pulmonary diseases, and will probably require, with the progress of
registration, to be classed in the Abstracts under a separate head, or
with the other tuberculous diseases.

Hernia (strangulated) and intussusception are inflammations of the
intestine, caused by pressure; in the former preceded by the escape, in
the latter by violent muscular action, of the bowel, and generally ter-
minating in mortification, with the symptoms of ileus. Constipation
may be either the effect of inaction (torpor), or of spasmodic constric-
tion (colic) of a portion of the intestinal tube: stricture is a contraction
of the submucous coat, either from previous inflammation, ulceration,
or heterologous deposits; and the symptons vary according as the
stricture may be situate in the cesophagus, pylorus, ileum, rectum, &c.,
and may consequently interrupt the ingestion of food or the passage
of feces. As the canals of the organs of the body transmit fluids,
obstructions and retentions form an important class of their derange-
DEATHS. | 243

ments; thus, besides the stricture of the intestine, there are obstruc-
tions of the gall-ducts, of the ureters, urethra, heart-valves, arteries,
veins, trachea, all of which may be fatal. The reduction of aliment is
the special function of the stomach and intestine; it is inferred that
this is imperfectly performed when there is nausea, heartburn, disen-
gagement of gas, or of acrid fluids; hence the designation, dyspepsia.
Little is known of the diseases and functions of the pancreas and spleen.
Liebeg has rendered it probable that the bile is absorbed from the
intestine; may not disorders of nutrition, therefore, which put a stop to
its destruction (combustion) in the blood, lead to its deposit in the cel-
lular tissue, or secretion in the urine ? Jaundice is, however, generally
connected with the diseases of the liver, and is always referred to the
liver as its source. The fatty degeneration of the liver occurs frequently
in phthisis; cirrhosis is an atrophy of the liver produced by the
pressure of the contractile tissue, developed in the capsule of Glisson.—
( Carswell.) The compression of the portal vein leads to venous
effusion, and almost invariably constitutes the disease which was called
by the ancients ascites.

Ischuria, diuresis, albuminuria, diabetes, stone, are the principal
functional diseases of the urinary system; the three first, though often
symptons ‘as subordinate phenomena are sometimes called) of nephritis
and other diseases, appear to have sometimes an independent existence.
As the sugar of diabetes is found in the blood and in the stomach, it
has been considered essentially a dyspepsia, and been classified with the
stomach diseases, as bile in the urine has been referred to the liver; but
we have custom, with the unquestionable, invariable existence of sugar
in the urinary secretion, on one side, and only a probable hypothesis on
the other. A secretion may be modified as well by a change of the
fluids, from which it is made directly or indirectly, as by a change in the
secretory organ ; and the oxalic acid, uric acid, triple phosphate, albu-
men, as well as sugar in the urine, may often be considered the
exponents of changes in the chemical processes of remote organs. The
same may be said of mismenstruation. All the diseases incidental to
childbirth are connected together by this function, and their seat in the
reproductive organs.

Besides inflammation, the osseous system may be the seat of all the
diseases of uncertain seat: brittleness and softening appear to depend
upon the excess or deficiency of bone-earth in the gelatinous tissue.
Skin diseases require no comment here: the innumerable varieties
depend apparently as much on the complicated structure of the integu-
mentary system, and its free exposure to the oxygen of the air, as on
the specific nature of the morbid processes.

Two or more diseases frequently coexist: vleuripneumonia, para-
plexia, and gastro-enteritis are examples of the compound names by
which these combinations have been designated. If two morbid states
invariably coexist, or two parts are simultaneously affected, and the one
affection imply the other, a single name is sufficient ; if the coincidence
be rare, a new name will be unnecessary ; and, us a general rule, it will
be better in such cases to write the names of the separate diseases con-
secutively, whether they arise from the same cause, or stand to each
other in the relation of effects and causes.

The phenomena of all the diseases which have hitherto been con-
sidered had reference to the nature of the morbid processes, or the
systems of functions and organs: two classes remain to be reviewed—
the class of epidemic, endemic, contagious diseases, and the class of
poisons, asphyxia, or injuries, in which the cause is the fundamental
fact around which the phenomena are naturally grouped,

Q 2
244 [PART Iv.

One person dies of corrosion of the stomach and hematemesis, another
of palsy of the heart, another of tetanic spasms of the respiratory
muscles, another of pure narcotism, another of a combination of these
phenomena which have in them something peculiar, and differ from the
spontaneous diseases with which they have been compared. All the
sufferers have been poisoned by oxalie acid, in various degrees of
dilution. To what single disease in the Nosologies can these affections
be referred? Verdigris produces a variety of symptoms—vomiting,
cutting pains in the bowels, jaundice, violent headache, cramps in the
legs, convulsions, palsy, insensibility,—and the poison itself is the pre-
dominating fact ; the nature of the morbid processes, and the lesion of
the parts or functions being of secondary importance, differing according
to the dose, the individual, and many accidental circumstances, but
possessing altogether, in connexion with each other, order of succession,
intensity, and result, a certain individuality of character, which
distinguishes poisoning by copper from poisoning by other substances,
and from other diseases. The diseases that poisons, such as oxalic acid
and the salts of copper or lead, occasion in the body, should evidently be
named, now that the diseases have been ably investigated and described
though they are not so well understood as their exciters. ‘I'he idea of
the metal, lead, is represented by the word “lead;” and as this name is
required for the purposes of speech, a name for the series of phenomena
caused by lead, or the salts of lead, in the human body, appears to be
equally indispensable in medical science. It is as necessary to distin-
guish the effects of a lead poison in the body, from the lead poison
itself, as to distinguish a “burn” from the fire by which it is produced ;
for lead, or arsenic, or any substance of the kind, proves a cause of
death only when it produces certain changes (diseases) in the organiza-
tion, and those changes are logically the direct cause of death. <A burn
or arsenicia may be the cause of death ; but fire and arsenic are only
causes of death by producing burn and arsenicia. Catharsis, narcotism,
intoxication, salivation, burn (blister, eschar), asphyxia, fracture, con-
tusion, wound, dislocation, are names that have already been adopted to
designate the pathological effects of chemical or mechanical agents.
Catharsis is produced by colocynth, scammony, jalap, rhubarb, aloes,
senna, castor oil, croton oil, elaterium, salts of soda, potash, magnesia,
and a hundred other substances ; in the effects of which careful obser-
vation might detect peculiarities, slight in some cases, but as broad and
obvious in others as the differences in the chemical composition of the
cathartics. In strict conformity, nevertheless, with the correct prin-
ciples of nomenclature, catharsis and hypercatharsis serve to express
the actions of the greater number of purgatives; yet it must not be
forgotten that these actions are of a peculiar nature, sometimes affecting
the whole organization, and constituting specific diseases, of which
catharsis is a leading symptom. Opium, hyoscyamus, hemlock, hydro-
cyanic acid, tobacco, belladona, digitalis, fungi, cause narcotism, and
the term narcotism designates sufficiently well the effects of some of the
common narcotics; but it would be absurd to confound the diseases
excited by opium and hydrocyanic acid, digitalis and poisonous fungi,
under a general designation. Catharsis, narcotism, intoxication, and
burn present nearly all the elementary phenomena of poisoning ; but
the number of combinations of elementary phenomena, and degrees of
intensity, like their chemical causes, are innumerable.

“ Miasm, properly so called, causes disease without being itself
“ reproduced. Carbonic acid and sulphuretted hydrogen, which are
“* frequently evolved from the earth, in cellars, mines, wells, sewers,
“ and other places, are amongst the most pernicious miasms.” (Liedig.)
DEATHS. | 245

Miasms produce diseases like ague, without being propagated by con-
tagion; but the poisons—carbonic acid, sulphurretted hydrogen, and
other gases, which are given off by organic matter in putrefaction,
afford an illustration of their action. The miasm which excites inter-
mitient fever may be designated pyretine ; and if it were not probable
that modifications of the marsh miasm induce, in certain circumstances,
remittent and yellow fever, specific names should be found for their
principles. Rheumatic fever is apparently caused by a miasm.* Its
changes of seat can scarcely be accounted for on the hypothesis that it
is a local inflammation of the fibrous tissue.

Certain matters which have not yet been analyzed produce small-pox,
glanders, hydrophobia, syphilis, measles, scarlatina, and other diseases ;
and as it was before proposed to give names to the well-defined diseases
produced by poisons, so, for the purposes of reasoning, it will be equally
useful to name these specific matters or transformations of matter by
which diseases are propagated either by inoculation and contact
(contagion), or by inhalation (infection). The following list exhibits
the popular and scientific names of diseases in juxtaposition with
the proposed names of their exciters; and it may be assumed
hypothetically, that in the blood corresponding bodies exist, which are
destroyed, and by the transformation of which the exciters are
generated or reproduced. The names in the second column terminate
in a, except a few in s. Lyssa (from Avoca, rabies), the old Greek
term, has been restored by Mason Good; I propose, for the sake of
uniformity, to call puerperal fever metria ; mumps, parotia; reserving
parotitis for simple inflammation of the parotids; croup, (racheia ; and
the disease from puncture in dissection, necusia, (vexvs the dead
body).

 

Diseases. Zymotic Principles.
Small-pox - variola. varioline.
Cow-pox - vaccinia. vaccinine.
Glanders equinia. equinine.
Hydrophobia lyssa. lyssine.
Syphilis - - syphilis syphiline.
Infection in dissecting necusia. necusine.
Erysipelas - - erysipelas. cerysipeline.
Puerperal fever metria. metrine.
Measles - rubeola. rubeoline.
Scarlet fever -  scariatina. scarlatinine.
Whooping cough pertusszs pertussine.
Dysentery - - dysenteria. i enterine,
Diarrhea - - diarrhoea. .

Cholera —- - cholera. ( cholerine.
Influenza - influenza. influenzine,
Typhus . - typhus. typhine.
Plague - -  pestzs. pestine.

The existence of gangrenine, ergotine, ophthalmine, tetanine, miliarine
diphtherine, parotine, aphthine, tracheine, may also be admitted. It
is maintained by some pathologists, that the same specific poison
produces several of these diseases—erysipelas, necusia, and metria, for
instance ; but while the diseases are described as distinct, it will be most

 

*The exciting cause of intermittent fevers, rheumatism, and [rheumatic]
neuralgia is generally admitted (?) to be malaria; and if viewed abstractedly, and
with reference to their specitic nature, it is probable that malaria is the only
exciting cause of these diseases.—Prout on Stomach and Urinary Diseases, p- 80,
246 [PART Iv.

convenient 1o consider their exciters as distinct, although they may be
convertible into each other, and be as nearly related as varioline and
vaccinine.

The chemical composition of these principles is at present unknown ;
but as salts are distinguished from each other by their relations to other
bodies, and, though they may have the same appearance in solution, are
found to differ by the compounds which they form with other bodies in
solution, so the existence is demonstrated by the effect, of the matter
here called “ lyssine,” on animals, although it cannot be detected by
the rough analysis of artificial chemistry. The smallest quantity
imaginable of dyssine inserted under the skin of a dog produces hydro-
phobia; and the bites of the infected dog will throw other dogs, and
even human beings, into a state similar to that of the deg from which
the charge of lyssine originally came. Varioline in the same manner
produces small-pox, if the patient has not previously undergone its
influence, or the influence of vaccinine—a modification of varioline.
The diseases of this class have been frequently spoken of as fermenta-
tions; and Liebig has now opened the way to the explanation of their
nature by a reference to the phenomena attending the transformations
of organic compounds, excited by the action of other compounds
simultaneously undergoing analogous transformations. Thus yeast,
which is gluten in a state of transformation, added to wort, which
contains gluten and sugar, converts the gluten of the wort into yeast,
and at the same time the sugar into alcohol and carbonic acid, the
two transformations going on together, and the latter ceasing when
the former ends. The yeast reproduces yeast, if gluten, from which
it was originally derived, be present; and if the temperature and
circumstances be favourable, fermentation may be spontaneous.*

It must he admitted, with respect to all the forms of these diseases,
that the body, in the cycle of external circumstances through which it
passes, may run into them spontaneously (in this they differ from the
class of diseases referred to external causes); for it is impossible to
trace them invariably to infectious sources; it is not @ prior? more
improbable that they than that other diseases should arise sponta-
neously ; and it is impossible to account for their existence in the world
upon any other principle than that of spontaneous origin. Still the
property of communicating their action, and affecting analogous trans-
formations in other bodies, is as important as it is characteristic in
these diseases, which it is proposed therefore to call, in this sense,
zymotic.f A single word, such as Zymotics, is required to replace in
composition the long periphrasis “ epidemic, endemic, and contagious
“ diseases ;” with a new name, and a definition of the kind of patho-
logical process which the name is intended to indicate, persons who
have not made themselves acquainted with the researches of modern
chemistry can scarcely fall into the gross error of considering this
peculiar kind of diseased action and vinous fermentation absolutely
identical, or of considering that others entertain that opinion. Licbig

 

* See Liebig’s luminous exposition of the doctrines of fermentation, in his
Chemistry of Agriculture, Physiology, and Pathology : two vols.

{ From (vuow, I ferment: zymosis fermentation, and zyma ferment, may also
be employed in English, not in the sense which they have in Greek, but as general
designations of the morbid processes and their exciters, Zymosis,and the verb from
which it is derived, occur in Hippocrates. See a good note and quotation from
Galen, by Fesius, in the @conomia Hippocratis, appended to the Geneva edition
(1662) of the works of Hippocrates. Coction appears to have becn used by the
father of medicine with the same qualification as ebullition and fermentation by
Sydenham. See his Treatise on Ancient Medicine, vol. i, CEuvres complétes
d'Hippocrate, par E. Littré, 1839.
DEATHS. | 247

draws a distinction between fermentation and putrefaction: the reasons
are mere urgent for distinguishing the pathological transformations
from fermentation or putrefaction, while it is admitted that they are
of a chemical nature, and analogous to fermentation; by which they
are moreover to a certain extent explained, although so little is known
of the series of chemical changes and products in any single zymotic
malady, or of the chemical reactions of the living forces and organs,
Smali-pox is by hypothesis the transformation of varioline, and certain
unknown concomitant chemical changes in the blood and skin:
manifesting the important symptoms which fall under direct observation.

Some of the morbifie principles are fixed; others are volatile; but
the greater part of them are fixed and volatile in different circum-
stances. Necusine, pestine, syphiline, lyssine, equinine, and vaccinine
are the most frequently fixed; they give rise, when placed on the skin,
particularly where the epidermis is removed, to their peculiar diseases ;
but contagion is not invariably the result of their contact; indeed, in
several of them it is the exception rather than the rule. Either there is
no matter in the organization susceptible of transformation, or the
specific transformation is overpowered by the vital energies; for in
every case, if the morbific principle (zymine) tends to impart its
movement to the organisation, the organisation, animated by the natural
forces, has a tendency to. continue its own processes, and to impart its
conservative movements to all the organic matters which are brought
within its sphere.

Varioline is converted in the cow (as Mr. Ceeley has shown) into
vaccinine and cow-pox affords an interesting illustration of the modifi-
cations which diseases undergo, and which may be imparted to them
by changes in their exciters. Waccinine taken from the cow effects the
transformation of the materies morbi in man almost as completely as
varioline; but it reproduces vaccinine; and in the process is never
fatal, never produces the variolous fever, and its vapour is never
infectious, like that of varioline. The mild form of small-pox which
appears in persons modified by previous vaccination, or which follows
small-pox inoculation, is an equally good example of the changes
induced in diseases by the actual constitution of the individual, and the
mode of infection.

Syphilis, erysipelas, necusia, metria, rubeola, scarlatina, and the other
zymotic diseases, also put on different forms, which may be referred to
the state of the exciter, the mode of its application, the matter on which
the exciter acts, or the vitality of the patient. A modification of
cholerine, or of enterine, probably produces diarrhea. Louis considers
dothinenteria (his févre typhoide) a different disease from the typhus
of this country, and points out the ulcerations, particularly of the
glands of Peyer, with the correlative phenomena, and the rose-spots
disappearing under pressure, as establishing its distinct character.*
The differences in certain cases are unquestionable, and may be
expressed by dothinenteria and typhus; but the two forms of the
disease occur in this country ; the characters are frequently mixed ;
and they are not greater than are observed in scarlatina simplex, and
scarlatina maligna, with black incrustations, and gangrenous inflammation
of the throat, in the erythema and phlegmonous erysipelas of
Mr. Lawrence, or in the varieties of other diseases.

The blood, which pervades the whole system, is the primary seat of
zymotic diseases; but this does not diminish the importance of the
local phenomena with which they commence, proceed, or terminate; for

 

* Louis, Fidvre typheide, vol. ii., p. 311.
248 [PART IV.

they affect (as poisons do) particular organs more extensively and
frequently than others, give rise to specific pathological formations or
secretions, and derive their character from the lesions and affected organs.

The heat disengaged in these diseases suggested the term fever,
derived from ferveo, as fermentum is from fervimentum.

Some zymotic diseases recur, others only happen once in life, or if
they happen twice, it is the exception: this has been explained on the
hypothesis that some but not all kinds of matter (zymin) are reproduced
in the organization after they have been destroyed by transformation
(zymosis) in attacks of disease.

The tendency of zymotic diseases to increase and decline in activity,
is one of their most remarkable properties ; and the suddenness of their
outbreaks, with the great mortality of which they were the cause,
excited at an early period the attention and solicitude of mankind.
This tendency is indicated by the terms epidemic and endemic; the
latter serving to designate diseases which are excited by miasmata, and
prevail in proportion to the quantity of miasm developed; the former,
epidemic, denoting the diseases transmitted by man to man, inde-
pendently of locality, or only dependent on locality, temperature, and
moisture as adventitious circumstances. For statistical purposes, the
epidemic, endemic, and contagious diseases have been classed under
one head, as they may all be excited by organic matter in a state of
pathological transformation. Ague is not contagious, and is apt to
recur; it therefore apparently approaches the class of toxical diseases ;
but I feel inclined rather to consider it a zymotic disease, in which, to
use the language of Liebig, the exciter is destroyed as soon as it is
reproduced; and this view is confirmed by the analogies of remittent
fever, or yellow fever, so intimately allied in some respects with ague,
in others with plague, and apparently contagious (though this is
disputed) in certain circumstances. Scurvy is a transformation induced
by the want or inadequate supply of vegetable food. It formerly
decimated the English navy, and is now met with in certain prisons.
Scabies and porrigo (both contagious diseases) are ascribed to an
insect (acarus scabici) and a low form of independent organization.
The mode in which zymotic diseases are propagated has afforded the
ground of an interesting comparison between their diffusion, blight of
vegetables, and the generation of animalcule.

Sydenham referred, in the following passage, to zymotic diseases
which were so rife in London formerly as to divert attention from pure
inflammations ; and, as they approach nearer than other diseases to the
definition of species in natural history,* justify the comparison which
he has instituted :—

“Tf the humours are retained in the body beyond the due time,
either (1) because nature cannot digest and afterwards expel them, or
(2) from their having contracted a morbific taint from a particular
constitution of the air, or (3) lastly from their being infected with some
poison: by these, I say, and the like causes, these humours are worked
up into a substantial form or species, that discovers itself by particular
symptoms, agreeable to its peculiar essence; and these symptoms,
notwithstanding they may, for want of attention, seem to arise either
from the nature of the part in which the humour is lodged, or from
the humour itself, before it assumed this species, are in reality
disorders that proceed from the essence of the species newly raised to
this pitch [zymine]; so that every specific disease arises from some
specific exaltation or peculiar quality of some humour [zymin] contained

 

* See note, page 24, of 4th Annual Report.
DEATHS. | 249

in a living body. Under this kind may be comprehended most diseases
which have a certain form or appearance ; nature, in fact, observing
the same uniform method in producing and bringing diseases to a
height or crisis as she does in the production or growth of plants or
animals ; for as every plant or animal is possessed of peculiar properties,
so is it likewise in every exaltation of any humour, after its being come
toa species or disease. We have a clear proof of this every day, in those
kinds of excrescences that grow on trees and shrubs (occasioned by the
ill quality of the nutritious juice, or other causes), in the form of moss,
mistletoe, mushrooms, and the like; all which are manifestly different
essences or species from the tree or shrub that bears them.”—Sydenham’s
Works, trans. by G. Wallis.

Sydenham’s methods of treatment were adopted by him, and recom-
mended as the results of experimental investigation. However their
use might have been suggested, their efficacy was determined by their
apparent influence on the recovery of patients; but in his exposition
of therapeutic principles, he keeps constantly in view his theory of
“commotion ” (comotio) ; “a general term which he chooses in order to
“ prevent all fruitless dispute about words that might arise from the use
“ of fermentation or ebullition (fermentatio vel ebullitio), which,
“ though they may seem harsh and metaphorical to some, are capable of
“ a commodious interpretation.”*

Thus, in speaking of “ continued fever,” he says, “ with regard to this
disease, I judge that the genuine indications are to keep the com-
motion of the blood [zymosis] within such bounds as suit the design
of nature, so as to prevent its rising too high on one side, whence
dangerous symptoms might follow, or sinking too low on the other,
whereby either the exclusion of the morbific matter might be hindered,
or the endeavour of the blood affecting a new state be frustrated.”
The early medical observers have directed attention to the analogies
zymotic diseases have with combustion, fermentation, putrefaction, and
poisoning. These analogies have been, to a certain extent, confirmed
by the researches of modern chemistry ; and Liebig has been led by
the study of organic transformations—fermentation, putrefaction, decay
—to develop a theory invented by the greatest practical physicians to
explain the phenomena of zymotic diseases.

Liebig observes, “that physicians had referred formerly to fermen-
“tation merely by way of illustration; ” from which it is evident that
he had not had time to consult the English medical classics on this head,
or he would have discovered, not indeed an anticipation of his own
admirable generalizations, but a theory very similar to his own—the
basis of their pathology—founded upon enlarged views, and well
calculated to prepare the way for his researches and the researches of
other chemists.

The three great contemporaries, Sydenham, Morton, and Willis, lived
in London when plague and epidemic diseases prevailed ; and much as
they differed, or were mistaken on some points, all announced more or
less clearly the zymotic hypothesis, They were not, it must be borne
in mind, mere chemiatric theorists; they had studied diseased action
as assiduously, and with as much sagacity, as modern chemists have
studied fermentation; Willis was a great anatomist; Sydenham and
Morton have left original pathological delineations, which have never

nn RRR
RR RRR a

* Onthe continued fever of 1661-4, sect. 1-4. He adds, “But since the terms
fermentation and ebullition have prevailed among the modern physicians, I have not
serupled to use them occasionally, meaning only to convey my thoughts more easil
thereby.”” y

ft Id. sect. 5. See also on the regular small-pox, 1677-9, sect, 30-33.
250 [PARY Iv.

been surpassed, and laid down plans of treatment which are still
followed.

Liebig, Dumas, and the chemists of this country, will, we sanguinely
hope, not rest satisfied with what has been done, but continue to
prosecute their labours with ardour and success; and, from the study of
the series of transformations of nitrogenous compounds, proceed to
investigate the transformations of the blood, tissues, and secretions
which accompany the production of varioline, typhine, and the other
zymotic principles. (4th Annual Report, pp. 186-205.)

Report on the Nomenclature and Statistical Classification of
Diseases.—Periodical Returns of the fatal diseases and injuries of the
population have been published in London since the commencement of
the seventeenth century; in the Department of the Seine, since 1809 ;
and in some States the national registers contain a column in which the
cause of death is inscribed. Since 1837 tke causes of death have been
classified and have been published in England in conformity with the
principles of a statistical Nosology which is there in use; and at the
Census of 1851 the diseases and infirmities of the population of Ireland
were returned and classed in the same order as the deaths,

The progress of the natural sciences is greatly promoted, as experience
has shown, by the adoption of a nomenclature which can be used in
every country, and which leaves but little doubt that the same thing is
designated by the same or by strictly synonymous words. The utility
of a uniform nomenclature in the registration of the causes of death was
so strongly felt at the first Statistical Congress, that the members
expressed their opinion in the subjoined resolution ; and Dr. Mare
@’Exspine and I were requested to prepare a report on the ground that
we had for several years the practical direction of statistical inquiries on
this subject in Geneva and England.

The resolution is to this effect : —

“ Ilya lieu de former une nomenclature uniforme des causes de décés
‘ applicable @ tous les pays. Cette nomenclature, dout importance ne
“ peut étre méconnue, fera Pobjet études ultéricures, et pourra tre
“ arrétée dans un prochain congrés.”

.

Objects of the Record and Tabulation of the Diseases of Mankind,

The state of health among-the people differs in different times and in
different places ; and the principal purpose of the registration of diseases
is to determine the degree of their variation in each district, and in each
class of the population, as well as the extent to which they are modified
by circumstances.

The causes of insalubrity are thus discovered at their source by death
itself; and it is found that in many instances these causes admit of
removal by sanitary measures.

The deaths that are the direct result in any way of human agency
undergo judicial investigation, which is often aided by the purely
statistical inquiry.

The difficulties that attend the inquiry into the diseases of a whole
population are numerous. They may be referred to several heads.
The phenomena are sometimes exceedingly complicated, and those of
the greatest importance pass within the human body. Medical science
is, notwithstanding all its achievements, still imperfect; the medical
observers all over the country are not always familiar with the latest
improvements in the practice of their art, and it often happens that they
are only called to see their patients in the last days of illness. In parts
DEATHS. | 251

of our towns, as well as in remote parishes of the country, many young
children and old people die without being seen by any medical man.

No perfect record of the diseases of mankind can, therefore, we
believe, be obtained in the present state of civilization; but experience
justifies us in saying that the record of the ascertained facts, and of the
opinions of the existing race of medical practitioners in Europe, is of
value, and admits of many practical applications.

The medical man who attends the sick in illness should be called upon
in the case of death to give a certificate stating the diseases of which
the patients died, the duration of disease (when known), and the date of
the last visit.

Where any person dies who has not been attended by a qualified
medical man, the body should be inspected, and the certificate filled up,
when practicable, by a district health officer, or by some specially
appointed medical man.

The plan that is pursued in Geneva, in Brussels, in Paris, and in
other cities, of appointing a medical officer to visit everybody, and to
report independently on the cause of death to an appointed health officer,
who has thus the opportunity of comparing the certificates from two
sources, is calculated to insure accuracy, and deserves to be adopted in
towns. But in the country districts economy of skilled labour is
indispensable. lf there the sick poor, while alive, are inadequately
supplied with medical advice and medicines, it is vain to expect that
two skilled officers can be specially employed to find out the causes of
death.

The public registers should embody in simple terms the last results
of judicial or other investigations into the causes of death.

Notwithstanding the differences of doctrine, there is now a general
agreement all over Europe in the designation of diseases, and popular
terms can in many instances be employed without risk of inaccuracy,

In each country—that the public register might be intelligible to the
people—-the common names should be used where they briefly and
distinctly designate a disease, except in cases where the vulgar name
may be offensive. It is, however, desirable for statistical purposes that
the names of diseases should be devoid of all ambiguity, and, to facilitate
the abstracts, that they should be single. Such double names as are
used in botany and the other sciences of natural objects would be
cumbersome, and are not required. :

In the national register we recommend the use of the popular names ;
substituting for them, however, the ordinary technical name whenever
it is necessary for the sake of accuracy or of brevity.

In popular and judicial nomenclature names have been employed
expressive of imperfect knowledge of the causes of death, and some of
these names must be adopted. Thus, a person dies suddenly at home,
and the cause is not discovered ; or a man is found dead from home,
without evident injury ; such cases are returned under “ sudden death,”
or simply “found dead,” with the addition of any important
circumstance.

A class of names in universal use, such as “ dropsy,” and frequently
occurring in the mortuary registers, is looked upon with little favour by
pathologists; some of whom have proposed that such names shall be
altogether discarded. And it is undoubtedly true that many cases of
dropsy, convulsion, paralysis, and other forms of discase are every day
traced to organic lesion of the heart, kidney, brain, or other organ; but
can this be done in all cases with all the assistance derived from the
autopsy? Can the lesion on which those diseases depend be discoyered
252 [PART IV.

with certainty where the medical man sees the patient only for a short
time under unfavourable circumstances ?

The permission to use vague terms in these cases, it is objected,
encourages negligence ; but the refusal to recognize those terms that
express imperfect knowledge has an obvious tendency to encourage
reckless conjecture. It appears, therefore, to be a safer course to retain,
for the present, terms of this kind, and at the same time to urge observers
to refer specifically to the primary organic lesion wherever it can be
satisfactorily determined.

Certain deaths occur in birth, in teething, in puberty, in child-bearing,
in the climacteric ages, in old age, which can be referred to no definite
disease—to no circumstance except the peculiarities of the condition of
the organization at those periods; names designating these conditions
must, therefore, be recognised.

Latin names might be used in the National Tables of the causes of
death, which would then be designated in a way everywhere intelligible
among scientific men; but the same object will be attained by using
strictly synonymous terms in the national idioms.

It is evidently desirable to extend the same system of nomenclature
to diseases which, though not fatal, cause disability in the population,
and now figure in the tables of the diseases of armies, navies, hospitals,
prisons, lunatic asylums, public institutions of every kind, and sickness
societies, as well as in the Census of countries like Ireland, where the
diseases of all the people are enumerated.

I have therefore included in the general list the greater part of those
diseases, such as ulcers, itch, blindness, and infirmities of various kinds,
to serve for the classification of the diseases that affect the health, as well
as of diseases that are fatal.

These diseases, as well as the diseases that are not prevalent in
Europe, are omitted in the Mortuary List.

The causes of death were tabulated in the early Bills of Mortality
( Tables mortuaires) alphabetically ; and this course has the advantage
of not raising any of those nice questions in which it is vain to expect
physicians and statists to agree unanimously. But statistics is eminently
a science of classification ; and it is evident, on glancing at the subject
cursorily, that any classification that brings together in groups diseases
that have considerable affinity, or that are liable to be confounded with
cach other, is likely to facilitate the deduction of general principles.

Classification is a method of generalization. Several classifications
may, therefore, be used with advantage; and the physician, the
pathologist, or the jurist, each from his own point of view, may legiti-
mately classify the diseases and the causes of death in the way that he
thinks best adapted to facilitate his inquiries, and to yield general
results.

The medical practitioner may found his main divisions of diseases on
their treatment as medical or surgical; the pathologist, on the nature of
the morbid action or product ; the anatomist, or the physiologist on the
tissues and organs involved ; the medical jurist, on the suddenness or
the slowness of the death; and all these points well deserve attention in
a statistical classification.

In the eyes of national statists the most important elements are,
however, brought into account in the ancient subdivision of diseases into
plagues, or epidemics and endemics—into discases of common occurrence
(sporadic diseases), which may be conveniently divided into three
classes, and into injuries the immediate results of violence or of external
causes.
DEATHS. | 253

Crass I.—Epipemic, ENDEMIC, AND ConTaGious DISEASES.
Zymotici [Morbi populares, vel Demici ?]

This class includes fever, small-pox, plague, influenza, cholera, and
the other diseases which have the peculiar character of suddenly
attacking great numbers of people at intervals in unfavourable sanitary
conditions. The diseases of this class distinguish one country from
another—one year from another ; they have formed epochs in chronology ;
and, as Niebuhr has shown, have influenced not only the fate of cities,
such as Athens and Florence, but of empires; they decimate armies, disable
fleets; they take the lives of criminals that justice has not condemned ;
they redouble the dangers of crowded hospitals; they infest the habita-
tions of the poor, and strike the artizan in his strength down from
comfort into helpless poverty; they carry away the infant from the
mother’s breast, and the old man at the end of life; but their direst
eruptions are excessively fatal to men in the prime and vigour of age.

Pestilence and famine have always obtained the special attention of
governments ; and epidemical maladies have a special claim now to the
attention of the statist, inasmuch as by prophylactic methods, of which
vaccination is an example, and by hygienic arrangements, the ravages
of epidemics may be greatly diminished. They are more than other
diseases under public control, and may be diminished to a large extent
by sanitary measures.

The diseases of the class may be referred conveniently to four groups,
of which (1) fever, (2) syphilis, (3) scurvy, and (4) worms, are types.

New names are wanted to designate new groups of phenomena, which
might perhaps be less equivocally designated by letters of the alphabet ;
but, to assist the memory, words have been employed which, by their
etymology, will suggest the group. We do not, however, in any case
accept the etymological sense as a definition or a description of the group
of causes which a name designates. Thus, parts of the body undergo a
specific transformation in the diseases of the first class, and they have
been designated Zymortic DisEAsEs (Zymotici) in England, without any
intention to imply that these diseases are fermentations.

The list has been drawn up so as to include all the principal diseases
which have prevailed as epidemics or endemics; and all those which are
communicable either by human contact or by animals in a state of
disease, as well as the diseases that result from the scarcity and the
deterioration of the necessary kinds of food, or from parasitic animals.

The Miasmatic diseases (Order 1) are diffusible through the air or
water, and are attended by fevers of various forms; the matter by which
they are communicated is derived from the human body (as in small-
pox) or from the earth (us in ague). (Types: small-pox, ague.)

The Enthetic diseases (Order 2) (from eberoc, put in, implanted) may
be properly called contagious, as they are communicated by contact,
puncture, or inoculation. (Types: syphilis, glanders). The venom
passes through the skin.

The Dietetic diseases (Order 3) arise when the blocd is supplied with
improper or bad food. (‘[ypes: scurvy, ergotism.)

The Parasitic diseases (Order 4) attack especially dirty populations,
and infest the skin, the intestinal canal, and all the structures of the
body. They are rarely fatal; and many pathologists contend that the
parasitic vegetable or animal products are the accidental consequences
of the diseases which they accompaiy.

The subsequent diseases fall under two great classes, differing most in
the property which those of the first class have of pervading several
254 [PART IV.

organs at once, or in succession; while the diseases of the other class
consist essentially of functional or structural derangements of particular
organs of the human body.

Crass II.—CowstirutionaL Disrases.— Cachectict.

The diseases of this class are sporadic; they are sometimes discovered
to be hereditary; they are rarely confined to one part, but before death
ensues they affect several organs, in which new morbid products are
often deposited.

The first order of Diathetic diseases includes gout, dropsy, cancer,
mortification.

The second order of tubercular diseases includes scrofula, tabes mesen-
terica, consumption, and hydrocephalus.

Crass III.—Locan Disrasrs—Monorganiet.

There are sporadic diseases, in which the functions of particular
organs or systems are disturbed or obliterated with or without inflamma-
tion and its products: some of the diseases are hereditary.

The diseases of the brain, spinal marrow, and nerves, form the first
order (1), under the designation of the diseases of the nervous system,
or, more briefly, brain diseases. The diseases of the organs (2) of
circulation, (3) of respiration, (4) of digestion, and (5) of the urinary,
(6) reproductive, (7) locomotive, and (8) integumentary systems,
constitute eight orders of local diseases.

(The division into general and local diseases is found to work well;
as functional disorder is more easily discovered than the precise nature
of the lesions of internal organs which are rarely examined after death.
The evidence may be sufficient to show that there is disease in the brain,
or the chest, or the intestines, but may not enable the observer to
determine whether it is or is not the result of inflammation. Such cases
are classed as “ diseases of the brain,” &c.]

Crass IV.—DerveLopmentat DisEases.—Metamorphici.

The fetus in utero, the infant prematurely born, the infant in the act
of birth, or shortly after birth ; the child in the first or second teething ;
the boy or the girl at the age of puberty ; the woman in childbirth, or
at the critical age when the reproductive function ceases; the person of
advanced age—are all liable to peculiar disorders, which in certain
instances are causes of death, and are in the common nomenclature
designated “ still-birth,” “ premature birth,” ‘“ infantile debility,” ‘“mal-
“ formation,” <“ teething,” ‘ chlorosis,” ‘ childbirth,” ‘climacteric
“ disease,” “old age.” We place all the cases in this class apart, and
join with them atrophy or asthenia, aud what is sometimes called
“ premature old age,’ in which the nutritive process is interrupted,
without other evident disease. They are all the incidental attendants on
the formative, reproductive, and nutritive processes; or the results of
undetected diseases at the periods of life when those processes undergo
great changes.

Crass V.—VIoLENT Deatus orn Diseases.— Thanatict.

All the preceding diseases are modified, and some are induced, by
external agents, but the present class comprises the evident results of
physical and chemical forces acting on the organisation. Burns,
asphyxias, wounds, poisonings, stings, are types of the several sub orders
of the class,
DEATHS. | 255

Fire, asphyxia, mechanical forces, poisons, stings, induce specific
diseases, which present a regular succession of phenomena, and should
in all cases havenames. Thus, as it is the “burn” and not the fire that
is the cause of death, so it is the disease to which “arsenic ”’ gives rise,
rather than the arsenic, that we should register.

Human agency plays so important a part in this class, that it might be
made the basis of the division into orders. Thus a man may die (1) a
glorious death in battle (pro patrid mori); he may die (2) by an act of
homicide (murder, manslaughter) ; he may die (3) ignominiously on the
scaffold (execution) ; or, (4) abandoning the post in which God has placed
him, he may take away his own life (suicide); (5) he may die by a
surgical operation ; and (6) he may die by accident.

If this grouping be adopted, the mode in which death is produced by
wounds, chemical injuries, poisons, asphyxias, and mechanical forces,
would form secondary heads.

At the instance of the Registrar General, instructions have been
prepared under the several heads of the Nosology, for the use of medical
men and coroners in England. In the several countries of Europe
similar instructions would be required, and might be modified so as to
meet the peculiar circumstances of each nation.

The most important point to attend to in the instructions is the
registration of the secondary diseases which intervene in the course of
other diseases, and the record of the duration of every fatal disease.

To render the ‘analysis of the causes of death complete, it will be
necessary to subject a certain number of them to a second analysis :
showing, for example, the various ways in which childbirth is fatal, the
circumstances in which fatal accidents occur, the cases of measles that
terminate in bronchitis or pneumonia, of scarlatina that pass into
dropsy, and the duration of each fatal case. These analyses would be
interesting chiefly to medical statists.

I have thus sketched in outline the classification of diseases from the
statistical point of view, and have arranged them all under the five groups
of Epidemic diseases (zymotici or demici), Constitutional diseases
(cachectici), Local diseases (monorganici), Developmental diseases
(metamorphici), and diseases that are the direct result of violence
(thanati).

The general statist will gain a notion of the three first classes, by
comparing them with the disorders arising in a most elaborate machine
—from electrical, magnetic, or chemical action, and from the wear and
tear of its particular parts. ‘The fourth class is exemplified by defects
of construction and by general decay. The fifth class is represented by
the act of breaking the machine to pieces, disintegrating its parts, and
putting an end to its movements, which when once stopped cannot be
recommenced.

By studying the causes which are injurious and fatal to men in our
countries and in our cities, statists will contribute to the removal of evils
which shorten human life and to the improvement of the race of men, so
that citizens of civilized States may be made to excel barbarians as much
in strength as they do in the arts of peace and of war.

In the words of Bacon, “If physicians [and we may add governments]
“ will learn and use the true approaches and avenues of nature, they may
“ assume as much as the poet saith—

“ Et quoniam variant morbi, variabimus artes ;
“ Mille mali species, mille salutis erunt.”

(16th Annual Report, Appendix, pp. 71-9.)
256 [PART IV.

Statistical Classification of Registered Causes of Death.—It often
happens that certain diseases are followed by other diseases, or that two
forms of malady are successively developed and are in intimate connexion,
Thus scarlatina is sometimes followed by dropsy, measles and whooping-
cough by bronchitis or pneumonia, typhoid fever by perforation of the in-
testine, phthisis by pneumothorax, hernia by peritonitis, stone by nephritis,
childbirth by metria. External causes are frequently fatal, not in a
direct way, but by developing phenomena that are recognized as diseases.
Thus arsenic induces gastritis (inflammation of the stomach), alcoholic
drinks induce delirium tremens, privation leads to scurvy and dropsy,
cold to mortification, burns to internal irritative diseases, contusions,
fractures, and wounds to erysipelas, tetanus, purulent deposits (pyemia),
and, under certain circumstances, to hospital gangrene.

It has been the general rule, in the classification, to refer the secondary
affections that supervene in the course of measles, scarlatina, phthisis,
and other diseases, to the primary diseases by which they are caused or
modified, and the diseases that are the direct result of external causes to
those causes. The partial exceptions to these rules occur in the above
classes of cases. At some subsequent period it will be right to investigate
these double causes.—(13th Anuual Report, p. 129.)

What are Causes of Death?—The human organism, although the
force with which it is animated is indestructible, dies inevitably under
a great variety of conditions. In one instance death is the direct effect
of mechanical violence ; a mere shock of arrested motion converts the
life force into a new form: in another instance blood is lost and the
processes of nutrition are stayed: then agents like fire or frost disintegrate
the parts, or chemical forces like opium still for ever the living action
in sleep. Submersion under water or stoppage of the air-ways shuts out
oxygen, and with the cessation of the supply of this element life is
extinguished as suddenly as the light of a lamp; so also life slowly
goes out when the supply of food is insufficient, as the flame of a lamp
dies when oil is withheld.

Adverse living molecular forins too assert their powers over the
structure, and, as in small-pox, syphilis, glanders, cholera, and the other
zymotic diseases, transform the body into their own substance and
habitation, so that it can live no longer its own life, but is transformed
first into multitudes of organic particles, and then mayhap, after many
transmutations, into air, water, and earth. What was a living nature of
the highest form becomes a dull cloud of matter, again after cycles of
changes to be incarnated.

The constitution of the tissues undergoes transformations in cancer and
tubercle and other analogous diseases as the blood does apparently in
diabetes.

The most common form of disease is inflammation and its resuits in
the several organs of which the body is a confederation; and upon
taking up these organs singly each is found to have its well characterized
diseases: the brain, no longer the seat of intelligence, sensibility, and
reason, becomes the seat of madness; the heart loses its wonderful
hydraulic precision; the lungs neither drink up nor discharge breath ;
the stomach transmutes its aliments no longer or transmutes them amiss ;
the liver and the kidneys fail to supply their specific distillations ; the
joints decay ; the muscular system, once finely adjusted in its movements,
is paralysed ; the skin loses its fresh colour, and changes into ulcer and
leprosy; the formative forces in some cases go wrong, or stop and
leave organs unfinished. The reproductive system, too, which creates
and perpetuates generations in endless succession, itself kills the parent
and the child in one flood,—one throe of agony.
DEATHS. | 257

Now, when it is considered how multitudinous and complex the
causes are, not of the one phenomenon, but of the many phenomena of
death, for death has its many phases as well ag life, it can scarcely be
surprising to find that out of nearly half a million of deaths no causes
were assigned in eight thousand or more instances. In 4,630 cases no
causes were specified ; in 3,506 cases it is only inferred that the deaths
were sudden, as in them inquests were usually held.

Through the co-operation of the medical practitioners of England and
Wales the majority of cases are certified on forms supplied by the
Registrar General. In London about 98 per cent. of the deuths are
certified, as far as the causes are concerned, by the medical attendants,
5 by the coroners, leaving only 2 in 100 uncertified. Out of 1,578 deaths
in London recently analysed 26 were uncertified, of which 4 only are
recorded where the deceased had no medical attendant. One of the
counties, Northampton, taken at hazard, yielded this result ; out of
every 100 deaths 91 were certified, 7 were uncertified; 2 died without
medical attendance. In some few counties many of the people get no
qualified medical advice during life, the medical man lives at great
distances, or the people, ignorant themselves, apply for relief to
irregular practitioners, men sometimes of natural ability, but often
possessing no claim to confidence, except that founded on boundless
faith in their own nostrums,-which perform the same amazing miracles
now as were performed in the dark ages by relics, charms, and
exorcisms.

It must be stated, moreover, that the causes of death assigned are
often inadequate, and frequently erroneous. A person is dead. What
was the cause of his death? is the question addressed to the medical
attendant. He has all the information to guide him in his answer that
he employed during life in the treatment ; but that may be insufficient.
Some few years ago “dropsy” would have been returned, and was
accepted in medical science as a disease, a cause of death. It is still
used rightly in some cases. But many cases are traced back further ;
the dropsy is found (1) to be associated with albuminous urine, and
affections of the kidney, such as Bright’s disease ; or (2) it is the result
of retarded circulation from organic disease of the heart; or (8) it is
ascites, an effusion into the peritoneal sac from obstructed circulation
through the liver; or (4) it is hydrocele, perhaps from injury; or (5)
it is ovarian dropsy; or (6) it is a consequence of scarlet fever; or-
(7) it is anemic; or (8) it comes on suddenly with fever; or (9) it is.
general and associated with scurvy. Now after the first step is made in
defining the seat and source of the “ dropsy”’ we have got at one link of ’
the chain of causes. The dropsy of scurvy, or anemia, may be traced
to famine, or to insufficiency of some elements of diet; that cause is
primary. Then the scarlet fever is the cause of the dropsy; but what
is the cause of the first disease ? how was the dead child infected ?
Ascites, the cirrhosis of the liver, may be traced to alcoholism as its
primary cause; or the heart disease may be derived from rheumatic
fever. And the rheumatic fever may be be the result of exposure to
malaria of a specific kind. Now in many cases the primary cause can,
but in many cases it cannot, be discovered. Yet to be able to prevent
death, the primary cause is of first importance, as it sets the rest in
motion.

There are affections of the brain, of the chest, and of other internal
parts, which can be distinguished by the pathologist on actual inspection,
but not otherwise; while other fatal functional derangements cannot,
under the most favourable conditions, in some cases be connected with

R
258 [PART IV,

any changes in the material structure of organs, even with the help of
the best available instruments.

Observers, with excellent intentions, are not always competent, or do
not devote the required time to their investigations. Their means of
observation are sometimes restricted; they only see the patient for a
few moments in his last hours; cor for a few minutes at a public
dispensary; while from children the subjective symptoms cannot be
gathered.

Where the organic injury is evident in the dead body, and is the
proximate cause of death, the inquiry after the first cause only com-
mences. Thusa man is found dead in the road in blood, with a wound
through his head; that was lethal ; but with what instrument was the
wound inflicted? A pistol. Who fired the pistol? The man now
dead, or another man? Himself. Then was it an accident or a suicide ?
What were the motives of suicide? Another man. Is the manslayer
a soldier fighting, or a duellist ? or is he guilty of murder, manslaughter,
or justifiable homicide ? In a railway accident the question “ who is
“ to blame?” involves “what was the cause,” what were the circum-
stances of the overthrow or collision?

On inquiries into the causes of this class the great tribunals of
European justice are occupied. To these causes of death by the violence
or malice or recklessness of men importance is everywhere attached.
But the causes of the whole deaths of a nation partially inquired into
everywhere have nowhere been published, except in England. The
English returns are at present, it is to be regretted, unique. And while
they are avowedly incomplete, as the chain of causes is not always
traced, and the true cause is sometimes mistaken, I hope to be able to
show that the returns are of use in their imperfect state, that they
require improvement in the present day, and that they are of incalculable
interest to mankind.

It is true that 48,634 persons died at the age of 75 and upwards in
the year, and thus attained advanced ages; 650 lived to the age of 95
and upwards; of whom 70 lived a hundred years and upwards, which is
the term of human life. But how fared it with the multitude? 184,187
persons died in ripe manhood at the age of 25 and under 65 years:
while 242,325, under the age of 25, were cut off and perished in
childhood and youth! Of the total recorded deaths only 392 were
referred to homicide; and paramountly important as the deaths from
this cause unquestionably are, occupying too so large a portion of our
juridical force, and testifying as the reduced number does to law and
police efficiency, it brings out with still greater force the magnitude of
the sacrifices of life from other agencies. What these agencies are is
assuredly well worth careful inquiry. Death is inevitable, but why is
life cut short? Why do the people of England live only a mean
lifetime of 41 years ?

Biology includes in its sphere of research death, which like birth is
common to man and to every living thing; so the extension of that
science will shed light on the causes of death. The laws of life involve
the laws of death ; and every forward step of the biologist will open
new fields in vital statistics. In the meantime the existing knowledge
admits of so many practicable applications as to justify us in asking for
its extension by all the means of accurate observation. It places at
the disposal of men now an incalculable control over the duration and
happiness of their lives; and it opens to the future a prospect of
discovering not indeed elixirs of life, not secrets of earthly immortality
to any individual, but protection against many of the dapgers which
beset the human race,
DEATHS. | 259

Science will naturally advance, and the extension of skilful prac-
titioners to the remoter parts of the country will supply good observers.
To them we must trust. Where death happens in such circumstances
as render it impossible to obtain a satisfactory certificate from a medical
man in attendance, the cause, I submit, in the interests of science and of
human safety should be investigated by a medical officer specially
appointed in each registration district.

One important step has been taken by a committee nominated by the
Royal College of Physicians, who have drawn up a complete nomen-
clature of the pathologicial causes of death. This will be distributed
among the practitioners of the United Kingdom, and will thus facilitate
the identification of that great class of causes. Synonymes are given in
the Latin, French, Italian, and German languages—(30th Annual
Report, pp. 207-10.)

History of the Registration and Classification of Causes of Death,
1837-75.—I propose now to state briefly how the causes of death have
been returned by the Registrar General, and what changes have been
made in their classification since the year 1837. In 1839, when the
first Report was written, this was the state of things—The registers
chad a column headed in conformity with the schedule of the Registration
Act “ cause of death,” which had to be filled up by information supplied
by the coroners, and the informants, who were seldom medical men.
Upon the application of the Registrar General the Presidents of the
Colleges of Physicians and Surgeons and the Master of the Society of
Apothecaries pledged themselves to this effect: “to give, in every
“ instance which may fall under our care, an authentic name of the fatal
“ disease.” They invited all authorised practitioners throughout the
country to follow their example; and to attend to an explanatory
statement which, among other things, earnestly recommended them
“immediately after death” to place in the hands of the qualified infor-
mants “written statements of the cause of death,” and to use “ the
‘popular or common name of the disease whenever the popular name
“will denote the cause of death with sufficient precision.” In every
case of inquest on any dead body, the Act says “the jury shall inquire
“of the particulars herein required to be registered concerning the
“ death, and the Coroner shall inform the Registrar of the finding of
“ the jury, and the Registrar shall make the entry accordingly.”

Upon examining the registers for the last half of the year 1837,
I found that they contained an ample treasury of facts, recorded more
or less in conformity with the instructions. The nomenclature was in
an unsettled state; and the knowledge of the “causes of death” was
imperfect. To take the inquests first: the juries instead of assigning
the causes of death evaded the question; they used such phrases as
“ accidental death,” “ visitation of God,” “natural causes,” and other
terms equally vague. They had not the necessary knowledge, in cases
of sudden death, to return the cause of death, even where that cause
might have been evident enough to the medical jurist ; and the coroner
could not instruct them. The coroner of the old school was quite unfit
for the new duties imposed upon him by the Act. He had little or no
knowledge of medical jurisprudence, and where the knowledge was
possessed there was a tendency to copy the old language of routine
sanctioned by the law books. The causes of violent deaths were
carefully studied, and commented on in the Statistical Nosology (1842).
In the Sixth Report, the returns of all the violent deaths of the year
1840 were analysed, distinguishing suicides, murders, manslaughters,
and executions from deaths called accidental; and further, the deaths

R 2
260 [PART Iv.

by lightning, by poisons, by burns, by asphyxia, by drowning, and by
mechanical injuries of various kinds inflicted by animals, carriages,
railways, manufactures, and mines. The report was sent by the Registrar
General to the Coroners of England with a letter calling their attention
to the new duties which had devolved upon them under the Registration
Act, and offering suggestions to be submitted to the juries so as to
render their findings conformable with the Act. The ‘“ questions” it
was shown “ to be proposed in reference to every case of death ascribable
“ directly to external canses are threefold: (1) was the death caused
“by human agency? did the person die by his own hands or by the
* hands of other persons ? or was his death accidental? (2) What was
“ the instrument, force, or thing by which death was caused? (3) What
“ was the naéure of the fatal injury inflicted upon the body ?” The first
is essentially the legal, the second the hygienic, the third the medical
point of view. ‘The ¢ime and the place have also to be distinguished.
Then it is shown by examples that the causes of death cannot always
be assigned in a vague word or two; several particulars have to be
sought out, and those to be selected which are likely to point to fatal
agencies and prevent their recurrence in future. Since that year the
causes of violent deaths have been returned, at one time for groups of
years but recently every year, in elaborated tables, of which the tables
in the present report are examples. Thus much has been done, but
much remains to be achieved under an improved organisation of the
coroner’s inquest.

The other deaths were returned in large numbers by the medical
attendants, who as a body entered cordially into the spirit cf the circular
that was addressed to them by the heads of the profession. But they
laboured under some difficulties. ‘They were often called in late when
the diagnosis was difficult; and in many remote regions the physician
had not visited the sufferers from chronic disease for some days before
death. Then there are many cases of disease obscure even where an
autopsy has been instituted; and in the great majority of cases this
method of verification was denied either by the reluctance of friends or
by the indifference to pathology of the older class of practitioners.
England is, I believe, the only country in which legal provision is
made for qualified medical attendance on the sick poor; but this pro-
vision is sometimes neglected, and persons of all ages, more especially
children and old people, are not attended at all, or are attended in their
last illness by quacks and unqualified practitioners. ‘The state of the
returns and the difficulties of nomenclature are referred to in my first
letter to the Registrar General, and it is evident that, imperfect as the
returns were and as the knowledge was on which they were based, the
facts bearing so directly on human life were of incalculable importance.

In the year 1845 the Registrar General supplied all the qualified
practitioners of England with books of blank certificates; and he
instructed the registrars not to recognise the certificates of men who
held no authentic diplomas. There was space for both primary and
secondary diseases, against which their duration was also entered in the
certificate. The ‘certified ” cases were distinguished in the registers.
The introduction of this system of medical certificates had an excellent
effect; it improved the whole character of the returns; and since the
year 1847* it has been in use with some improvements in its form.

 

* The causes of death were abstracted for the years 1837-8-9-40-1-2. The
improvement due to the certificates was so apparent in 1847 that the new series
was commenced at that date. It might not be without some use to abstract at a
future time the returns for the years 1843-4-5-6, which preceded the great cholera
epidemic of 1848-9.
DEATHS. } 261

The grant of the certificates was voluntary. The new Act of 1874
(37 & 38 Vict. cap. 88.) enforces the grant of the medical certificate
by penalties. The form of certificate is embodied in the regulations.

The recorded causes of death are exceedingly numerous; and it often
happened that the same cause was returned under different names,
which will be found in the alphabetical list at the end of the Nosology.
Some classification of these causes was necessary, and I at first tried
Cullen’s classification, and then endeavourel to use Mason Good's, but
found that neither of them would work. It was impossible to arrange the
diseases as returned under the classes and orders of the existing classi-
fications. In casting about for a classification, it struck me that it
should have special reference to the causation and prevention of death ;
and that would be most effectually accomplished by making three distinct
groups of (1) deaths by epidemic, endemic, and contagious diseases ;
(2) deaths by sporadic diseases; and (3) deaths by evident external
causes. This classification was framed, and used in forming the abstracts
of causes of death for 1837.

After more than three years experience I discussed the principles of
nosological nomenclature, and drew up the statistical nosology on the
same basis as before, but with some extensions and imprevements.

(1.) The first group of EPIDEMIC, ENDEMIC, AND CONTAGIOUS DISEASES

is thus defined: “ This class comprises diseases which have
“ been observed to be epidemic, endemic, or contagious. The
“ blood is probably, in the greater number of them, the primary
“ seat of disease; and they may be considered, by hypothesis,
“ the results of specific poisons, of organic origin, either derived
“ from without or generated within the body.”

(2.) The second group consists of SPORADIC DISEASES OF UNCERTAIN
OR VARIABLE SEAT. “ This class consists of diseases of variable
“ seat, or diseases in which the nature of the morbid product
“ and action is, as in cancer, of more importance than the part
“ affected.”

(3.) SPORADIC DISEASES OF SPECIAL SYSTEMS AND ORGANS form the

third group. “ This class consists of congestions, inflamma-
“ tions, the results of inflammations in certain parts, and
“ mechanical or functional diseases.” The sub-groups com-
prise deaths by diseases of the nervous system, of organs of
circulation, of respiratory organs, of digestive organs, of urinary
organs, of organs of generation, of organs of locomotion, of
integumentary system.

(4.) The fourth class consists of deaths directly referable to EXTERNAL

CAUSES: POISONING, ASPHYXIA, INJURIES.

This classification was in use with little alteration until I was requested
by the International Statistical Congress, in conjunction with Dr. Mare
@Espine, to frame a project based on this resolution, passed at Brussels:
“Ilya lieu de former une nomenclature uniforme des causes de décés
applicable & tous les pays.”* My report was presented to the Congress
convened by the French Government at Paris, and appears in the
appendix to the Registrar General’s 16th Annual Report (published in
1856). Profiting by experience and by criticism, I carefully revised
the English classification, and submitted it in proof to the most eminent
physicians, surgeons, and statists of England, Scotland, and Ireland, to
whom I was indebted for many valuable suggestions. The causes of

 

* For the classification recommended by the Congress, see Compte Rendu de la
deuxiéme session du Congrés International de Statistique, Premiére annexe,
pp. 349-359, Paris, 1856. (See also pp. 250-5 of this volume.)
262 [PART Iv.

death were thus definitively divided into five classes; and the classes
were further sub-divided into twenty-three uew orders.

The order corresponds with the Family of Natural History. I did
not think it desirable to go further so as to follow the Linnzean analogy
of double names for genera and species, but to stop for statistical purposes
at single names for single diseases, without distinguishing the varieties.

The causes of death were abstracted with distinction of age and sex
so early as 1847, and in the 18th Report (pp. 120-123, 150-176) a table
is given of the numbers of deaths of males and females in each of the
seven years 1848-54 from the several causes classified. The causes of
death for England, with the same distinctions, were given for the year
1855; and they were given in every subsequent report. Previously to
1847 the causes of death were given without distinction of age for
divisions and for counties or for groups of districts.

During the course of years some changes, and I believe improvements,
were made in the classification, The deaths by violence were dis-
tributed under the five orders of accident, battle, homicide, suicide, and
execution, and under the sub-heads of fractures, gunshot wounds,
wounds, burns, poison, drowning, suffocation, and hanging. Some new
or newly discovered diseases were introduced, such as diphtheria
(separated from scarlet fever in 1855), puerperal fever (separated from
childbirth in 1847), want of breast milk (classed before with atrophy
and debility); typhus, enteric, and simple continued fever were first
distinguished in the returns of 1869, having been previously returned
under the head of typhus. The returns necessarily follow the leading
of the heads of science at a distance; amd formerly the enteric or
typhoid fever was confounded with typhus by many practitioners.
Glanders was separated from erysipelas in 1855. Cancrum oris (noma):
appears as a separate head in 1847. Some few diseases were trans-
ferred from order to order, The 38rd Report gives the series of returns
complete for the years 1888-42 and 1847-70 as regards 113 heads,
according to the recent classification ; and those changes are, when it is.
necessary, explained in notes which should be consulted by all who have:
occasion to use the facts for the earlier years.

Besides the 113 diseases and injuries, there are about 153 others
quite distinct in their nature, but of rare occurrence; so to facilitate the
labour of classifying the 546,453 deaths from 266 causes, under
seventeen different ages, the abstract sheets were so arranged that
temporarily the rare diseases were written in the margins, and the tick
by which the case was denoted was at the same time made in the line
devoted to some allied disease, of which the numbers were not much
disturbed by the addition. Then at the end of the year the deaths by
these extraneous diseases were published ina separate Table. ‘This.
series appears in the Reports for 1855-74.*

In the present report the diseases all appear in their proper place in
one table; and those that have been introduced, printed in italics, are
generally bracketed together under the cause with which in the shorter
series they are grouped. .

Although it has not been deemed right to go to the expense of publishing ~
separately the causes cf death for males and females at several ages in
every district of England and Wales, the abstracts for each separate
district are kept for reference in the library of the General Register
Office. —(88th Annual Report, pp. 225-30.)

 

* This Supplementary List was continued in the Reports till that for 1880 Gnelu-
sive), after which the classification was revised, and the Supplemental List was
absorbed in an extended list of diseases. A full list of the changes of classification
introduced in 1881 will be found in the Registrar-General’s 44th Annual Report,
pp. xxix-xxxiv. (Hditor.)
DEATIIS. | 263

Medical Certification of Causes of Death—Under 6 & 7 Will. 4.
c. 86. s. 25. the medical attendant of a deceased person in the last
illness, is bound to give information, if applied to within eight days,
with respect to the cause of death. For the convenience of members of
the medical profession, and to promote the accuracy and uniformity of
returns, books, consisting of blank forms of certificates were issued
in 1845 to all physicians, surgeons, and apothecaries legally qualified,
and practising medicine in England. These forms have therefore been
in use for fifteen years; and it must be admitted, that the working of
the system has, on the whole, been attended with much success.

With a view to ascertain the measure of that success, Tables have
been prepared, and appear at the end of this Report, showing the
number of cases in the three months ending 31st March 1858 in
which the cause of death was certified by the medical attendant
or the coroner, or was not certified; and the results are exhibited in
divisions, registration counties, and sub-districts.

In the quarter of the year, as stated, 125,819 deaths were registered
in England and Wales; and of these, 99,040 were certified in respect to
the causes by medical attendants; 5,023 by the coroner ; 7,275 were
noé certified from want of medical attendance; and 14,481 were not
certified from neglect, or for some reason the nature of which is seldom
indicated in the register. Or, to make the proportions more clear, out
of 100 deaths registered 79 were certified by medical attendants, 4 by
coroners, 6 were not certified because not attended medically, and
11 not certified, the reason being not usually assigned. For these
11 out of every hundred, certificates would not be received by
registrars, in some cases on account of difficulties of communication
which many parts of the country present, in some cases in consequence
of neglect, in a few on account of that perverseness or contumacy that
is peculiar to some individuals. But in an immense majority of
instances the medical profession has shown that willing co-operation
which might be expected from a highly-educated and public-spirited
body of men; and in most of those cases in which the machinery fails,
it is at least doubtful whether a more stringent penal enactment would
not be inoperative.

In London the working of the system is as successful as could be
desired. Out of 100 cases, 92 were certified by medical attendants,
5 by coroners (97 in all); 1 not certified because there was no
medical attendance, and 2 not certified for reasons not assigned.
Next to the metropolis are the South-eastern and South Midland
Divisions, where 90 and 89 respectively were certified by medical men
and coroners. In the Hastern and North-western, medical and
coroners’ returns were in the proportion of 85 per cent. ; in the West
Midland 82; in the South-western 78; in Yorkshire and the Northern
Counties 77 ; in the North Midland 72 ; and in Monmouthshire and Wales
only 61.

In Liverpool and West Derby, out of 3,841 death, 3,558 were
certified by medical attendants, 156 by coroners; in all 3,714. In
Manchester, out of 1,755 deaths, 1,370 were certified by medical
attendants, 87 by coroners; in all 1,457. In Liverpool and West
Derby it was stated that in the quarter 58 persons had no medical
attendance in their last illness ; in Manchester the number of persons
deprived of that advantage was so great as 181.

In Yorkshire as many as 10 persons out of a hundred who died had
no medical attendance ; in the Welsh Division at least, 12 out of the
same number were not medically attended.—(2lst Annual Report,
pp. 212-13.)
2¢4 [part Iv:

Compulsory Medical Certification of Causes of Dezath—Hitherto
the grant of certificates of the cause of death by the registered medical
practitioners of England has been purely voluntary, and the Registrar
General has to thank the medical profession for the hearty co-operation
he has received from them in the administration of the Act. In the
Births and Deaths Registration Act of 1874 (37 & 38 Victoria) the
Legislature has inserted the subjoined clauses :

Certificates of Causes of Death.

20. With respect to certificates of the cause of death, the following provisions shall

have effect :

(1.) The Registrar Geueral shall from time to time furnish to every registrar
printed forms of certificates of cause of death by registered medical practitioners,
and every registrar shall furnish such forms gratis to any registered medical
practitioners residing or practising in such registrar’s sub-district :

(2.) In case of the death of any person who has been attended during his last
illness by a registered medical practitioner, that practitioner shall sign and give
to some person required by this Act to give information concerning the death a
certificate stating to the best of his knowledge and belief the cause of death, and
such person shall, upon giving information concerning the death, or giving notice
of the death, deliver that certificate to the registrar, and the cause of death as
stated in that certificate shall be entered in the register, together with the name
of the certifying medical practitioner:

(3) Where an inquest is held on the body of any deceased person a medical
certificate of the cause of death need not be given to the registrar, but
the certificate of the finding of the jury furnished by the coroner shall be
sufficient.

If any person to whom a medical certificate is given by a registered medical
practitioner in pursuance of this section fails to deliver that certificate to the registrar,
he shall be liable to a penalty not exceeding forty shillings.

And under the penalty clause (39) it is enacted that “ Every person
“ who refuses or fails without reasonable excuse to give or send any
certificate in accordance with the provisions of the said Acts (Regis-
“ tration Acts, 1836 and 1874) shall be liable to a penalty not exceeding
* forty shillings for each offence.”

Thus under the Amendment Act every registered medical practitioner
in England is bound, under penalty for refusal, to give “a certificate
‘* stating to the best of his knowledge and belief the cause of death.”
This will only bring a salutary pressure to bear on the few practitioners
who neglect to give such certificates as have hitherto been given freely
by their brethren.

Where the persons deceased have not been attended by registered
medical practitioners, and there has been no inquest, there is no
provision to secure the certification of the cause of death in the Act;
but this defect may be met to some extent, for under clause 4+ the
Registrar General, with the consent of the Local Government Board,
is empowered “to make regulations for prescribing any matters
“ authorised by this Act to be prescribed, and to revoke and alter such
“ regulations.

In England every poor person, unable to pay for medical advice, can
obtain the services of a poor law medical officer gratuitously, so that
the day may not be distant when nearly every person dying will: be
attended by a registered medical attendant.

At present a certain number of educated practitioners holding
good degrees are not on the register; and hitherto their certificates
have been received by order of the Registrar General, who did
not wish to bring any undue pressure to bear on them. But to comply
with the new Act it will be desirable for them to register, as only

certificates of registered practitioners are recognised under the above
clause.

<c
DEATUS. | 265

The refusal of certificates from quacks and pretenders will enlighten
the public, and distinguish the qualified practitioner from the
unqualified,

In several foreign states every dead body is visited by a medical
inspector, who inquires into the cause of death, and grants a certificate,
without which the burial cannot take place. As a measure of police
this has some advanteges. But under the Amendment Act the medical
attendant is consulted, and is entrusted by the State with the duty of
returning the cause of his patient’s death; he performs in death from
disease the office which the coroner executes in sudden deaths, or deaths
from violence; and this arrangement, while it is most satisfactory to
private families, is less costly, is probably most agreeable to the
practitioner, and supplies more authentic information than could be
procured from any other source.

Sometimes the medical practitioner falls into the error of the
coroners of old, and omits some essential fact in the associated links
of the cause of death. It is importunt to avoid this mistake. For
example, measles is often followed by pneumonia, and other seguele ;
now measles is the primary cause of death in such a case, but it is
rendered fatal by the supervention of pneumonia, which is one of its
developments. The cause of death is, therefore, properly returned
“measles, pneumonia.” So when scarlet fever is followed by fatal
dropsy, the scarlet fever as well as the dropsy is properly returned.
By error, death has been by some practitioners ascribed solely
to pyzemia, peritonitis, or hemorrhage, whereas these secondary
diseases have sprung from precedent childbirth, which should never be
suppressed.*

It is true that the disease of which a person dies is at times unknown ;
the medical practitioner has had inadequate means of observation ; he
may be imperfectly skilled in advanced diagnosis ; or the symptoms may
be indistinct, complicated, and only explicable by autopsy. In such cases
the certified cause is vague ; but it does not follow that the whole series
ef returns subject to such imperfections is useless. If the attainable
though imperfect knowledge of disease suffices for the purposes of
medical practice, it cannot be worthless for medical statistics —(35th
Annual Report, pp. 221-3.)

Causes of Death in Inquest Cases.—The intention of the inquest was
to discover crime, with a view to its punishment and prevention ; and
in the imperfect state of science at that time “sudden death” was fixed
on as a prima facie grcund for inquiry. Now it is well known that
many spontaneous diseases take away life suddenly; and that in some
of the most atrocious murders by arsenic, by antimony, and by cruelty,
death is slow in its approaches. The mere fact that death is sudden is
a ground for medical inspection, but not necessarily for an inquest ; and
there are many violent deaths of which a medical inspector may
ascertain the causes without moviug the apparatus of the inquest, there
being no more suspicion of crime in such cases than there is in deaths
from fever, pleurisy, or consumption.

With the extension the inquest had attained it left the causes of
about 466,560 deaths—of 95 per cent. of the total number in the year—
unexplored ; yet it is now ascertained that vast numbers of these deaths
are referable to negligence; or to causes which admit of removal by
hygienic treatment, and by sanitary regulation. To take one class of
causes only found to prevail with the greatest intensity in the dense
population of towns,—it can be shown that with the present distribution

* See note on p. 226. (Editor.)
266 [PART Lv.

of population by age, the mortality in many healthy districts is below,
and in none above, 17 annual deaths to 1,000 living: and at this rate
the deaths in England and Wales would have been 392,151 in the year.
The actual deaths registered were 492,265. Hence it follows that at
least 100,114 deaths were the results of causes not everywhere,—not
necessarily in such fatal operation. The mean lifetime of people living
in the least unhealthy districts of the kingdom is 49 years ; in all
England 41 years; thus life is abridged by full 8 years. The half of an
English generation is cut off before the forth-sixth year is uttained ;
and we have seen how small a fraction of the loss of life is the result of
intentional homicide. After judicial inquiry, only 125 death are referred
to this head, whereas full 100,000 deaths due to violations of natural
laws call for inquiry, with the prospect of success in the discovery of
causes still prevailing, which are as fatal as the serpents, wild beasts,
and savage criminals of past ages.

The attempt to extend the inquiry into the causes of death was
made in London in the sixteenth century, after the College of
Physicians was founded by Linacre. The fatal plagues impressed the
minds of statesmen, but to one of the companies of the city of London
is due the credit of publishing the first weekly bills of mortality.
It was not, however, until 1837 that the,inquiry into the cause of
death was instituted in every case of death under the Registration
Act. Then the Registrar General engaged the medical colleges to
afford him their assistance on the ground of its scientific utility, the
“Cause of Death ” having been inserted in the schedule of the Bill
by the House of Lords, and accepted by the House of Commons,
after its importance had been urged by no less a body than the British
Association. <A Certificate Book first issued by the Registrar General
in 1845, to legally qualified medical practitioners, a statistical Nosology,
and a letter to the coroners completed the administrative machinery
under which the results of the inquiry into the causes of death are
recorded.

Without entering into metaphysical disputes on casuation, it is
evident, that to be of practical use, the cause of death recorded must be
as clearly °defined as possible, and that the verdicts of juries should
express the exact essential facts, and not vague generalities.

The inquest is a most valuable institution, and, under the intelligent
coroners of the country, we may hope to see henceforward the true
causes of the deaths into which they inquire set forth in systematic
completeness, as under the Act 6 & 7 Will. 4. c. 89. they have the
power to call in a medical expert, and to direct him to perform a post-
mortem examination, with or without a chemical analysis. The new
Registration Act relies entirely on the jury, instructed by the coroner,
for a return of the cause of death, whenever an inquest is held.—(35th
Annual Report, pp. 220-1.)

Mortality from Phthisis and from Diseases of the Respiratory
Organs.—Phthisis differs essentially in its pathological products, in its
complications, and in its fluctuations, from bronchitis. For example,
the mortality by bronchitis is immediately doubled, or trebled, by a
depression of the temperature of the air, while the deaths by phthisis
exhibit little variation. But these diseases are often confounded ; and
the distinction between chronic bronchitis, or the bronchitis of miners,
and consumption, was even recently not obvious to many practitioners,
Under these circumstances what significance is to be attached to the
fact that the mortality per 1,000 by bronchitis ranged from *822 to ‘978
DEATHS. | 267

in the three years 1850-2; and frcm 1°558 to 1°648 in the four years
1860-63; while the mortality by pneumonia and pleurisy slightly
declined; and the mortality by phthisis ranged from 2°624 and 2°826
to 2°511 and 2°611? Is it to be inferred that there has been an actual
decrease of death by consumption, and an increase of death by
bronchitis? Is the effect of the treatment by cod liver oil in phthisis
visible in the returns?

If we divide the 14 years into three periods, as in the following
Table, it will be observed that ihe mortality ascribed to phthisis
decreased from 2°811 per 1,000 to 2°574; while the mortality by
lung diseases increased from 2°769 to 3°809; by phthisis and lung
diseases the mortality in the two periods ranged from 5*580 to 5°883.

AVERAGE Annual Rate of Mortatiry to 1,000 living from Patuisis
and Lune DisEases in Enevanp, for the Three Periods 1850-54,
1855-57, and 1858-63.

 

 

Puruisis and Lune
DISEASES.
Lune
Yrars. PuHTHISis.

DISEASES. INCREASE

ToTaL. in the
PERIODS.

(5 Years.) 1850-54 - 2°769 2°811 5°580 —
(8 Years.) 1855-57 - 3:103 2°683 5° 786 0:206
(6 Years.) 1858-63 3°809 2°574 5883 0:097

 

 

 

 

 

 

To carry the analysis further, the ages of the dying from phthisis and
bronchitis must be distinguished; and this is done in the next Table,
which shows that phthisis reigns from the age of 10 to 55, and after
65 gives place to bronchitis. The mortality per 1,000 by phthisis
among males of the age 15-25 was 3°28, 3:12, and 3°10 in the three
periods ; among females 4°00, 3:93, and 3°76. Again, at the age
25-35 the mortality of males by phthisis was 4:04, 3°93, and 3°94 ; of
females 4°68, 4°51, and 4°46. The decrement is not considerable, but
as age advances it becomes greater; it is greater too in the first 5 years
of life.
268 [Parr Iv.

Average Annuat Rare of Morratiry per 1,009 from Paruatsis
and by Broncuiris in Enaranp and Warxs, 1848-63.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the 7 Years In the 3 Years In the 6 Years
1848-54. 1855-57. 1858-63.
AGES.
|
Phiten Baenchias. Phthisis.| Bronchitis.{ Phthisis.| Bronchitis.
MALES
|
All Ages 2270 « 1°01 2°54 1°35 2°45 | 1°58
0-5 1°69 | 2°65 1°35 3°51 EOF 4:42
5-10 "65 | “12 *50 14 *47 “16
10-15 NEZ y “O4 ‘75 “05 °67 *05
15-25 3°28 | “08 3°12 *09 3°10 “09
25-35 4:04 | Nh 3°93 i 3°94 +
35-45 - - 3°95 “42 3°96 55 3°92 "59
45-55 3°91 1:07 3°74 1°33 3°72 151
55-65 3°59 2°59 3°29 3°33 3°23 3°79
65-75 - 2°69 5°89 2:44 8°01 2°05 8°76
75-85 1‘1l TOOT a 1°01 14°63 *83 16°14
85-95 *60 13°80 "45 21°05 *53 22°76
95 and upwards *26 | lordi _— 12°63 “44 23°57
\ |
FEMALES.
|
All Ages 2°92 ‘91 2°75 1°26 2°62 1°46
0-5 1°61 2°26 1°32 3°00 1°05 3°78
5-10 ‘73 “12 “60 “16 “56 217
10-15 - 144 ‘05 f 124 “05 1°21 “05
15-25 - 4°00 ‘09 3°93 “09 3°76 “09
25-35 4°68 | 16 4°51 "23 4°46 #221)
35-45 4°18 | °34 4°10 “45 3°98 “50
45-55 372k | *85 3°07 122 2°93 1°26
55-65 2°71 2-18 | 2-41 3:16 | 2°16 3-5]
65-75 1°94 5°25 | 1:57 6°97 | 1:36 6-34
| 75-85 *93 9°06 °73 13°25 “60 14°79
85-95 - -| +53 11°87 “46 17°65 “32 20°46
95 and upwards 42 13°51 °33 15:08 30 21°32

 

 

 

 

 

 

 

 

 

The great increase of the mortality of bronchitis is at the age after
65; but at the age 45-55 the increase is noticeable. The increase in
infancy is also considerable.

The mean temperature of the three periods differs little; in the first
and last periods it was equal or 49°'4. The year of lowest temperature,
1853, in the first period was 47°'7; in the last period, 1860, it was
47°°0.
DEATHS. | 269

AVERAGE ANNUAL Rate of Mortatiry from Pararsis and BRONCHITIS
in ENGLAND and WALES, 1848-63.

 

 

 

 

 

 

 

Averace AnnuaL Rate or Morrarity To 1,000 Livine.
In the In the In the In the In the In the
AGES. 7 Years | 3 Years | 6 Years | 7 Years | 3 Years | 6 Years
1848-54.| 1855-57.{ 1858-63.] 1848-54.) 1855-57.) 1858-63.
MALES. FEMALES.

All Ages - | ook | 3°89 | 4°03 3°83 4°01 4:08
0-5 - 4°34 4°86 5°49 3°87 4°32 4°83
5-10 a7% *64 ‘63 °85 “76 °73

10-15 - 91 “80 *72 1:49 1°29 1°26
15-25 - 8°36 3°21 3°19 4°09 4°02 3°85
25-35 ~ 4°21 4:14 4°16 4°84 aes 4°67
35-45 4°37 4°51 4°51 4°52 4°55 4°48
45-55 - 4:98 5°07 5:23 +°06 4°19 4°19
55-65 6°18 6°62 7°02 4°89 5°57 5°67
65-75 - 8°58 10°45 10°81 7:19. 8°54 | 9°70
75-85 - 11°38 15°64 16°97 9°99 13°88 15°39
85-95 - 14°40 21°50 23°29 12°40 18:11 20°78
95 and upwards 10°73 12°63 24°01 13°93 15°41 21°62

 

 

 

By grouping the deaths from bronchitis and phthisis together, as in
the above Table, we obtain this singular result: the mortality at the
ages 5-35 declined ; at the ages 35-55 the increase of mortality was
scarcely perceptible; at all the ages after 65 the increase was
considerable.—(26th Annual Report, pp. 186-8.)

Puerperal Mortality, 1847-54.—The word “births” in these reports
is used to express the number of children born alive; and as some
children are still-born, while others are born two, three, or four in
succession, at one childbearing, the “births”? do not express exactly
the number of childbearings or accouchements.

The exact danger of childbirth to the mother is found by dividing
the number of mothers who die by the number of childbearings. Now,
excluding the still-born, the number of childbearings is obtained by
reducing the births in nearly the proportion of 1 to :9902; but taking
the still-born into account the proportion of live-born children must
be nearly as 100 to every 102'531 mothers bearing children in the
year.*

 

* In 1852 the single births were 611,829; the twins were 12,72, representing
6,036 childbearings; the triplets were 111, representing 37 childbearings; thus
representing 617,902 childbearings in the aggregate. Consequently, to 100 births
there were 99 childbearings, or at 100 childbearings 101 children were bern. This
is exclusive of the still-born. In France the births were 1,925,624, or, including the
still-born and those dying before the registration of birth (‘ morts nés et morts
avant la déclaration de naissance, c’est a dire, dans les trois jours de la naissance),
1,993,891. To every 100 live-born there are 3°545 still-born or dying before
registration ; for the above numbers are in the ratio of 1 to 1°03545. But +9902 x
1-°03545=1'02531; and if we apply these ratios to the above facts it will follow
that every 100 children born alive imply that 102°531 mothers have been delivered
of one or more live-born or still-born children. But a further correction is required
for the children born alive who die before registration: the still-born will probably
not exceed 8 to 100 live-born.
270

[PART IV.

The subjoined Table shows that in the year 1848 siaty-one mothers
died to every 10,000 children born alive, and that since that year the
mortality has progressively declined to forty-seven in 10,000, This is
a gratifying result, and there can be no doubt that by further care and
skill the annual deaths (3,009) in childbirth may be largely reduced.

Deatus of WoMEN in CHILDBIRTH in the Hight Years 1847-54,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of Deaths from Deaths of
Mothers to
YEARS. 10,000
Metria and Metria Accidents of Children
Childbirth. ene Childbirth. born alive,
1847 3,226 784 2,442 60
1848 3,445 1,365 2,080 61
1849 3,339 1,165 2,174 58
1850 3,252 1,118 2,139 55
1851 - 3,290 1,009 2,281 53
1852 3,247 972 2,275 52
1853 3,060 792 2,268 50
1854 3,009 954 2,055 47
8 Years, 1847-54 - 25,868 8,154 17,714 54
Children Estimated Born alive
born alive. Number stillborn. or dead,
1959 4 Bitths - 624,012 - 29192 -~ 646,134
Childbearings 617,902 - 21,906 639,808
Average
Aggregate. annually.
The total live-born children in 8 years (1847-54) were 4,761,278 595,160
n 7 years (1848-54) ,, 4,221,313 603,045

On an average of 8 years to every 10,000 children born alive
54 mothers died; so about 53 in every 10,000, or nearly 1 in 189,
accouchements were fatal.

What is the mortality in England of women at different ages by

This is shown in the subjoined Table, from the observations

childbirth ?

of seven years, 1848-54,

 
DEATHS. | 271

Morrarity oF Women BEARING CHILpREN at different Ages,
in the Seven Years 1848-1854.

 

 

 

 

 

 

Deaths of Mothers in 7 cba
Deaths of Mothers to sfc, living. from
Childbirth to every 100 Chiltpirth
every 100 Childbearings. Lee and from all
Women living.
Age of other Causes.
Mother.
By Metria By Metria
and other By other and other By other
‘ By | Accidents . By | Accidents
Accidents . -7 4, (Accidents . : 1848-54.
: Metria. | of Child- * Metria. | of Child-
of Child- birth of Child- birth
birth, corto. | birth. .
15-25 "668 *277 “391 ‘041 017 +024 ‘861
25-35 *425 “148 277 *098 034 "064 1-°090
85-45 *633 °154 ‘479 ‘098 *024 ‘074 1°296
45-55 “883 +163 +720 “009 *002 “007 1°622
15-55 *530 *172 °358 “064 "021 *043 L135
Cols. 1 2 3 4 5 6 ”

 

 

 

 

 

 

 

 

 

By disregarding the decimal points, the Table shows the proportion of deaths to
every 100,000 : thus,—to every 100,000 Childbearings at the age 15-25, 668 women
died by metria and other accidents in childbirth; 277 by metria alone; and 391 by
other accidents of childbirth; to every 100,000 Women living at the same age
15-25, the proportional number of deaths were 41; namely, 17 from metria, and
24 from other causes. The mortality from Childbirth and from al! other Causes at
that age to every 100,000 females living, was 861.

What is the danger of death by childbirth among women of different
ages who bear children during the year? This isa different question ;
which is of practical importance, both in medical science and in the
business of life insurance. The defect in the English schedule, which
as yet contains no column for the ages of the parents of the children
registered, renders it impossible to answer this question with precision.
It will, however, be useful to obtain an approximate answer ; and this
we have been able to give, by determining the probable proportion of
women who bear children at each age from the Swedish returns; and by
applying the fraction expressive of this proportion to the English women
living in 1851 at the corresponding age, the probable number of them
who become mothers every year is determined. The total number thus
determined for the year 1851 is 609,845; while the actual average
number of the births in the seven years by the returns was 603,045.
It is thus evident that the estimate differs to no great extent from the
facts; and it may be assumed that the births, corrected for twins,
triplets, and _still-born children, in England, would represent nearly
609,845 child-bearings,

 

* The mortality from all causes in the 7 years 1848-54 is increased in
consequence of the two cholera epidemic years 1849 and 1854 being included in
this average.
272 [PaRT IV-

It will be observed that in seven years 3,232 mothers died annually
of childbirth; 1,052 by metria, and 2,180, or twice that number, by
other causes. Nearly the whole of the deaths occur among women of
the ages 15-45 ; a few also die of childbirth at more advanced ages.

On comparing the numbers in columns 4 and 7, it will be seen that
among women of the age 15-25 the annual rate of mortality per cent.
by all causes is *861, of which the 1-21st part (or *041) is by child-
birth ; at the age 25-35, and 35-45, the annual rates of mortality per
cent. by all causes were 1°090 and 1°296; of which © 098 and again
‘098 were wrought by childbirth. Thus at the age 25-35 one in 11
deaths from all causes is by childbirth; at the age 85-45 one in 13
deaths by all causes is by childbirth. At the age 45-55 when child-
bearing is rare, the general rate of mortality is 1+ 622, and the proportion
by childbirth is *009, or one in 180 deaths from all causes.

These numbers are affected not only by the changing rates of mortality
in childbirth and in other diseases, but by the various numbers of women
at different ages bearing children; thus at the age of 15-25 only one
woman in 16 bears a child in the year, and at 45 and upwards the
proportion is inconsiderable; while at the age 25-35 one in every
4 women bears in the year, and at 35-45 the proportion by the Swedish
returns is about ene in 6. (See the following Table.)

CHILDBEARINGS at Four Periods of Life in SwepEN (1880-35).

 

 

 

 

Proportional Numbers.
Women living |CuILpBEARINGS
at Two in
Age. Enumerations Five Years Oe tee en | Women living
1830 & 1835. 1831-35. Numbers bearing | to One Annual
Children Childbearing.
annually.*

1 2 3 4 5
15-25 515,257 79,225 6°15 16°26
25-35 428,718 248,589 25°19 4°31
35-45 383,771 148,610 15°49 6°46
45-55 298,047 7,189 “96 103°65
15-55 1,625,793 483,613 11°90 8:40

 

 

 

 

 

 

 

* This column is derived by multiplying the number of childbearings in the five
years 1831-5 (col. 3) by 100, and then dividing by 23 times the women living at the
two enumerations 1830 and 1835 (col. 2).

It will be seen by column 2 of the Table (see page 271) that the mortality
among 100 women in childbirth at the four periods of age is *668; +425;
*633; and *883. Thus the danger of dying in childbirth is greater (+ 668)
at the age 15-265 than it is (-425) at 25-35. It is inthis early age that a
large number of the first children are borne by their mothers ; and these
first births are for various reasons attended with peculiar hazards, The
pregnancy of ycung women, consequently, in the present state of mid-
wifery, involves the risk of dying expressed by *668 in 160 cases, while
the risk of dying in a year from all other causes at the same age (15-25)
is *820=-°861—‘041. Now if the woman remain as amenable to other
diseases as other women, the mortality rate in her case becomes ‘820
+:668=1°'488; or is increased in the ratio of 5 to 9.
‘DEATHS. | 278

In the same way it may be inferred, on the same hypothesis, that the
rate of mortality from childbirth and all other causes within the year
is 1'417 at the age 25-35; 1°831 at the age 35-45; and 2°496 at the
rage 45-55.

The mortality in child-bearing is least (*425) at the age 25-35, when
‘more than half of the annual children are borne by their mothers ; it
rises to '633 at the decennial period (35-45), and to +883 at the last
period of all. The rates of mortality at the three periods are in nearly
‘the same ascending ratio as 2, 3, and 4; that is, the *633 is nearly a
half more than °425, and *883 is a third more than ‘633. The rates
of mortality at intermediate years can b2 interpolated; for the
calamitous death of mothers in childbirth is governed by a mathematical
law.

It may be probably assumed that the child-bearing women of a
population are, in the language of the Insurance Offices, “ select lives,”
at least ‘‘select” in a certain sense; but it can only be determined by
further researches whether they are less or more liable than other
women to be attacked or to die by the diseases not incidental to child-
birth. It is only well known that when they are attacked by zymotic
diseases, such as cholera and small-pox, they succumb in unusually
high proportions.

By taking all these considerations into account, the actuary will now
be able to calculate from the foregoing Table the premiums that cover
the risk of childbirth at different ages ; and the physician will, from the
‘same facts, see how much his art has to accomplish before the 3,000
English mothers who perish annually in giving birth to their offspring
can be saved. Natural and adventitious difficulties are in the way, but
they may in many cases be overcome ; for “‘in sorrow” and not in
death ‘“ thou shalt bring forth children,” is the law of nature.

The death of young women in child-bearing points to some of the
-dangers to be guarded against; and many of the remaining dangers
would be removed by a class of educated nurses. (17th Annual Report,
pp. 72-4.)

Registered Puerperal Mortality, and Mortality in Lying-in-
Hospitals.—Childbirth is of course a physiological process, and under
favourable conditions, where the mother has been previously taken
iproper care of, is attended with little danger. Unfortunately English
mothers do not escape scatheless; nor can this be expected under
existing circumstances ; 3875 mothers died during 1870 of the conse-
‘quences of childbirth. But there is evidence of improvement. In the
four years 1847-50 no less than 59 mothers died to every 10,000
children born alive; in the four years 1867-70 the deaths had sunk
to 45.

The error of collecting poor lying-in women into hospitals has been
discovered, and to some extent discouraged ; medical men have adopted
wiser measures; they have taken greater precautions against infection,
and midwives have been better taught. Still there is great room for
improvement.

A large proportion of the mothers of England have been, from time
immemorial, attended by midwives: and this is an excellent and natural
arrangement, as midwifery is a business for which intelligent women are
admirably fitted. Until lately it was assumed that midwives were born
not made, their profcssional eduration was wholly neglected, or leit to
chance, and it still rests on an unsatisfactory footing, although efforts
have been made to impart systematic instruction in some quarters.

s
274 [PART Iv.

The midwife should be taught all the mechanical part of the art, and
be theroughly initiated into the practice of health-keeping, she would
then be in a position to render her sex essential service.

I may be permilted here to make a few observations on the accuracy
of the registration returns of deaths in childbearing. It is connected
with a controversy, which has been waged with some warmth, and its
settlement is of the first importance.

Sceing how destitute of comforts, means, and medical appliances many
women are, the thought occurred to some benevolent person that they
might be received and delivered in hospitals. It was the extension of
the hospital system to midwifery cases, which have some analogy with
wounds and injuries for which hospitals have been used from the date
of their foundation. Contrary to expectation the advantages these
institutions offered were over-balanced by one dread drawback, the
mortality of mothers was not diminished, nay, it became in some instances
excessive, in other instances appalling. The inscription—Lasciate ogni
speranza vot ch’entrate—would have been as appropriate over their
cpen doors as it was over the gloomy underworld of the great Italian
poet. “TI could adduce a mortality of 1 in 3 in a certain period of the
“ history of a great hospital,” says no unfriendly writer that I shall
soon quote, who shows that in the Dublin hospital the deaths of mothers
are in the proportion of 1 to 100 delivered, which he appears to con-
sider the normal rate. Le Fort, who bas assiduously collected the
extant statistics, asserts, as the general result of his inquiries, that “the
“ mortality of women delivered at home is 1 in 212, and that the mor-
“ tality of women delivered in hospitals is 1 in 29.” This a very
distinguished physician, Dr. J. Matthews Duncan, M.D., F.R.S.E., pio-
nounces “a terribly erroneous statement,” in a book written expressly
on the * Mortality of Childbed and Maternity Hospitals.”*

Dr. Duncan first criticises Le Fort’s statement that 1 of every 29
women delivered in a maternity dies. He does not question the fact
that “taking the data of all maternity hospitals together, Le Fort finds
“ that 1 of every 29 delivered has died.” But he questions the value
of the fact in the argument. If the maternity of a hospital like La
Charité “is so badly managed as to have a mortality of 1 in 7, what does
“ that show with a view to the question of the mortality of childbed
“* generally, or in hospitals as compared with that in houses?” asks
Dr. Duncan.f For myself I am inclined to attach a much greater im-
portance to these facts than Dr. Duncan does: they at least show that
the mortality in the aggregate of lying-in hospitals as hitherto con-
structed and managed, is as high as 1 death of a mother in 29 delivered,
and some of them go the length of justifying Dr. Duncan’s statement:
“I dare say an hospital could be so constructed and managed as to
“ fill all the inmates!” Dr. Duncan argues that these exceptional
cases should be set aside, that only well conditioned maternities should
be selected for argument, adding “ it is well known that the best mater-
“‘ nities are susceptible of vast improvements.” So the case against
lying-in hospitals is over-stated according to this eminent writer, who
then proceeds to demolish the other branch of the argument, namely,
that based very much on the English registration returns, according to
which only one mother died to 214 children born alive. The chances
by these returns in favour of a mother surviving are thus 213 to 1.

The English deaths are not all returned by medical men, but 92 in
100 of them are so returned all over the country, and in London the
proportion is 98 in 100, so that practically the facts are certified by the

 

* Ediuburgh, 1870. t+ Duncan, p. 15.
DEATHS. | 275

medical practitioners of the country. The certificate book, with which
every legally qualified practioner is supplied, contains this instruction :

“ Whenever childbirth has occurred within one month before death,
“ it should be registered in connexion with the cause of death.”

There may be an indisposition in some cases to record the child-birth
as the cause, but there is no reason to believe that practitioners have
generally shrunk from the performance of their duty. Dr. Duncan,
however, is of a different opinion. “To show what sources of error in
“ the registrar’s reports are hiddeu from observation, I shall,” he says,
quote from Dr. Barnes a passage bringing one to light from a single
locality.

“Tt is stated in the Registrar General’s report for 1856, that the
mortality in childbirth in England and Wales in 1847 was 1 in 167,
and that it had fallen to 1 in 227 in 1856. Now, having applied to
Dr. Elkington for the puerperal statistics of Birmingham, J learn that
the registrar of that town says, that ‘no one ever specifies the deaths
in childbed or from puerperal fever.’ ” *

Dr. Barnes is one of the ablest physician accoucheurs of the day, and
one of the most authoritative writers, it is not therefore surprising that
this statement has been repeatedly cited since as decisive of the value of
the registration returns by the medical practitioners of the Kingdom.
Dr. Duncan, the scientifie author of one of the best works on fecundity,
stamps the passage with his express approval.

Let us look at this passage, shorn of the halo of authority, and it
comes to this, that Dr. Barnes Jearnt from Dr. Elkington of Birmingham
that the registrar of that town said, that “no one ever specifies the
“ deaths in childbed or from puerperal fever,’ and this is adduced to
“ confute a statement in the Registrar General’s report for 1856.” It
is very easy to be accurate, or to verify a plain statement such as the
above, but it is, as we all know, still easier to be inaccurate, and to
accept aloose random statement as true. Strangely enough we find in
the very report quoted this fact, that in the Birmingham district where
nearly all the causes of death are returned by the medical practitioners,
they returned in the year 1856 five deaths from puerperal fever, and
seventeen from other causes connected with childbirth.t

Thus the reproach on the veracity of the medical certificates of Bir-
mingham is swept away, and the superstructure of argument on this
sandy foundation Dr. Duncan himself will probably be contented to
“ throw aside out of view.” It must be admitted that it scarcely bears
the light. Than Dr. Barnes and Dr. Duncan no one can better appre-
ciate scientific accuracy, but so pertinacious is error, so extensive has
been the circulation of this passage, that unless they themselves consent
to callin their false coin it will remain in circulation for an indefinite
period. During the year 1870 the births in Birmingham were 8678,
and according to the registration returns 86 mothers died of childbirth,

Dr. Duncan draws a proper distinction between deaths in childbirth
and deaths of childbirth. “Deaths in childbirth,” he says, ‘ are all
“ deaths, from whatever cause, occurring within the four childbed
“ weeks, including the period of labour.”

This distinction is necessary, and is drawn in the registration
abstracts. Pregnant women are subject to diseases like other women ;
they may be killed by accidents, and may be attacked by small-pox and
scarlet fever, which in them almost invariably prove fatal. Women
suffering from phthisis or heart disease, or other chronic diseases, bear

¢

a

‘¢

x

“
“«

a

 

* From Dr. Duncan’s Mortality of Childbed and Maternity Hospitals, pe,
tT See p. 190, an p. 163.

Ss 2)
276 [PART Iv.

children, and in the abstracts the deaths are referred to these fatal
causes, to which, rather than to incidental childbirth, their deaths are
attributable. Thus, in addition to 3875 deaths from puerperal fever and
the various accidents of childbirth, 719 women died soon after child-
birth, 231 of small pox or some other zymotic diseases, 138 of phthisis,
101 of heart disease; 41 women who were returned as pregnant,
probably in the early states, also died of various diseases.

A certain number of sach cases find their way into lying-in hospitals,
but not Timagine great numbers, as many of the cases of heart disease,
phthisis, and so on will be treated in general hospitals, workhouses, or
at home. If we add the 719 to the 8875 the proportion of deaths in
childbirth to children born alive is 1 in 172; while the proportion of
deaths directly referable to childbirth itself is 1 in 204 in the year 1870.

To ascertain the degree of error in the returns, those made for the
London Weekly Tables during six weeks were scrupulously examined ;
confidential inquiries were made in every doubtful case of the medical
attendants, with this result: that only ove doubtful death by childbirth
was not so returned as to be easily distinguishable; 66 were properly
returned. All the cases of death from peritonitis, haemorrhage, and the
like diseases in women of the childbearing age were inquired into; only
one of these was a death by childbicth, 5 were cases where the women
were in the early stages of pregnancy (not admissible into lying-in
hospitals), or had miscarried, and the rest were ordinary cases of disease
in women not pregnant. The births during the six weeks were 12,814 ;
taking the deaths of mothers corrected at 67 the proportion was one
death in London to 191; while taken at 66 it is one death to 194.
Stated otherwise, the deaths distinctly returned were in the proportion
of 5°15 to 1000 children born alive, whereas by the correction they
beeome 5°25 distinctly referable to childbirth and not to other diseases
under which a certain number of pregnant women die.

Dr. Duncan had a careful search made in the Scotch registers of
deaths in Edinburgh and Glasgow, and found that 153 mothers died
out of 16,893 within six weeks after delivery; or one in 107. He also
deduces from certain returns of private practice a rate of mortality
among mothers not very different from this. And from all his re-
searches Dr. Duncan draws this inference, that “not fewer than one in
* every 120 women delivered at or near the full time die within the
« four wecks of childbed.”

Upon this I may remark (1.) that this represents the danger of child-
bearing as much greater than it is according to popular or medical
repute ; it is at the rate among childbearing mothers of ‘833 per cent.
per month, or at the rate of 10 per cent. per annum: about 10 times the
ordinary rate of female mortality at that age, and equal to the rate
among men in the worst climates. This is given as the average of all
deliveries ; and as Dr. Duncan has well shown that the first delivery is
the most dangerous, such a rate, if general, would represent marriage
and childbearing as a most perilous ordeal for a young woman to
encounter.

(2) Is it not possible that childbirth may be more dangerous in Edin-
burgh and Glasgow, where the general mortality is high, than it is in
all England; and is it by any means certain that the cases of death
happening in the six weeks after 16,393 deliveries in these cities are
sufficient to represent the experience of those cities, to say nothing of
all Scotland, or of all England. Jt would imply also—differing as it
does from the returns of deaths due to childbirth—a degree of inaccuracy
in the returns of the canscs of death in the two cities for which we are
scarecly prepared.
DEAIIIS. ] 277

(3.) With regard to the published deaths in the private practice of
eminent accoucheurs is it not possible that there may be a natural selec-
tion against their success ? Eminent accoucheurs are in many instances
called in because the case is expected or found to be unusually difficult,
dangerous, or requiring the use of instruments. Thus, when Sir James
Simpson reports that at a certain time he lost four cases in at most 180
deliveries, we may be sure that this mortality of lin 45 is something ex-
ceptional. The circumstance that the facts are few is sufficient of itself
to suggest selection. Accordingly we find that J. Clarke reports the loss
of 22 mothers by death on 3847 deliveries, Dr. Churchill of 16 on 2548.

(4.) By Dr. Le Fort’s Tables the death-rate among 934,781 women
delivered at home was 1 in 212, or nearly 4:7 per 1000: which differs
little from the general English rate.

(5.) While in the 11 large English towns the mortality rate is 4°9, in
the 64 healthy country districts it is 4°3 in 1000.

(6.) As a set off against these cases of excessive mortality in the
private practice of eminent accoucheurs, I may cite the returns with
which I have been favoured by Mr. G. Rigden, M.R.C.S., an able con-
scientious practitioner in Cauterbury, personally known to me, who has
kept records of all his cases, aud prepares the statistical health reports
of that city. The analysis of 4132 consecutive cases in midwifery yields
as the result of his observation 9 deaths: 3 from convulsions and coma,
4 from puerperal fever, 1 from heart disease, and one from a cause not
stated. He, as a general rule, is a fortnight in attendance, within which
period his observations are strictly confined; but he believes that in no
instance did any other death occur within the month, as he must have
heard of and recorded it.

Upon all these grounds I feel justified in questioning the deduction
of Dr. Duncan. I have shown that the anecdote on which he reasons
to invalidate the accuracy of the medical certificates of English regis-
tration is a fiction; I have shown that in London the returns bear the
strictest examination; nor is this direct evidence rebutted by citing
evidence as to other classes of facts of a different nature. Where is the
logic of reasoning such as this: Drs. A., B., and C. lost in the limited
sphere of their practice, a high proportion of mothers delivered by them ;
in Edinburgh and Glasgow a much higher proportion died in the
six weeks after childbirth ; therefore the normal mortality in childbirth
is high, and therefore the English registration certificates are untrue,
indeed suppress the fact of the connection of death with delivery in
nearly half the cases. Excluding such cases as death by small-pox,
phthisis, and other fatal diseases not connected with childbearing, and
corzecting for defective specification, I am disposed to set down the
mortality at present prevailing in England at not more than 5 deaths of
the mother to every 1000 deliveries : or of 1 to every 200 deliveries.

Still-born children may occasion death in childbirth, so that a correc-
tion should be made for, their exclusion, and a correction of another
kind is required for the births of twins and triplets to get the exact
mortality of women in childbirth. Our tables in their crude form show
the proportion of mothers dying to children born alive; the necessary
corrections I have discussed in former reports.

If the lying-in institutions have at all suffered by comparison with
the national returns, by including deaths not due to childbirth, it is their
own fault; they should register the facts, and analyse them more accu-
rately, Ifthat is done I do not conceive that Dr. M‘Clintock’s figures
will be borne out drawn from home practice, representing the deaths
among the inmates from non-puerperal diseases as 34. to every 97 from
childbirth itself. ,
278 [PART Iv.

Miss Nightingale, in her notes On Lying-in Institutions, after dis-
cussing the whole question, has given on page 75 a good form of
register which the institutions would do well to adopt, as it would
supply all the information required for the statistical analysis of their
cases. Miss Nightingale’s book was evidently suggested by the failure
of the effort the committee of the fund made to establish a training
school for midwives in King’s College Hospital. She shows that, with
every care, 27 poor women, or 1 in 29, died out of 781 delivered, and
she shows besides the reason why. Her second chapter, on the
“ Constitution and Management of a Lying-in Institution” and training
school for midwives and midwifery nurses, is not only well worth
studying but carrying into effect. For so destitute are some poor
creatures, that either in such separate institutions, or in workhouses,
they must have help; and this necessity may be turned to account in
a training midwifery school, (33rd Annual Report, pp. 406-11.)

Puerperal Mortality, and Mortality in Maternity Charities —In
treating of the mortality from childbirth we have to consider several
cases, Two lives are at risk, and the following are the four possible
combinations of their fates :—

(a.) The mother (m) and child (c) generally survive - me
(6.) The mother survives (m), the child (c') dies me!
({e.) The mother dies (m’), the child (c) lives - - mie
{d.) The mother dies (m'), and the child dies (c') m'cl*

There is generally one child at a birth; but there may be two, three ,
“or more; and they may be still-born, or die immediately after delivery,
or die in the first month (called chrisomes in the old Bills of Mortality).

The mother usually survives; but in a few rare cases she dies during,
or soon after, delivery, the child surviving or dying.

The cases of still-born children are not returned to this office, and
the registers do not enable us to distinguish the deaths of mothers or
children in the three classes (4., c., d.). In rare instauces the mother
‘dies and the child survives. {mn the still sadder case mother and child
are entered together in the same black book.

I have every year specially dwelt on the causes of death in childbirth
for two reasons; firstly because the lives themselves are at the most
precious ave, and secondly because skill can do more here in averting
danger and death than in other operations,

In the 380 years (1847-76) no less than 106,565 mothers died
in childbirth; that is, 5 to every 1,000 children—one to every 200
children—born alive. The proportions varied from year to year; 42

 

* From the returns of the Royal Maternity Charity it appears that 9019
(m-++m!) mothers were delivered; 8,998 (m) surviving, 21 (m?) dying; while 9,117
(c +c!) children were born, of whom 8,832 (c) lived, 285 (ce!) died, including 244
still-born, 41 live-born. Then before delivery we have these four probabilities: —

me *96648 mother and child will live;

mc’ *03119 mother will live and child die;

m'e *00226 mother will die and child survive ;

mc’ +0007 mother and child will die;
note that (m+m!) (¢+ce!) = 9019 x 9117 is the divisor of the numbers from which
the probabilities mc, &c. are derived.

Thus the probability that the mother will live, is +96648 + -03119 = -99767; will
die, is ‘00233. The probability that the mother will live and the child will die
is ‘03119. The probability that the child will live is +96874; that it will die is
*03126. Mother and child survive in 966 deliveries out of 1,000; mother lives,
child dies in 31; mother dies, child lives in 2 cases; in only :07 mother and
child die. In the case of two or more children, the problem is somewhat more
complicated.
DEATHS. | 279

mothers died in 1857 and 69 in 1874 to every 10,000 children born
alive, and these were the extreme limits. In the year 1876 the
mortality of mothers was 47. :

This is a deep, dark, and continuous stream of mortality. How can
it be accounted for? In the present state of obstetrical science a certain
number of deaths from divers causes is inevitable. There are cases
which foil the most consummate skill. Then there are difficult cases
which defeat the ordinary practitioner, and the instructed midwife. But
great numbers of midwives have never beeu instructed and have never
mastered their art so as to deal with intricate cases. The Obstetrical
Society of London shows in its valuable Report that in the country
villages from 30 to 90 per cent., in the small towns of 10,000 inhabitants
5 to LO per cent., of the cases are attended by midwives. Perhaps as
large a proportion is attended by midwives in the large manufacturing
towns as in the villages. In the east end of London also from 30 to 50
women in 100 delivered are attended by midwives; in the west end of
London few.*

In answer to the question “ Are the women instructed in midwifery,”
the Committee of the Society on Infant Mortality says, “ Answers in
“ the negative have been received from all parts of the country, with
“ the exception of Glasgow and Sheffield.” From “several districts
“ the replies indicate not merely a want of any special education, but
“ gross ignorance and incompetence, and a complete inability to contend

with any difficulty that may occur.” ‘The Committee notices that in
London many women are practising who have received a certain amount
of instruction at various institutions. Thus a very large number of the
mothers is attended by midwives; some instructed in practice, others
incompetent to deal with ordinary cases of difficulty. A large proportion
of the mothers is attended by physicians, surgeons, and apothecaries ;
some at the head of their art in Europe, and others skilful or unskilful
in various degrees. Dr. Pitman, Registrar of the College of Physicians,
says, “To the best of my belief the College included “ midwifery as one
“of the subjects of its examination as early as 1518.” The Licentiates
of the London Apothecaries Company have been examined in midwifery
since 1830.t There appears to have been a general, but not a special,
examination in midwifery by the examiners in both the College of
Physicians and the Hall; at the College of Surgeons the midwifery
liceuse is a distinct qualification from that of membership. It is granted
by the college under a clause in the Charter of the 18th of March 1852.
The license was conferred for the first time on the lst of December
1852.

There is no examination in midwifery for the membership,

The midwifery examinations, the nature of which is published by the
College, “are still in abeyance arising out of the difficulty in obtaining
“ examiners.” Thus a registered M.R.C.S., without any other qualifi-
cation, has passed no examination in midwifery. Many are in large and
successful widwifery practice; others, it is to be feared, must labour
under disqualifications disadvantageous to themselves and their patients.

Under this state of things four thousand six hundred and ten mothers
died in childbirth annually in the five years 1872-6. What number of
these lost lives, have we any reason to believe, would have been saved

4

* 34th Report of Registrar General, pp. 225-6.

t+ Mr. Wheeler, the Secretary of the Society of Apothecaries, states that in
consequence of « correspondence between the Obstetrical Society, Sir Robert Peel,

and the Company in 1829, the next printed regulations enjoined two courses of
midwifery during the second year of study.
280 [PART IY.

had all been watched over by skilful midwives acting under skilful
physicians ?

I must here notice two remarkable institutions which have furnished
returns that will enable me to answer this question. The Royal
Maternity Charity was, as I have said, founded in 1757. It had in
1876 two physicians and 22 midwives (located in different parts of
London) who delivered in that year 3,069 married women at their own
homes. The midwives are instructed by the Charity’s Lecturer, Dr. J.
Hall Davis. 2,952 of the women were “delivered by the midwives
themselves; ” in 117 cases the physicians were called into consultation,
either from complication in the delivery, or from serious illness before
or after labour.* The cost was not more than 9s.a case. On an average
a midwife delivered 134 women in the 365 days; at average intervals of
less than 8 days (2°7 days); she may also have private practice. The
midwives are superannuated when old. There is an auxiliary fund
managed by visiting ladies ; who are authorised to expend about. 5s. in
each case of need. “It was painful to hear from the midwives, ‘they
“‘ report, of the lamentable and destitute condition in which some cf
“ the patients were found.” Others were in better circumstances.

Now the deaths of mothers to 9,019 delivered hy the Royal Maternity
Charity in the three years 1875-7 were 21. The mortality was at the
rate of 2°33 to 1,000 deliveries. Dr. Roper, M.D., one of the physicians.
of the Charity says, “ Our maternal mortality is as correct as possible,
“ because whenever a patient is taken ill after confinement, her case is
“ followed up either to recovery or death.”

The Birmingham Lying-in Charity was founded when the Lying-iz
Hospital of that town was broken up, and has similar rules to those
of the London Maternity Charity. The mothers are attended at their
own homes by four instructed midwives, acting under a Consulting
Medical Board. 8,607 mothers were delivered in ten years, of whom
20 died. ‘I‘he mortality was at the rate of 2°32 deaths to 1,000 mothers
delivered, or as nearly as possible the same as in the London institution.
The midwives are not allowed to practise privately ; and they must be
fully employed, as each of the four midwives delivered about 215 women
annually. The physician was called in one time in sixty. Precautions
are taken against the spread of puerperal fever. The Birmingham
Charity bas the merit of publishing a very interesting statistical report.

At the rate of mortality among the patients of these two charities in
London and Birmingham, the annual deaths by childbirth in England
und Wales would have been 2,009; the actual deaths registered were
4,610; so that 2,601 mothers perish annually through the want of such
an amount of care and skill as the midwives, acting under the consulting
physicians of the two charities, bring to bear in their attendance.

Some allowance should be made for the circumstance that these
charities oniy undertake to attend wives, and that they have apparently
fewer than usual of mothers bearing their first children (primipare).
Upon the other hand, these mothers are often poor; and I] have a
further careful return of 4,390 cases in the private practice of Mr. G.
Rigden, of Canterbury, where the deaths were 9 in 4,390 deliveries,
or 2°05 per 1,000. Other private practitioners, keeping equally
accurate accounts, could no doubt supply results equally favourable.

Childbirth is not fatal in itself, but by reason of certain supervening
diseases or injuries, which should as well as “ childbirth” be always

 

* Report of Charity for 1876, p. 25.

+ Letter dated March 25th, 1878.

£ See Registrar Gencral’s 33rd “annual Report, p. 412; an extract from which
will be found on p. 277.
DEATHS. | 281

stated in the medical certificate of the cause of death in conformity with
the instructions in the medical certificate books in the hands of all
registered practitioners. In the five years 1872-76, of thy 23,051 deaths
in childbirth, 10,498 were referred to meéria (puerperal fever), 8,400 to
specified diseases or injuries, and 4,153 to causes not specified, and
therefore imperfectly certified.

The number of liveborn children registered in 1876 in the United
Kingdom was 1,155,186; of whom about 173,278 belonged tothe middle
and upper, and 981,908 to the lower, classes of society. Certain additions
should b3 made for the cases of stillborn children. But assuming that 30
per cent. of the mothers registered were attended exclusively by medical
men, 687,336 will remain among the iower class to be attended by
midwives. In towns a midwife in full practice may attend 100 vases a
year, or one every 3 or 4 days on an average; but one case a week
(52 in the year) will be a fair average, so at least 10,000 instructed
midwives will be required. At the Census of 1871 only 3349 midwives,
such as they have been above described, are returned: 31,180 women
were returned as nurses.

It has been wisely decided by the University of London to confer the
same medical degree on women after the same examination as men. So
it is not now a question of sex. The M.B. or M.D. is proved by
examination qualified as far us that goes to practise medicine in its
obstetric as well as other branches. But we may accept the practical
proposal of the Obstetrical Society to license and register midwives not
versed in the full knowledge of medicine, but competent to deal with all
the ordinary cases of labour. They could follow their calling at a rate of
remuneration which it would be well worth the while of the working
man to pay; and in cases of complication call in the help of the
experienced physician. The local examination by competent boards
might be in the large central or county towns. ‘The register could be
conveniently kept, with the Registrar-General’s sanction, by the Super-
intendent Registrars ; and the licensed midwives would be authorised to
certify the births of the children they bring into the world.

What is wanted besides examinations are good local schools, founded
on the admirable system now in operation in London and Birmingham.
The Royal Maternity Charity was founded in 1757, when, under the
administration of a great minister, the population of England took a
start which has continued up to the present day. This institution does
not appeal to the imagination, but its utility, economy, and simplicity
commend it to the minds of practical statesmen. The Dukeof W elling-
ton became its President in 1818, the year after the Princess Charlotte
died, and remained its President until the year of his death (1852). He
was “a liberal contributor to its funds, and a judicious dispenser of its
“benefits.” The Duke saw its importance ; midwifery had given him
his Guards. It would have been difficult to get the Duke to preside
over some of our sensational societies, but he at once saw that the mothers
of workmen and soldiers had claims for skilful help at their homes in
the sorrows of labour. It was a plain good thing that appealed to his
mind. Who will perfect the work ?

Two things are wanted in every great centre; (1) a society to set
midwives to work under an obstetrical practitioner charged with their
instruction and guidance; to be followed by (2) a Self-supporting
Society among the independent third class, who woukl thus provide
themselves all the skilful help in childbirth their means will enable them
to command, The results will amply repay the contributions. (39th
Annual Report, pp. 241-21.)
282 [PART ly.

Mortality from Alcoholism.—The deaths ascribed to alcoholism or to
alcoholic drinks deserve close attention ; they are of two kinds, (a) deaths
by delirium tremens, and, (6) deaths ascribed directly under various
names* to intemperance. The number of such deaths was 817 in 1849
and 1,120in 1876. The proportion of deaths from alcoholism to popula-
tion (a million) in the five quinquenniads 1850 to 1874 was 46, 41, 40,
40, 34 annually; there was a decided and gradual decline from first to
last. The decline was most striking in delirium tremens about the nature
and cause of which there can be no mistake ; unfortunately in the last
two years the old level was attained, not as regards delirium but as regards
alcoholism of other kinds. In the three years (1871-3) of high wages
in the manufacturing districts the proportion of deaths by alcoholism
was low. The deaths by drink rose on the other hand in the three years
(1874-6) of depression probably because some sought consolation in
drink, because the hours formerly spent in the workshop were spent in
the public-house, or because the previous habits then began to bear fatal
fruit, The fact remains, independent of any theory, that in three years
of hard work and high wages—three years of prosperity—2,230 people
died of drink; while in the three years of idleness and reduced wages—
three years of adversity —3,316 died of the same causes—delirium tremens
and other results of intemperance. This is contrary to a current opinion ;
and it may be worth while to point out that in the three years of prosperity
the annual consumption of spirits in the United Kingdom was less than
in the three years of adversity. It was 36 million gallons a year in
prosperity, 42 million gallons a year in adversity. The working classes
did not throw away their earnings to the extent some have asserted.
The savings banks had a capital of 532. million at the beginning of 1871 ;
to which 8,610,2312. were added in the three years of prosperity,
8,612,236/. in the years of adversity, making 70,280,1204. held at least
to a considerable extent by the working classes.

The ages at which deaths from alcoholism are registered are shown
below. They precede the ages at which deaths from insanity are most
frequently recorded.

Dearus from ALcoHoLism in EngLanp and Wates, 1871-6.

 

AGES AT DEATH.

 

A 22
‘Ae@us,|| 10- | 15- | 20- | 25- | 35- | 45- | 55- | 65- | 75- | g5- | BE
. 22,
oS

 

 

 

 

 

 

 

 

 

10 | 54 | 337 | 531} 468 | 248] 72 9

 

3 Years Males - | 1,729 js
1871-73 { Feinaies: 501 = 10 | 81} 153) 147 80 | 24 6
of Prosperity (Persons - | 2,230 10 | 64 | 418] GSE] 616 | 828] 96] 15
3 Years Males - | 2,484 12) 81 | 504 | 761] 610 | 384] 120] 12) -
1874-76 { Fennales 832, 1] 21] 188 | 241] 229 | 137 58 6 a
of Adversity (Persons - | 3,316 13 | 102 | 642 /1,002) 839 | 521] 178] 18] 1

 

 

 

 

 

 

 

 

The greatest number of deaths from alevholism was registered at
35-45, an age when the brain is most active; the greatest number of
deaths from insanity at 65-75.

The number of deaths in six years ascribed directly to alcoholism was
5,546, rather more in number than the 5,450 deaths referred directly to
insanity. The ages ave shown in the following table.

* Alcoholism, intoxication, dipsomania, drunkenness, ebriositas, inebriety, are
some of the words occurring in the registers.
DEATHS, | 283

DEATHS ASCRIBED to ALCOHOLISM and to INSANITY in ENGLAND and
WaAtgs in the 6 Years 1871-76.

 

 

 

 

 

 

 

 

 

 

 

 

 

Ce

AGES. fae Pan qo- | 15- | 20- | 25- | 35- | 45- | 55- | es- | 5- | s5- | 25

us. 82

oe ao 5,546 23 | 166 | 1,060 | 1,686 /1,454 | 849] 274] 33) 1) -

va et 5,450 8 5 73| 124] 473 | 716 | 811 | 1,052 |1,295 | 757 | 128 | 8
\

 

 

 

 

 

 

 

As insanity induces paralysis, so alcoholism induces diseases to which

a certain number of cases of alcoholism are ascribed in the certificates.
Cases of delirium tremens are not necessarily fatal, as under judicious
treatment many patients recover; and about their diagnosis there is
litde chance of mistake; for they can only be confounded with rare
inflammations of the brain. This distressing disease is thus described in
the lectures of Sir Thomas Watson. The picture is true to the life ;
and should be carefully contemplated.
“Let me remind you in a few words of the peculiar characters of
delirium [tremens]. If you question the patient about his disease, he
answers quite to the purpose; describes, in an agitated manner, his
feelings, puts out his tongue, and does whatever you bid him; but
“ immediately afterwards he is wandering from the scene around him to
““ some other tliat exists only in his imagination. Generally his thoughts
“ appear to be distressful and anxious ; he is giving orders that relate
«« to his business to persons who are absent ; or he is devising plans to
“ escape from some imaginary enemy. He is haunted by ocular spectra;
“ fancies that rats, mice, or other reptiles, are running over his bed:
“ sees spiders crawling on the ceiling, or a horse’s head thrust through
“the wall of his room. He addresses remarks to strangers whom he
* erroneously believes to be present. He looks suspiciously behind the
“ curtain, or under his pillow, and he is perpetually wanting to get out
“ of bed; but he is readily induced to lie down again. It is very seldom
“ that he meditates harm, either to himself or to others ; there is rather
“ a mixture of cowardice and dread with the delirium.’’*

The few cases of delirium tremens induced by shock from injuries,
would be referred to those injuries, so that all the deaths under this
head in the registers may be accepted as deaths by excessive drinking in
some of its various forms.

The effects of great and excessive doses of alcohol are well known;
and so are the effects of the excesses of habitual drunkards.

Ramazzini described very clearly the effects of alcoho] breathed in
small continuous doses in the distilleries of Modena, not in cellars but in
open porticoes, where the alcoholic vapour was necessarily diluted. The
men who work in this vapour for several months, and generally pass the
winter in the distilleries, grow, he says, “ lethargic, shrivelled, emaciated,
*“ melancholic, vertiginous with loss of appetite.”f The next step
leads us to the effects of drinking between meals through the day, which
is also injurious, as is shown in the high rates of mortality among
publicans and wine merchants. The effect of total abstinence has not
yet been studied on a large scale, except so far as to show that no
evident evil ensues, and that many under the regimen are perfectly

“

‘
‘+

aa

 

* See Lectures by Dr. Thomas Watson on the Principles and Practice of Physic,
Vol. I., p. 407.
+ Ramazzini De morbis Artificum, Ed. 1717, Genevae, cap. xx.
284 [PaRT lv.

healthy. T will show here in contrast the rates of mortality among two
classes who differ considerably in habits, but have as a rule, ample
supplies of the necessaries of life; namely, the clergy and the publicans
and others dealing in alcoholic drinks. Now the publicans, and cer-
tainly the wine merchants, are not as a dody “ habitual druukards ;” nor
drunkards in any sense. There are drunkards among them, but they
are exceptional, marked men; what as a class they suffer from must be
“taking a glass” at intervals between meals with customers or in late
hours alone. Tow fatal this tippling is the following Table shows.

AwnncAt Rates of Morratity per 1000 at Four Ages among CLercy-
mpeN and Protestant Ministers, and among Pusiicans and WINE

 

 

 

 

 

 

MERCHANTS.
Publicans
Protestant Beer-sellers,
Acus. Clergymen. Ministers. Wine and Spirit
Merchants.
95-35 4°65 5°83 14°49
35—45 6°28 7°30 20°44
45-55 13°24 9°33 28°59
55 —65 22°70 24°60 43°03
Norr.—The facts on which these calculations are based are taken from the

 

Supplement to the Registrar General’s 35th Annual Report, pp. clxxil., clxxy.

A few clergymen abstain from alcoholic drinks for various reasons ;
they have not as a body “ taken the pledge,” but the temperance of the
clergy of the day is beyond question, and neither they nor the well-bred
classes of society usually drink spirits or wine without solid food. At
the ages in the prime of life, Protestant ministers are nearly as healthy
as the clergy of the Anglican church.

J may cite many other classes that drink in moderation, such as
carpenters, or again, agricultural labourers who drink beer, but whose
means are limited, and who in the country are less exposed to tempta-
tion. ‘Their mortality does not at all approach that of the publicans and
spiris dealers. AJ1 scientific observation goes in favour of temperance
in drinks.

A Committee of the House of Lords, the Duke of Westminster in the
chair, sat to inquire ‘‘into the prevalence of Habits of Intemperance,
“ and into the manner in which those habits have been affected by
“ recent legislation, and other causes.” The report is valuable in its
scientific evidence as giving the results of the most recent research.
The opinion that alcohol is always eliminated by the organs unaltered
is refuted. Experiments upon animals, and man, as for example, “the
experiments of Professor Binz, of Bonn,” clearly prove, says Dr. Burdon
Sanderson, “that there is no disengagement of alcohol by the breath,
“ unless the quantity taken is above a certain ill-ascertained limit; that
“ limit is about two ounces [of absolute alcohol]. ‘That is to say, that
“ an ordinary man may take as much as two ounces of alechol, and the
“ whole of the alcohol will be oxidised.”* Qu. 9381. It is to that

 

* Reckoning 1 part of sherry as 0°20 of alcohol, there are about 2°+4 oz. of alcohol
in half a bottle of sherry.
DEATHS. | 285

extent food; the oxidation produces some of the forms of force.
Dr. Brunton asserts that alcohol in small doses increases the gastric
secretion, and thereby aids cigestion ; it is then absorbed into the blood ;
it increases the action of the heart, and dilates the fine vessels, so that
the warm blood from the interior of the body pours over the surface
and gives a feeling of pleasant warmth and comfort. In the end as
more blood is at the surface when the external air is extremely cold the
person may be chilled down and die in consequence of the cooling.
Such is Dr. Brunton’s view.* That can only result from excess. It is
evident that chemistry and physiological reasoning throw much light on
the action of alcohol. But experience, which may be held to be a
series of experiments, can alone determine the precise effects of food
and drink of different kinds on the forces and health of men. Wine
and ale contain different kinds of alcohol, «thers, and other organic
compounds ; but the predominating spirit is athylic or commen alcohol
(C, H, O). “Pure aleobol gives no taint to the breath, and good
“ alcoholic liquids only leave that smell which belongs to their ethers.”
Some of the alcohols are extremely noxious. The wines are subject to
changes, which Pasteur calls diseases of wine, and traces to different
kinds of ferments.{ This explains some of the sad effects of bad spirits
and wines on the people who drink them. Dr. Parkes shows in his
experiments that good claret up to a pint had no sensible effect on the
temperature of the interior of the body, but it raised the pulsatious of
the heart from 76°83 to 80°5. The psychical effect of the claret is nct
recorded ; but 4 10 8 ounces of alcohol in the 24 hours produced
torpor and sleepliness. §

Food (1) nourishes the body, replacing waste denoted by urea, and
keeps the blood and all the tissues ina suitable fluid, physical condition ;
(2) it generates heat, which is in proportion 1o the amount of oxygen
consumed—carbonic acid and vapour exhaled ; (3) it sets free muscular
force ; and (4) finally it acts on the mind or generates psychical force.
Water, milk, wheat, oats, rice, fruits, meats of various kinds, suffice for
the first three purposes; but under the fourth head these elements are
supplemented by coffee, cocoa, tea, tobacco, spices, wines, and spirits.
They directly aifect the brain and nerves. Grape, hop, and barleycorn
thus find a place. Their effects are not learnt from chemistry but from
the senses, of which the poets of all ages and philosophers are natural
expositors.

I will now state my reasons for believing that the present mixed
dietary of wines and ales, in due proportion with vegetable and animal
food, while it yields the maximum energy of life, is conducive to its
duration. ;

I will first notice a fallacy in some reasonings on the subject. Alcohol
in excessive dozes produces death and its effects are traced through the
various organs of the body. On such a basis this is the reasoning.
Alcohol in given repeated doses is fatal; therefore in every dose it
poisons men quickly or slowly according to circumstances. It is always
a poison. Test this argument on the active remedies of the pharma-
copeia. Take arsenic; in doses of ten grains it kills a man in

 

* See Evidence before Lords Committee. Qu. 9246-9378. It is borne out by
the experiments of Binz in the paper cited below.

{ Effects of alcohol on warm-blooded animals. By C. Binz, M.D., Journal of
Anatomy and Physiology, vol. viii., pp. 233-41. He shows by experiment, as Todd
had, that in fever alcohol reduces the temperature.

+ Sce Pasteur, Maladies des Vins.

§ See Proceedings of Royal Society, vols. 18 and 19.

’
286 [PART Iv.

excruciating agony in a few hours. In small doses has it any injurious
effect ? None whatever. On the contrary, it restores or preserves
health. Fowler’s arsenical solution cures ague. Sulphuric acid is
according to the dose a corrosive poison, or a remedy for the diarrhcea
premonitory of cholera. Opium puts out life or simply soothes and
sends sufferers to sleep. Chloroform kills ove patient in a thousand, but
it quells pain in tens of thousands and is otherwise harmless, so it is
stil! administered in surgical operations. Excess in meats of any kind
induces indigestion; and over-feeding is probably as fatal as over-
drinking ; yet no one advocates entire abstinence from food; and only
vegetarians abstain from animal food; ascetics justly call fasting
mortification.

Alcohol has undoubtedly a medicinal effect in many maladies; it
stimulates the fainting heart after shocks of every kind. Port wine is a
potent remedy in fevers: instead of raising it reduces the burning heat
of the blood, and calms the delirium of the brain. Alcohol appears to
arrest the action of zymotic diseases ; as it prevents weak wines from
fermenting. Like camphor, alcohol preserves animal matter ; this is
not now disputed. But may it not do more’ May it not prevent the
invasion of some kinds of zymotic diseases? I invite the attention of
those who have portrayed the bad effects of alcohol to consider whether
it does not prevent the action of various infections on the temperate.
The neglect of this side of the question throws a doubt on many of
their inferences. The deaths ascribed to zymotic disease in 1876 were
96,€60, to alcoholism 1,120; now it is evident that any effect depressing
the prevalence of zymotic diseases that kill their tens of thousands will
save the lives of thousands: the same sanitary improvements that:
diminish the prevalence of disease undoubtedly diminish intemperance
and feverish thirst.

It is a remarkable fact that the cfficial returns show that the
mortality of grocers was at every group of ages much higher in the
year 1871, after they had begun to retail spirits, than it was in 1860-61;
see the following table. The deaths from alcoholism among the other
classes in that year were nearly ihe same as they were in 1860-61.

Morratity per Cent. of Grocers, 1860-1 and 1871.

 

 

 

 

Acrs - te | ee eee a gel epee Pee
upwards.

Years 1860-1 -| +531) +840] +993 | 1-280 | 2-053 | 4-334 | 12-498
1871 - “592 | 1-115 | 1°021 | 1-466 | 9°567 | 5-461 | 13-442
Excess in 1871 -o61 | -275 | +098] -186 | -514/ 1-197 | +954

 

 

 

 

 

 

 

 

 

 

Notr.—In 1860 an Act of Parliament was passed by which, for a license of 2/. 2s.
or 3/. 8s., according to rental, grocers or dealers in other commodities than wines and
spirits might sell wzze in quart or pint bottles in any quantity less than two gallons
not to be consumed on the premises ; previous to that year the license was 10/. 10s.,
and the quantity was unrestricted. In 1860 also an Act of Parliament empowered
licensed dealers in spirits (grocers among others) to take out a license, additional to
the 10/. 10s. license for spirits, authorising them to sell foreign liguors in reputed
quart bottles or bottles ir which the same may have been imported; while a further
Act passed in 1£61 allcwed the sale of Foreign or British €pirits in any quantity not
less than cre reyuted quart bottle. In 1§72 the Jaw compelled retailers cf wines or
spirits to get a megistrate’s certificate prior to the grant of a license.
DEATHS. ] 287

The clergy of the Church of England are quite justified, without
insisting on total abstinence, in endeavouring to promote temperance of
which they themselves experience the full benefit. The rate of
mortality among publicans of 85 and upwards is 38°94 per cent. ; among

the English clergy it is 2°96. Their duration of life is shown in the
accompanying Table in comparison with that of other classes. The

 

Doration or Lire in various Crasses of the Communiry, notably in
those of CLERGYMEN and PUBLICANS.*

 

 

 

MEA‘N AFTER-LIFETIME IN YEARS AT AGE &.
AGE.
(e) Gosek | piste” ot Ba or
un ae Tile ae the Clergy. Ministers. Publicans.
15 - 43°2 47°2 — — 88°0
25 - 36°1 39°9 °42°1 41°6 313
35 + 29°4 32°9 33°8 33°8 254
45 - 22°8 25°7 25°7 26°0 20°0
55 : 16°5 18°6 18°6 17°9 14°9
65 - oe 10°8 12°0 11°9 11°4 10°3

 

 

 

 

 

 

The Table may be read thus :—At the age of 25 the mean after-lifetime of the Clergy is 42'1
years, of Publicans is 31°3 years, the difference in the two classes being nearly 11 years: thus the
future lifetime of the Publican is one-fourth or 25°7 per cent. shorter than that of the Clergy-
man. The mean after-lifetime at age 25 is 42°1 years among the Clergy, 41°6 years among
Protestant ministers, 39°9 years in the Healthy Districts among populations chiefly agricultural,
86'1 years among the whele population, and 31°3 years among Publicans. Clergymen of this
age have lived 25 years, and will on an average live 42 years longer, so their mean age at death
is 67 years; while Publicans of the same age live on an average only 31 years longer, and their
mean age at death is 56. They lose 11 years of life. At the age of 45 the mean after-lifetime of
the Clergy is 25°7 years, exactly the same as that of the populations of the Healthy Districts ;
it is 26°0 years among Protestant Ministers, 22°8 years among the whole population, and 20°0
years among publicans.

Note.—The above calculation of the mean after-lifetime is based for the Clergy on 59,084
years of life and 1,105 deaths; for Protestant Ministers on 24,944 years of life and 472 deaths;
for Publicans on 228,592 years of life and 7,127 deaths. See Sup. to 85th Report, pp. clxxii-clxxv.

 

report of the Lords Committee will no doubt be of great practical
importance, and may suggest further scientific research to determine
the points at which wine loses its natural virtues and becomes a poison.
Dr. Parke’s careful experiments were made on a soldier not in
conipany, and the effects on his mind were not noted; yet, that is more
striking and important than the effect on temperature, and on the
secretions. The effect on the brain stands before that on the heart.—
(89th Annual Report, pp. 228-37.)

Violent Deaths in Londcn, England, and Foreign Countries prior
to 1839.— Whether violent deaths are on the increase is a question of
some interest. The London Bills of Mortality, so far as they can be
relied upon, furnish data (see the following Table) for obtaining some
approximation to the proportion of deaths by violence in the Metropolis
to the deaths by all causes from the middle of the 17th century.

 

* See also Extracts from Supp. to 85th Annual Report on pp. 39°~494.—(Editor.)
288 [PART IV:

Tan e of the Violent Deaths in the London Bills of Mortality.

 

and
Suffocated.
‘Total,
including
found Dead

Years.

Drowned
Burnt and
Scalded.

Suicide.
Killed.
Murdered.
Poisoned.
Smothered
Executed.
Total.
Total
Deaths.

 

 

 

 

 

i
1647 t0.1700 | 3,448 | 419 | 901 |3,520 | 683 | 96} 108 |1,043 10,218 | 478 | 10,696 |1,054,201
1701 ,, 1749 | 8,943 384 1,978 [3,1z0 | 419 (115 | 151 | 681] 10,791 || 1,770 | 12,561 1,223,343
1750 ,, 1799 |5,679 | 744 1,571 |3,546 | 218 | 76 | 288 | 935] 13,057 || 510 | 13,567 |1,043,759
1800 ,, 1829 |8,635 | 1,150 | 1,090 | 2,632 99 109 | 216 | 595] 9,526 | 406] 9,982 | 586,322
18373,, 1889) — | — |; — | — | — |—] — —| 3119 || — cad 123,098

 

Proportion of Deaths by Violence in 10,000 Deaths from all Causes.

1617 t0 1700 | 82°7 | 40] 85 | 33°4] G5] ‘91 1°70] 9°9] 96°9 4°5) 101°4 10,000
1701 ,, 1749 | 32°3 | 3°1 | 162 | 25°5 | 34] °9] 12 | 5°6 | 88°21) 14°95 | 102°7 10,000
1750 ,, 1799 | 54 4 | 7°1 | 15°0 | 84°0 | 21] °7 | 2°8 | 9°0 | 12571 4°9 | 130°0 10,000
1800 ,, 1829 | 62°0 | 19°6 | 18°6 | 449 | 1°7 [179 | 3°7 /10°1 | 162°5 69 | 169°4 10,000
18373,, 1839 | — = = = as |e — | 253°4 = ad 10,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the first period (1647-1700) the annual rate of mortality was
about 7, in the second 5°2, in the ,third 5, in the fourth 3, per cent. ;
whence it may be deduced that, in the i7th century 6°8 in 100,000, in
the 18th century 5:4, in the 19th century 5, died violent deaths. Out of
a given amount of population the deaths by drowning increased in the
latter half of the 18th century ; the deaths by scalds and burns were
twice as great in 1800-1830 as in the 17th century. The tendency to
suicide remained nearly stationary; so did death by poisoning. All
the deaths by personal violence rapidly decreased. Jn a population of
100,000, according to these accounts, about 23 were killed, 4°6 mur-
dered, in the 17th century; in the 19th century about 13 were “ killed,”
and 0:5 were murdered. The chance of being murdered diminished
nine-fold. The executions were more frequent in the latter half than
in the beginning of the 18th century, compared with the population
within the Bills of Mortality, they were not however half so frequent
in the first 30 years of the 19th century as in the latter half of the
18th century, when about 7 were executed annually to a population
of 10,000. Relatively to the murders the number of executions
increased.

The violent deaths in Sweden, Prussia, and France, as given in the
official returns, are compared in the following Table with the results of
the English returns.

 

f ‘
| Annual Number of To a Population of

 

Mean
Population. | 4 scer- | Other

Acci-
; Total
tained | Violen’ dental |, ot

 

 

Suicides. Violent

Suicides. |Deaths. Deaths. Pete. Denths,
Sweden - - 1810-30 2,616,874 134 1,637 1,771 51 62°6 67°7
Prussia - 1820-34 | 12,393,162 1,112 4,912 6,024 9°0 39°6 48°6
France - 1839*) 34,154,224 2,747 6,402, 9,149 8'0 18°7 26°8

Englandand Wales 1838-9 | 15,666,800 1,000 | 10,679 | 11,679 6°4 68°2 T4°5

 

 

 

 

mee population of France was $3,510,910, in 1826; the annual rate of increase is 605 per
cent,
DEATHS. | 289

‘The Swedish Abstracts appear to be made on the same principles as
our own. 378 infants, said to be “suffocated (overlaid) through the
“© earelessness of nurses,” have been excluded, as the number referred
to this head in the English (and probabiy the Prussian and French)
Returns is inconsiderable. With the 378 children overlaid, and 27
deaths ‘ascribed to ardent spirits, the violent deaths in Sweden would
amount to 1,771 + 405 = 2,176, or 8°2 in 10,000 annually. The
mines and lakes of Sweden make the violent deaths numerous; 947
persons (792 males and 155 females), were drowned every year. The
‘suicides were numerous in Prussia and France; nevertheless the
Return made by the police in Prussia is said to be incomplete. If an
addition were made to the 1,000 ascertained suicides in England, for the
snicides among the 2,400 drowned, the tendency to suicide would, I
fear, be found to be quite as great in England as in France or Prussia.
The Return of other violent deaths in Prussia is incomplete: for
besides the 4,912 given above, and stated to be by ‘a variety of fatal
‘“* accidents,” several are probably mixed up under the head “ external
“ causes or injuries,” (comprising 7,368 deaths) with phlegmon, morti-
fication, hernia, urinary diseases, and cancerous ulceration. There is
no means of separating into its constituent parts this aggregation of
miscellaneous cases.*

Neither the Prussian nor French Returns appear to comprise deaths
by homicide, which would not, however, affect the results to any great
extent. The French Returns are evidently defective; they profess to
give all the accidental deaths which came to the knowledge of the
Minister of Justice, who is not paid on the same principle as the
coroners of this country. If, instead of 27, we admit that, exclusive
of homicide, 37 in 100,000 Frenchmen met their deaths by violence in
the year, this will make little more than half the mortality by violence
in England; where, after every deduction has been made for defects in
the foreign Returns, the mortality by violent deaths is greater than in
Sweden, Prussia, France, and probably any nation of Europe, in which
civil war is not raging.

The reason of this is explained by the precediug analysis, without
implying any extraordinary negligence. Relatively to the population
of England, few countries have such an extent of coast, rivers, and
canals, or so many men employed in navigation; so many fires, furnaces,
and chemical processes in operation ; medicines and poisons distributed
in so many shops; so many mines, manufactures, or buildings ; so many
horses, carriages, and railways; such a vast amount of force of every
description at its disposal. The great number of violent deaths in
England may, therefore, be accounted for on the assumption that the
danger in the manufactures, mines, and conveyances, is the same as in
other countries ; but that the frequency of exposure to it is greater.

It must not, nevertheless, be imagined that the number of “ accidental ”
deaths, injuries, and mutilations, cannot be reduced in England. Deaths
in ships, manufactures, and mines, are indiscriminately called ‘ acci-
“ dental;” yet it is well known that fewer lives are lost by shipwreck
in Her Majesty’s service than in emigrant vessels; that less accidents
happen in one factory than in another; and that the men are crushed,
burnt, or blown to pieces, much less frequently in the coal mines of
certain proprietors, than in those of others. Many “accidental deaths ”
are, therefore, indirectly caused by human agency. Many of the
accidents happen from ignorance and carelessness. The knowledge of

 

* Medicinischer Zeitung, Nos. 44, 45, Nov. 1835. Translated by Mr. Deverell in
Transactions of the London Statistical Society, p. 121.

T
290 [PART Iv.

the accidents to which people are exposed in different occupations may
put them more on their guard against danger.—(3rd Annual Report,
pp. 85-88.)

Coroners’ Returns of Violent Deaths, 1852-6.—In England a special
officer has been elected by the people, from the earliest times, to visit
the body of every person slain or wounded, and to inquire into the
circumstances of each case. The mere fact that the death was sudden,
or that the body was found in water, if the coroner was called upon,
rendered inquiry imperative; and it is accordingly enjoined in the
statute (4 Edward I.) regulating the coroner’s office.

The progress of science has created new forces, often fatal, and has
produced new substances, of which our forefathers had no knowledge.
Machinery is organized on a large scale, so that the lives of numbers
of men are liable to be destroyed, not by malicious intent, but by the
negligence of other men who have their lives in charge. Thus, great
numbers die by railway accidents ; many perish in mining operations ;
children are suffocated in bed or are burnt by “their clothes taking
“ fire.’ Poisoning is not mentioned in the act of Edward ; but poisoning
is now, unhappily, a common cause of death. Poisons are the most
insidious instruments which assassins can employ, and they were
evidently little known in England before the Reformation; yet the first
English legislators directed inquests to be held on the body dying
suddenly, because death might possibly even then be the result of secret
violence. Persons slain generally die suddenly ; hence, it was made
the rule to hold inquests in cases of sudden death. Such was the wise
provision of the law.

A man is killed; the coroner receives notice, and summons a certain
number of men to inquire, under his direction, into the causes of the
death, and to pronounce, after hearing the evidence, a preliminary
verdict of acquittal or of guilt. The utility of the inquest is evident.
Tt recognized, in barbarous times, the value of human life. No man
could be slain without inquiry. It was a simple means of discovering
the guilty, and it brought home blame to the negligent; at the same
time the innocent were protected against false imprisonment, for
“guilty”? was not the verdict of a despot, but of a jury of twelve or
more ordinary men who fairly represented public opinion. The verdict
threw a shield around the innocent, who, without the inquiry might
have been falsely suspected: it left no excuse for private vengeance:
and, undoubtedly, the coroner and the jury deterred many evil natures
from the commission of crimes which they would have perpetrated had
not the dread of the inquest interposed, Lives were thus saved, and
every man enjoyed a sense of security which the commission of murders
with impunity would have destroyed in the great mass of the population.
For, without the inquest, assassination would be the death of many men
—the dread of ail.

The corover’s inquest is entirely a popular institution. The county
coroner is elected by the freeholders ; and it is one of the great advan-
tages of the inquest that it engages the great body of the people in the
administration of justice ; public opinion is thus never in favour of a
man whom a jury has pronounced guilty. Assassins and bravoes have
been shielded from discovery by people in foreign lands who have never.
served on juries. Through inquests the ereat body of the English
people have been taught also, to some extent, the action of general
causes, such as nuisances, in destroying life.

Coroners are elected for counties, and in some cases, for sub-divisions
of those counties ; boroughs and some districts have special coroners.
DEATHS. | 291

England and Wales have, apparently, 324 coroners, some of whom
appoint deputies; they held, according to Mr. Redgrave’s returns,
inquests on 21,801* bodies in the year 1856. ‘The total charges amounted
to 67,0002., averaging 3/. 1s. 6d. for each death into which inquiry was
made. The charges included the coroner’s fees (1. 6s. 8d. on each
inquest), and mileage (9d. a mile, reckoning only one way, from his
usual place of abode to the body) ; medical fees for evidence, autopsies,
and analyses; witnesses’ expenses, constables’ allowances, and payments
to jurymen, and for rooms. .

The findings of the juries are classed under the following heads by
Mr. Redgrave :—

Injuries from Causes unknown 424

Homicide 482 Including—Murder - 205
Manslaughter - 271
Justifiable Homicide 6

Suicide 1,314

Accidental Deaths 9,716

Ascertained Violent Deaths 11,936

Natural Deaths 7,102

Found dead 3,183

 

: F These numbers are 420 in excess of
Tae el a on Wee 22,221 { the true number—owing to duplicate

entries.

 

It would thus appear that nearly 10,285 of the bodies died of disease,
or in ways not positively ascertained to be violent; and that 11,936
died violent deaths, which involved charges of murder, manslaughter,
or justifiable homicide in 482 cases. Ultimately 265 persons were,
according to the Criminal Returns, committed to trial for homicide
(murder 82, manslaughter 183); and 109 were convicted (31 of murder
and 78 of manslaughter).t Of the 31 convicted murderers 16 were
hanged. This was the ultimate result of 21,801 inquests; 109 men and
women were convicted of homicide, and variously punished. It is
asked, upon the face of this return, ‘‘ Whether, under our police system,
“ such a number of inquests, leading to no results, is necessary ?”
“No evidence,” it is said, “of crime to satisfy a coroner’s jury was
“ found in 21,325 cases; and of the 476 verdicts of murder and
“ manslaughter only a few were sustained by sifted evidence before the
“ judges, for only 109 convictions ensued.”

It must, however, be recollected that 1,314 suicides are included in
the return; and the importance of inquiring into these cases will not be
disputed. Murder, moreover, may sometimes be disguised under the
appearances of suicide. 8,183 bodies were fownd dead ; aud the utility
of inquiry into ail these deaths will scarcely be questioned.

The examination of the whole series of violent deaths shows con-
clusively that the coroner should sit in every case, for the denunciatior
of the guilty, for the comfort of the innocent, and for the information
of the public, who should be taught the nature and the extent of all
the dangers by which they are surrounded: for some of those dangers
they at learn to avoid, and many of them can be diminished or entirely
removed.

 

* These numbers are corrected for duplicate entries in the original Table. The
corrections are made on Mr, Redgrave’s authority. The details cannot now be
corrected.

t Judicial Statistics, 1856.

T 2
292 [PART Iv.

Whenever adeath occurs suddenly it is wisely enacted that an inquest
shall be held; and in interpreting the word “sudden” the fact that the
deceased has or has not been recently visited by a legally qualified
medical practitioner should be taken into account. Under this inter-
pretation a considerable number of inquests is held on persons who die
of common diseases, the effects of which, if scrutinised hy medical
witnesses, leaves little doubt of their nature. The supposition of
violence is thus negatived, and this decisive result isample compensation
to society for the expense.

Virtually, it is true that of twenty-one thousand inquiries only a few
lead to the committal and conviction of criminals ; but the utility of
the inquest is not to be proved by the number of erimes committed, but
by the number of crimes prevented ; and it is gratifying to find that
homicide is comparatively rare in England and Wales. Few countries
present so low a proportion of murders. Yet, the instant that the
provisions of the law are disregarded, and inquests are not freely held,
such homicidal eruptions break out as the poisonings in Hssex, the
atrocities in Norfolk, which Sir James Graham feared “had resulted
“ from an interference with the duties of the office of coroner,” and the
systematic poisonings of Palmer, in Staffordshire, who was executed in
the year 1856.* The increase of subtle poisons lying for sale in the
shops, the increase of life insurance, and the immense number of violent
deaths in England, demand the observance of all the existing safeguards
of life.

The legislature, in the year 1837, extended the inquiry under the
Registration Act so as to make it embrace the cause of every death in
England and Wales. The informant, in registering a death, has to
answer the question, What was the cause of death ? and in all cases of
inquest on any dead body it was enacted (6 & 7 Gul. 4. c. 86. s. 25.),
that “the jury shall inquire of the particula’s herein required to be
“ registered concerning the death, and the coroner shall inform the
“ registrar of the finding of the jury, and the registrar shall make the
“ entry accordingly.”

In a letter which was published in the Appendix to the third annual
Report (1841) I discussed the coroners’ returns of violent and sudden
deaths. The defects in the “information” were pointed out; and in
the year 1845, after further experience, a letter was addressed to
coroners, accompanied by observations on the registration of the causes
of violent deaths. Your letter to the coroners concluded in these words:
“T confidently anticipate that for the future, in all cases in which
«¢ inquests shall be held, the finding of the jury, as recorded in the
“ register book of deaths, will contain all the particulars which it is
“¢ desirable to ascertain.”

It is gratifying to find that the “ cause of death” as returned by the
coroners exhibits improvement. The information is still, however, in
many cases very imperfectly given. fn the case of railway accidents
the nature of the accident is not defined in a large number of instances :
the deaths in mines are well descrtbed: of the deaths by burns, 2,181
are referred to the clothes taking fire in the 5 years 1852-6, and 75 to
conflagrations, but in 7,739 cases the circumstances are not distin-
guished; the poisons are not stated in many cases of death by poisoning ;
the deaths by drowning are often obscure, but they are evidently

 

* It was stated before a Committee of the House of Commons in 1851, that the
constabulary of Staffordshire were instructed not to furnish ‘notices ” of deaths to
the coroners, except when crime was suspected. And the coroners were informed,
that if they held inquests in such cases their fees would be disallowed. Under these
regulations Palmer committed several murders.
DEATHS. | 293

imperfectly returned where the cause can be ascertained; we learn that
588 persons were drowned while bathing, 215 by falling from ships and
boats, 265 by shipwreck, 4 while sliding and skating, and in the greater
part of 11,758 cases of drowning the information is left imperfect.
Suffocation was the cause of 1,624 deaths, which were left unclassified.
The coroners’ returns state that in 1856 the verdict of suicide was
returned in 1,314 cases; only 1,182 were distinguished in the registers,
owing, it is believed, to obscurities in the verdicts. In 195 cases of
suicide, 182 of murder, 257 of manslaughter, 2,402 of accident in the
5 years 1852-6, the means by which death was caused are not expressed ;
thus, it is impossible to learn the total deaths from poisoning or from
drowning, or from any particular agent, through these serious oversights
in the coroners’ returns. In the calculations it has been necessary to
distribute 5,328 cases of violent deaths so as to get approximations to
the numbers of deaths by railways, mines, mechanical injuries, chemical
injuries, and asphyxia. Yet this classification was expressly made
to include the greatest number possible of the facts as they were
returned in 1840; and we are scarcely yet prepared for a more minute
classification.

The Tables contain, nevertheless, much useful information. The
returns for the five years 1852, 3, 4, 5, G, include 68,454 violent deaths.
On an average 13,71] such deaths were registered annually ; of males
10,057, of females 3,653. Thus to ove female three males die by
violence,

On an average 480 deaths are returned as occurring annually by rail-
ways; the numbers rose from 391 in 1852 to 548 in 1856. The number
of the deaths by violence from these as well as other particular causes is
probably understated, as it has been already remarked that the manner
in which some accidents occur is not distinguished. Yet these numbers
greatly exceed the deaths returned to the Board of Trade. In 1856 the
Board received accounts of 232 deaths from railway accidents, whereas
548 deaths were registered as having occurred in connexion with rails,
railway carriages, and railway works.

In mines 1,136 persons were killed annually ; 985 in coal mines, 151
in copper, tin, lead, and other mines. We hear chiefly of deaths by ex-
plosions in coal mines, but accurate registration shows that the deaths by
the explosion of fire-damp are 198 to 939 from other causes. The fall
of coal, stone, &e. kills 509 persons in mines annually, including the
crushed ; 157 fall into the pits or shafts. Few women are killed by
either railways or mines. The deaths by all other mechanical injuries
are 4,157 annually, comprising the deaths of 3,328 males and 829
females. Falls from heights, scaffolds, windows, stairs, ships,—and falls
in walking,—kill 1,077 persons annually; of whom 253 are females,
falling chiefly from heights, windows, or down stairs. The fall of heavy
bodies kills 832 persons annually. 1,107 persons are killed annually by
horses and horse conveyances, more than double the number killed b
railways. The numbers exposed constantly to accidents of this kind are
probably greater than the numbers exposed to accidents on railways.
The accidents by horses and horse conveyances make less noise in the
world than railway accidents; and it is only when the aggregate results
are collected by registration that the truth is revealed. The returns are
however defective, for 546 annual deaths sre referred simply to fractures,
leaving the cause of the fractures unspecified.

584 persons die annually by wounds, 161 by gunshot wounds, 233 by
cut throat, and 190 by other wounds. A large number of these deaths
are cases of suicide.
29+ [PART lv.

3,045 persons died annually of chemical injuries, that is, almost ex-
clusively by burns and sealds. 1,184 females. are burnt to death, 815
males. And how is it that so many females die this painful death ?
The coroners have not yet enabled us to answer the question explicitly.
But of the 451 cases where the information is given, 436 were from the
clothes taking fire, and only 15 from fires. In the five years 1,349
females are stated to have died from the clothes taking fire ; 890 were
girls under 10 years of age, 173 were of the age 10-25, and the rest
were women of higher ages. Of the 832 males who died from their
clothes taking fire, 526 were boys under 5 years of age, 226 were boys of
the ages 5-10, and only 80 were of the age of 10 years and upwards.
At these early ages the boys as well as the girls wear combustible
clothes. Of the 3,195 males and the 4,544 females who died of burns,
though in what way the returns do not state, a large number undoubtedly
died in the same way. The discovery of these appalling facts will, it
may be hoped, lead to new precautions against this danger, and probably
the clothes will in the end be rendered by some chemical process incom-
bustible. Of scalds by drinking scalding water, 142 males and 88
females, nearly all children under five years of age, are stated to have died.
The larynx is closed in these unhappy cases, and the child is suffocated.
It will be observed that the young boys are more incautious than the
young girls; 125 boys and 79 girls of the ages 1 and under +4 died by
drinking scalding water.

Tie deaths by lightning are so interesting in a scientific point of view
that it was thought right to give them in detail. The deaths of mules
and females at different ages, and in the several divisions and counties,
are shown.

401 persons died annually of poisoning, and in nearly 113 cases the
poison is not specified. Opium is the principal specified poison ; by that
drug 125 persons are said to have died, namely, 89 by laudanum, 34 by
opium, and 2 by morphia. 34 persons were killed annually by prussic
acid, including 15 by the essential oil of bitter almonds. Arsenic stands
next, and to it 27 annual deaths are referred. The salts of lead kill 23
persons annually, the salts of mercury kill 10, oxalic acid kills 18,
sulphuric acid (oil of vitriol) kills 15 persons annually. The deaths
from these poisons are understated, as the 113 deaths from unspecified
poisons are chiefly caused by them, and in some cases the poisoning is
not discovered, and the death is erroneously ascribed to disease.

3,826 annual deaths are the result of interrupted respiration (asphyxia),
including 2,566 deaths by drowning. These returns are incomplete.
Persons drowned at sea, whose bodies are not washed on the English
shores, are not registered; hence large numbers of the marimime
population perishing in the sea remain unregistered. Of the dying by
drowning 2,044 were males, 522 were females; they were generally
adults. Bathing, shipwreck, falls overboard, are the principal assigned
circumstances to which drowning is referred, but the circumstances
are unassigned in nearly 2,352 cases.

Suffocation is stated to have caused 708 deaths annually; it was
referred to choking by food in 57 cases, bedclothes in 188 cases, over-
laying in 106 cases, mephitic gas in 16 cases, limekilns in 13 cases,
charcoal in 3 cases. But the cause of suffocation was not stated in
nearly half the cases.

494 persons die by hanging every year, 384 males and 110 females,
and 50 are strangled annually.

Some of the persons executed have not been distinguished in the
registers from other persons hanged, instead of 35, the number actually
executed in the five years was 405.
DEATHS. | 295

[ have alrealy referred to the imperfect returns of 195 suicides, 182
murders, 257 manslaughters, 2,402 accidenta, 1,684 injuries. Often the
way is not aszertained in which iafanticide is committed.

1,033 suicides were returned annually so as to be distinguishable in
the register, which is probably less by a tenth than the numbers actually
distinguished, Hanging is the most common form of suicide; cut-
throat and drowning stand next in the order of frequency: eight-tenths
of the suicides are committed in one of these three ways.

The inconceivable importance of inquiries by coroners will be evident
from the number of the violent deaths, which exceed the deaths in all
our wars, and may undoubtedly be prevented to a large extent.

The contentions of the county coroners and the magistrates have
already been referred to. The county coroners pay the expenses of
inquests, and are afterwards reimbursed out of the county rates. By a
decision of the courts of law, the magistrates consider themselves justified
in deciding in every case after the inquest has been held whether it was
“necessary.” If they consider it unnecessary, they stop the coroner’s
fees. The utility of the coroner’s office is greatly impaired by this state of
things. The cause of death is sometimes not ascertained. He ceases to
be responsible for holding inquests, which are disallowed on no settled
principles. Cases occur in which the coroners refuse to hold inquests on
the bodies of persons dying by violence, dying suddenly, or found dead;
and in other cases they hold inquests for which they are mulcted to the
full extent of their fees and allowances. ‘The coroner is thus degraded
in the eyes of the country. His is a high judicial office, and yet it is
assumed that for the sake of putting a fee in his pocket he will hold an
unauthorised useless inquest on a deal body. The cansorship is an
invidious office, and is as injurious to the magistrates as it is to the coroner.
They are appointed by the crown, he is elected by the freeholders. The
juvisidictions of the offices are sometimes conflicting. The coroner holds
inquests in prisons, and in county lunatic asylums, which are under the
control of the magistrates. The magistrates are not elected by the rate-
payers, and their limitation of the expenditure on an institution which
has the protection of the life of the people for its object is viewed with
suspicion. No unseemly disputes appear to have arisen in boroughs
where the coroners are paid by the representatives of the ratepayers.

All the expenses of the county coroners are now paid out of the
county rates. They were formerly, it is believed, paid out of the poor
rates with the exception of the coroner’s fees. And more inquests are
now required than were necessary formerly, when violent deaths were of
rare occurrence. The aim of the magistrates is apparently to keep down
the county rates. But it has been seen that all the expenses of inquests
amounted to 67,000. This is a small portion of the county rate. The
324 coroners of the whole of England and Wales reeeived 29,0682. in
fees in the year 1856, or rather less on an average than 90J. each.
After deducting 91 coroners who held less than ten inquests each in the
year, the incomes of the rest was about 123/. on an average. The
highest income amounted to 1,692/. The mileage was fixed in the last
century, and is evidently too low in many districts. ‘The coroners pay
the salaries of their deputy coroners and clerks out of the above
incomes.

Of all judicial officers the coroner appears to be paid on the lowest
scale, Yet his office is subordinate to none inimportance. Its require-
ments are high. He should inspire public confidence by his intellectual
as well as by his moral qualities. Without a knowledge of medical juris-
prudence in its extensive sense, it is impossible to conduct satisfactorily
an inquiry into the causes of deaths, often surrounded by unusual
obscurity. His duties are by no means attractive. He is liable to be
296 [Pant ly,

called upon to hold inquests at all times. The inquiries are often pro-
tracted. It is his duty to view the dead bodies in all their revolting
changes. His mind is conversant chiefly with deadly accidents ; with
the sudden deaths from which people pray to be delivered ; with suicides ;
with infanticides; with manslaughters; with dismal murders, which no.
poet’s art can turn into tragedies.

It is the men undertaking ail these painful duties whose pay is con-
stantly liable to be disputed by the magistrates. And no other judicial
officer is paid in the same precarious way. What would be thought of a
proposal to make the pay of the county court judges depend on the
number of their decisions, and to allow them te adjudicate only in such
a number of cases as the county magistrates consider reasonable. The
judges are not fined, as the coroner is, when their decisions are reversed.
The chief coroner of England, the Lord Chief Justice, is not paid by
fees ; and instead of a precarious income he enjoys a certain salary, with
a vested right ina pension. The coroner is paid by fees, which can be
withheld by the justices; his income fluctuates, and when he is old and
disabled, he has no pension to retire on.

The subject is so important that it should be inquired into. And the
comparative merits of the pay by fees and by salary should be carefully
weighed. The unseemly contention between two high classes of the
officers of justice should be brought to a close. When the coroners’ pay
is placed upon a proper footing, several improvements might be intro-
duced into the conduct of the inquest. Certain classes of cases should
be laid down in which inquests should invariably be held, and others
should be held on the coroner’s responsibility. It should be proclaimed
that the inquest involves no suspicion, as indeed its most important
function is to dissipate unfounded suspicions. Without an examination
of the organs of the body, and often without an analysis of their contents,
the cause of death cannot be determined, either negatively or affirma-
tively. And this examination would be most satisfactorily conducted by
one medical officer in each district, who would become by experience
expert in manipulation, and sagacious in judgment. He might undergo,
before his appointment, a special examination in medical jurisprudence,
and be very properly the health officer of the district.

While all existing rights are scrupulously respected, and the selection
is left in the hands of the freeholders, it would perhaps be found possible
to diminish the exorbitant expenses of contested elections, and at the
same time to secure adequate acquirements in the coroners. Physicians,
surgeons, clergymen, barristers, solicitors, now undergo examinations.
Why should not the future candidate for the office of coroner be required
to produce a diploma, certifying the possession of a competent knowledge
of medical jurisprudence ?

These improvements would necessarily raise this important office to its
proper dignity, and greatly increase its public utility. The causes of
death would be ascertained. New safeguards of human life would be
provided. (19th Annual Report, pp. 196-205.)

Violent Deaths in Mines and on Railways, 1863-72.—There are
two groups of violent deaths which have been separately distinguished
since 1863, the violent deaths in mines, and the violent deaths on
railways. These two great branches of industry are carried on under
unusual circumstances, and without the utmost vigilance and skill they
involve great sacrifices of life.

The mines are of two kinds, the coal mines, and the copper or other
metallic mines, each kind involving its peculiar dangers. The danger
of the coal miner arises from gaseous explosions and from falls of coal,
DEATHS. | 297

stone, and other bodies from the roof. The copper miner is free from
the danger of explosion but deprived of the advantages of ventilation,
he works in impure, heated air, which induces a peculiar form of lung
disease, developed after a certain number of years’ exposure. Here we
have to do only with violent deaths, which are much less common in
copper than they are in coal mines.

The mortality by violent deaths in mines and on railways is shown
in the two Tables annexed, at the several ages, as calculated on the
population living at those ages.

Deatus from VIOLENCE in ENGLAND AND WALES “connected with
Raitways,” at several Groups of AGEs, in the 10 Years 1863-72 ;
and the AnnuaL Deatu-rate per 100,000 Persons estimated to be
living in the Mippxe of that Perron.

 

 

 

 

i é Annual Rate of
a _ Deaths from Mortality per 100,000
taken as the Middle Violence “connected ]| Persons Living from
of the Period of the with Railways,”: in Violence “ connected
Groups of Y 1863-72 the 10 Years 1863-72. with Railways,”
Ages in Years, ears ° in the 10 Years 1863-72.
Males. Females. Males. Females. Males. | Females.
All Ages - | 10,557,066 | 11,120,459 8,316 663 79 6
Under 5 - | 1,465,041 1,459,879 111 52, °8 4
6 - | 1,278,784 1,280,543 248 57 19 “4
10— - - - | 1,155,596 1,139,628 434 61 38 "5
15-- =| 1,953,189 2,074,028 1,969 78 10°1 dh
25— - - - | 1,512,774 1,677,922 1,867 82, 12°3 6
35—- - | 1,202,007 1,296,129 1,362 V7 11°3 6
45— - - 916,226 976,513 1,065 101 11°6 10
55—- Ss 610,625 661,846 745 77 12°2 1°2
65— - - - 334,023 387,133 379 57 11°3 15
75and upwards 128,801 166,843 136 21 10°6 13

 

 

 

 

 

 

 

 

 

Deatus from VIoLENcE in Mines in ENGLanp anp WaALEs in the
10 Years 1863-72 at different Groups of Agrs, and Mran
AwnuaL Rate of Morvarity per 100,000 of the Mate Porv-
LATIon and of Miners.

 

 

 

 

 

 

Tenens econ’ Mean Annual Death-rate by Violence in
in the 10 Years 1863-72. Mines, in the 10 Years 1863-72.
Groups of
Ages in Years. In all Tn ail In coal | In other than|
In all Mines to Mines to || Mines to] Coal Mines
Inall || InCoal other | 100,600 of 100,000 of || 109,000 to 100,000
Mines. || Mines.) yyings, ae the Mining wo ater other
re 5 iners
bs lation. Population living. Vino
Aged 10 & upwards | 11,482 |) 10,167 | 1,315 14°7 83775 395°9 157°7
1— - - -| 1,559 || 1,451] 108 13°5 425°9 498°6 143 9
15— . - 3,278 2,860 413 16°8 291° 4 334°9 153° 4
25— : - 2,590 2,289 301 271 322°1 375°3 155°0
35— 1,941 1,689 252 16° 359°6 421°5 181°2
45— - -| 1,283 || 1,138] 150 14°0 392°0 476'9 167°2
bi— 2 643, 572 71 10°6 387°9 479°6 152°7
65— - a 169 152 17 51 276°1 838'2 104°6
75 and upwards 24 21 3 19 166°0 198°5 83°1

 

 

 

 

 

 

 

 

 

 

 

The above Table shows the mortality by violent deaths in mines as
calculated on the respective mining population, and on the general
male population of England and Wales.
298 [PART Iv.

With regard to the violent deaths of every kind on railways, either of
passengers or railway servants, the mortality has been calculated on the
whole population living at several periods of life. This may be
‘compared with the loss of life in mines.

We have no means of determining the mean population exposed to
risk on railways, but the number of railway male servants of every
kind in 1871 was 84,625, including 13,715 engine drivers and stokers,
22,083 railway officers, clerks, station-masters, and 48,827 railway
attendants and servants. This is exclusive of 45,070 railway labourers,
platelayers, and navvies.

The number of railway journeys in 1872 was 423,000,000, exclusive
of journeys by season ticket holders, making perhaps in the aggregate
500,000,000. Taking each journey as of 9°6 miles and allowing half
an hour for its performance, it follows that the average number of
passengers exposed to risk through the year does not exceed 30,000.
Adding the 30,000 to 84,625 the total nnmber of persons exposed a
year to risk, and among whom the deaths on railways may have
occurred was 115,000. Now the deaths were 1,160, so the annual rate
of mortality was 11 in 10,000.

We have no means in the returns of separating the deaths of pas-
sengers from the rest, and there is reason to believe that the companies’
returns in which this distinction is made are incomplete.

We do not know the mean ages of railway passengers and railway
servants in the aggregate, but dividing the deaths at cach age by the
living at cach age in the whole population, then it is seen that the
mortality at seven decennial ages over the age of 15 differs little among
men : the loss of life by violence on railways is at a rate slightly above
1 in 10,000 ; it is 1°0 at the age 15-25, 1°2 at the age 25-35.

It will be seen upon comparing the above figures with those made by
the companies to the Board of Trade for the corresponding years that
the latter were exceedingly defective, and the returns which have been
made in these Reports deserve the merit of having called public
attention to the excessive number of deaths among the railway staff, as
the mortality of that meritorious class of men might be greatly reduced.
(25th Annual Report, pp. 228-9.)

International Statistics of Violent Deaths, 1873-G.—English mortality
from violence presents a considerable contrast with what is observed
in Italy. There the homicides amounted in 1876 to L504 ;* against 412
recorded in England and Wales during that year. Thus to 1,000,000
of population there were 54 homicides in Italy against 17 in England.
If we had the same proportion the homicides would have amounted to
1,309 in England and Wales. In Rome the proportion is much higher :
it is 141 in Rome, in Sicily 137.

Although the results in England are so much more favourable as
regards homicide than in Italy, it is the reverse with other violent
deaths; there the violent deaths in 1876 were 6,656 against 18,358
(exclusive of executions) in England; or 240 in 1,000,000 of population
in Italy against 757 in England.

If we deduct the 1,024 suicides and 1,504 homicides, there will
remain 4,128 violent deaths in Italy; from which we deduct also
47 deaths from intemperance, and 6 from hydrophobia and bites of
vipers, and one by privation. To render them comparable with the
English returns we obtain 4,074 which are thus accounted for :—

 

~ The homicides are thus classified according to the returns made to the “Stato
Civile”: involuntari 285; voluntari 1,163; infanticide 56. They are little more
than half the number given by the Judicial Statistics. There is no coroner’s inquest
in Italy.
DLATIS. | 259

Deaths. by Violence in Italy in 1876.

Drowning - 1,324
Suffocation - - - - 137
Explosions - - - 131
Burns - - - - 337
Lightning - 147
Falls 1,109
Crushes from falls of fabrics, trees, earth 332
Horse and horse conveyances - - 167
Railways - - - 84
Agricultural machinery - 34
Violence of animals - - - 68
Avalanches - > - 7
Injection of poisonous substances 34
Unknown and various causes - 163

4,074

 

Upon comparing these with the English returns the difference is
evident. There are no mines in Italy; and the physical forces set in
motion by coal are much less than in England and Wales. The railway
accidents and burns are less fatal there than in th's country. Upon
looking back to the state of England in the last century we shall find
a state of things very like what is prevalent now in Italy, and our
progress in the industrial arts has been accompanied by hecatombs of
deaths which it becomes necessary to endeavour to avert by special
measures. The genius of the country has been directed to the achieve-
ment of certain works, and has never asked at what expense of life.
The time has come to ask at what cost? and to consider carefully how
life may be saved. For though there are fewer homicides in Hngland
and Wales than in Italy, it must be recollected that the lives are equally
sacrificed by negligence as if they were taken by the red hand of the
murderer. The mine inspectors and the railway inspectors are well
employed if they suggest improvements by whivh life may be saved ;
and the same analogy would lead us to try how far similar miuds may
be directed to the suggesting ways of saving life. The medical health
officers will be well employed in this direction.

Tape showing the Numsrr and Proportion to a MILLION LIviNG
of Dratus from VIoLENcE, in each of the under-mentioned
CountTRIEs, in 1876.

 

 

 

 

Proportion to 1,000,000 living.
Deaths 2 ao

: rom a omi- All Acci-

CounTRIEs. Vio- | Suicide. “ie, | 22. | Ganses 2 ane

lence Negli- of |Suicide,| Homi-

gence. | y,°% uicide.) “cide and.
Violent * | Negili-
Deaths. gence,

; |

Switzerland - - 2,550 540 109 1,901 924 | 196 3 SO
United Kingdom - >| 25,798 2,052 533 | 23,213 775 62, 3 a
England & Wales - | 18,358 1,770 412 | 16,176 757 | 73 17 667
Scotland* - - = 2,516 128 4 2,384 720 37 1 682
: Ireland . - 2,083 111 88 1,884 391 21 17 353
N jorwayt = 1,295 126 23 1,146 724 70 13 641
Finland : 1,179 64 66 1,049 626 Ba 35 557
Sweden, : - - 2,740 409 88 2,243, 619 92 20 507
Prussia’ - | 16,815 3,432 547 | 11,836 616 134 21 461
Bavaria - - : 2,629 522, 198 1,909 519 103 39 377
Belgium - 2,577 439 85 2,053 483 82 16 385

Austria - | 19,150 |, 2,488 a -- 71 113 _ —
Italy ° : . 6,656 1,024 1,504 4,128 210 37 54 1k)

 

 

 

 

 

 

 

 

 

 

*The above facts given for Norway are for the year 1873, for Seotla 5 i
min eee y y v Scotland 1875, for Finland 1874,
300 [PART Iv.

It will be seen in the annexed table that the United Kingdom is at
the head of every country except Switzerland in the number of violent
deaths. The avalanches and falls down precipices no doubt give
Switzerland its fatal pre-eminence. (4¢th Annual Report, pp. 229-30.)

Statistics of Suicide, 1838.—The tendency to suicide is least among
persons who carry on occupations out of doors; and greatest among
artisans who are weakly from birth, are confined in-doors, have their
rest disturbed, or have little muscular exercise.

Taking the numbers as they stand, 1 in 9,332 masons, carpenters,
and butchers committed suicide in the year ; and 1 in 1 ,669 tailors,
shoemakers, and bakers: the tendency to suicide in the first class was.
as 1°0 to 5-6 in the second. The corrected mortality from suicide
was 1°38 to 10,000 in the first class, and 7°43 to 10,000 in the second
class. The requisite correction will be made, without further notice,
in the subsequent rates. It does not affect the relative mortality of
different classes.

A similar result is obtained by comparing the suicides in the class of
labourers with those among artisans and tradespeople ; for the tendency
to suicide is twice as great among artisans as it is among labourers.

The proportion of suicides in the miscellaneous class, designated by
Mr. Rickman, “capitalists, bankers, professional, and other educated
men,” is very near the average.

Numbers. Suicides. Other Violent Deaths. Suicides in 10,000.
55,853 22 23 4:9

It has been remarked by theoretical writers who appear to have had
this class principally in view, that suicide is most prevalent in countries
where tbe greatest number of people are educated ; and M. Brouc, after
an elaborate inquiry, lays it down as a “social law,” that suicide is
most common where education is the most diffused; that suicides and
scholars increase in the same ratio. Modern education and literature,
it is said, have led to an increase in the number of suicides.* In
England suicide is, in fact, most frequent in the metropolis, the south-
eastern counties, and the northern counties, where the greatest number
can write; and it is the least frequent in Wales. The intermediate
counties range from 62 to 48, who could write, in 100; the suicides
from 4°5 to 6°8 in 100,000.

 

 

 

Number out of
100 Persons Suicides
—_— married, who i a a o
could write oe
their names.
Metropolis - | 82 10°9
Durham, Sia anibetiond: Cumberland, West- ,
morland 68 6°5
Surrey, Kent, Sussex, Hampshire, Berkstiire | 62 8-4
Monmouthshire and Wales 41 2:2

 

 

There is a general but no constant relation between the state of
education thus tested, and the commission of suicide. It may be
admitted that there is some relation between the development of the

 

* Considérations sur les Suicides de nétre époque-—Par M. Brouc, Annales.
@ Hygiene. Tome 16, p. 223.
DEATHS. | 301

intellect and self-destruction; but the connexion must be in a great
measure indirect and accidental. In opposition to the arguments derived
from agricultural districts, and labourers in towns, there is the fact that
suicide is more frequent among several classes of artisans than it is
among better educated people. If the progress of civilisation is to be
charged with the increase of suicide, we must therefore understand by
it the increase of tailors, shoemakers, the small trades, the mechanical
occupations, and the incidental evils to which they are exposed, rather
than the advancement of truth, science, literature, and the fine arts.

A comparison of the suicides among servants and the preceding class
would throw some light on the influence of mental cultivation. But
servants, comprising coachmen, cannot be distinguished from street
coach-drivers in the registers,—so that the two classes must be referred
to one head; standing in point of education, however, nearly on
a level.

 

 

Numbers Ascertained | Suicides to
r. Suicides, 10,000.
Servants and Coachmen 20,292 11* 6°7
Capitalists, Professional, and other
Educated Men - - 55,853 22 4°9

 

 

In corroboration of this result, it may be stated that about 2°0 in
10,000 persons assured in the Equitable Society, and 7°8 in 10,000
Dragoons and Dragoon Guards, have been ascertained to commit suicide
every year.

Of 26,665 paupers and others not included in the previous classes,
9 committed suicide, or, with the correction, 4 in 10,000. It does not
appear from the registers that either poverty or riches have any great
disturbing influence on the tendency to suicide. The influences of their
attendant evils are nearly equal. The poor man has an average standard
of enjoyment which he can scarcely fall below, and is less exposed to
cruel reverses than the affluent; who are, on the other hand, assured,
by the abundance of their resources, against the frequent fluctuations
in the supply of the primary necessaries of life.

Intemperance and suicide, as well as other violent deaths, are found
associated in the registers; and the professions peculiarly addicted to
drunkenness have more than the due proportion of suicides. Drunken-
ness leads to this; but drunkenness is a sort of indirect suicide, and
both are tendencies of the mind, indulged often from the same motives,
and promoted by similar causes.

There is no reason to believe that suicide has been latterly increasing
in England. The fact, nevertheless, that 1,000 persons are ascertained
to commit suicide yearly, and that nearly as many more are returned as
drowned. &c., in which the verdicts do not state whether death was
accidental or suicidal, is sufficient to arrest attention on all the relations
of the question.

Some plan for discontinuing, by common consent, the detailed, dramatic
tales of suicide, murder, and bloodshed in the newspapers is well worthy
the attention of their editors. No fact is better established in science

 

* 5 were registered servants, 1 a waiter, 1 « pot boy, and 4 coachmen.

+ Tables of Equitable Society, 1834, p. 29. Army Statistical Reports, 1839,
“ The United Kingdom,” p. 7.
302 [PART Iv-

than that suicide (and murder may perbaps be added) is often committed
from imitation. A single paragraph may suggest suicide to twenty
persons; scme particular, chance, but apt expression, scizes the imagi-
nation, and the disposition to repeat the act, in a moment of morbid
excitement, proves irresistible. Do the advantages of publicity counter-
balance the evils attendant on one such death ? Why should cases of
suicide be recorded at length in the public papers, any more than cases
of fever? It would be out of place to refer here to the moral or strictly
medical treatment; but it may be remarked, that the artisans most prone
to suicide are subject to peculiar visceral congestions—that suicide is
most ccmmon in unhealthy towns~and that the influence of medicine
on the mind, and on the unstable, ungovernable impulses which are
often the harbingers of suicide—is incontestable. To place the shoe-
maker, tailor, baker, or printer in the same favourable circumstances
with respect to air and exercise as carpenters and masons would ke
impossible. But the workshops of all artisans admit of immense im-
provemcnis in ventilation. Cleanliness is greatly neglected. Neither
the men nor all the masters appear to be aware that the respiration of
pure air is indispensable; that the body requires as much special care
as the tools, instruments, and machines; and that without it, neither
the body nor the mind can be preserved in health and vigour. The
new parks and public walks will afford the artisan an opportunity of
refreshing his exhausted limbs and respiring the fresh air; and the
health and temper of the sedentary workman may be much ameliorated
by affording facilities in towns for athletic exercises and simple games
out of doors, which, while they bring the muscles into play, unbend,
excite, and exhilarute the mind. Moral causes, and the regulation of
the mind, have perhaps more influence on the educated classes; but all
must derive benefit from out-door exercise. (8rd Annual Report,
pp. 79-82.)

Manner of Suicide, 1858-63.—The constancy of the death-rates from
suicide, not only in the act but in the mode of suicide, has struck
statists from the first, and it has been particularly well illustrated by
M. Guerry and M. Quetelet.

Under the obscure workings of insanity, and amidst the conflict of
the passions, in a great variety of unhappy circumstances, an order is
observed, which can be expressed in laws, and men can by means of
these laws estimate or predict future events. Thus it is found that 56
persons, 8 women and 53 men, shot themselves dead in the year 1868;
and by virtue of the law, if it be assumed that the same number of
persons shot themselves in each of the five preceding years, the error
will not ke considerable ; for the numbers were 54, namely, 53 men and
1 woman in the year 1862; and 59, 59, 54, and 60 in the preceding
years; making the average annual number 57, from which the deviation
is only 3 or 1-19th either way. By virtue of this law any one may
predict that, the circumstances remaining the same, 57 persons now
living will shoot tiemselves in the year 1866. In the six years 253
persons killed themselves annually by cutting the throat or stabbing
themselves; the numbers ranging in those years fiom 215 to 276; that
is from 88 below to 23 above the average,

Some erroneous inferences are sometimes drawn from these remark-
able laws. It has been assumed, for instance, that because numbers
expressing events, such as suicide, succeed each other regularly year
after year, that those numbers are perfectly correct. Now this does
not follow, for it has been found that the same law extends to errors,
and it is quite possible, nay probable, that the number of suicides in
DEATHS. | 303

England is understated, as some unknown numbers of the persons found
drowned are suicides.

It is established as a law, that the same causes or equivalent causes
invariably produce the same effects on the minds of men under the
same conditions; but it does not follow trom this principle that suicide
cannot be brought under any control. A certain number of lunatics
destroy themselves; anything, therefore, which prevents or cures
lunacy diminishes suicide. In some in-door employments, where tre
conditions of health are disregarded, the tendency to suicide is deve-
loped; and by changing the conditions the tendency is diminished.
Idleness, as much as strain of mind, predisposes to suicide; change the
conditions and the disposition to suicide is changed. Suicide has
generally been treated as ignominious crime; but it sometimes puts
forward pretensions to heroism and applause ; it is therefore influenced
by public opinion. In certain states the mind appears to be fascinated
—as in the disposition to plunge from a height—by the presence of a
fatal instrument, such, for example, as prussic acid, a pistol, a rope, or
a razor ; and the withdrawal of the means of death suffices to save the
life. Diminish the facilities of procuring poison, and you diminish the
peculiar kind of suicide. Discontinue the use of a razor in a country,
and you diminish the cases of cut-throat—(26th Annual Report,
p- 193.)

Causes of Death in the Metropolis, 1629-1835.—The following table
expresses the liability of the living to death by all the great classes of
diseases during six periods of the last two centuries. The first and
most difficult step here was to determine the absolute rate of mortality
in the six periods, The population in the liberties of London,
enumerated in 1631, was 180,178; the deaths in the liberties during
the eight years, 1628-35, were 54,299, of which 1-24th were still born :
excluding these, the annual mortality was 5 per cent. This represents
the mortality of years free from pestilence, but not the absolute
mortality of the period, which, for the 24 years, 1620-48, was 7 per
cent. Column A. shows, therefore, the fatality of diseases in years
intercurrent between epidemic years. Column B. is an approximation
to the mortality and diseases of London in the middle ages, although it
includes 14 years subsequent to the great fire, and to the last epidemic.*
The mortality of London in the 17th century did not differ very
sensibly, before the French revolution, from the mortality in the

 

*The enumeration of 1631 was published by Graunt, in the Appendix to his
Observations, under the title “ Anno 1631, ann. 7, Caroli I.: The Number of Men,
Women, and Children, in the several Wards of London and Liberties, taken in
August, 1631, by special Command from the Right Honourable the Lords of hig
Majesty’s Privy Council.”” The results agree remarkably with the later enumera-
tions, three of which, 1801, 1811, and 1821, make the population of the liberties of
London (97 parishes within, and 16 parishes without the walls,) 130,100, including
a correction for seamen and strangers. Without correction, the population, in 1831,
was 123,683. The enumeration of 1631 has, therefore, been made the basis of these
calculations ; as it is not probable the population, in the same space, ever exceeded
130,178. The deaths in the 97 + 16 parishes during 31 years, 1616-46, amounted
to 279,964; which diminished , for the still-born, and divided by the population
(130,178) of the intermediate year, give 6°68 as the annual rate of mortality. The
fire disturbed the observations in 1666, so that it was more difficult to obtain an
approximation to the mortality in the 20 years, 1660-79 ; but the enumerated deaths
in the 10 years, 1670-79, were 94,644; in the 5 years, 1660-4, 483,000; in 1665,
the epidemic year, 56,558 ; whence 237,349 were deduced as the total deaths in the
20 years. Reduced 3 for the still-born, the annual rate of mortality was 8°85 per
cent.; but, to avoid the risk of exaggeration, the rate of this period, including the
plague year, 1665, has been stated in the table at 8 per cent.
304 [PART Iv.

current years 1629-35: the mean expectation of life at birth, 1728-37,
was calculated by Mr. Simpson to be 19°2 years; while in the 10 years,
1771-80, it was 19°6 by Dr. Price’s 16th Table. Nearly 5:2 and 5:1
deaths happened annually out of 100 persons living. The mortality of
London in 1801-10 had considerably diminished and was estimated by
Mr. Milne to be 1 in 84°19 annually—2-92 per cent.* The annual
deaths in the 18 years, 1813-30, are stated by Mv. Edmonds at 2°82 per
cent.; and as the deaths reported in the bills, 1831-5, were 1-8th
more than the deaths in the five years preceding, the mortality has
been assumed to be 3°2 per cent. in this period including an epidemic
year,

Meay AnNuat Number of Deatus in Lonpon from 20 Classes of
Disease in 100,000 living.

 

 

 

 

 

 

 

 

 

 

 

 

is A. B. Cc. D. E. PF.
iy
1629-35. | 1660-79. | 1728-57. | 1771-80. | 1801-10. | 1831-5.
Chrisomes, overlaid, convul-)
sions, worms, teething,mold- |
shot head, dropsy on the
bead, inflammation of brain, 1,681 1,591 1,827 1,682 789 625
rickets, livergrown, canker,
thrush, croup, whooping-
cough - - - -J
Small-pox - 189 417 426 502 204 83.
Measles - 16 47 37 48 O4 86
Scarlet fever - = = = = = 53
Fever : - 636 785 785 621 264 111
» Spotted : 45 90 _ _ — _—
Plague : 125 1,225 —_ — — as
Dysentery - ‘ - 221 894 50 17 L- 1
Surfeit or cholera - 63 148 1 = _ 135
Inflammation - = = 10 31 101 307
Pleurisy : - 14 6 10 5 4 39
Asthma and tisick - = = 112 85 89 136
Consumption : 1,021 1,255 905 1,121 716 567_
‘| King’s evil, scrofula - 14 5 z — 3
Dropsy : - - 146 349 218 225 131 133
Apoplexy and suddenly - 47 30 48 65 49 59
Palsy and lethargy - - 14 17 12 18 19 28
Old age, bedridden - 370 388 415 324 241 357
Casualties - - - 65 76 85 70 40 57
Childbed and miscarriages - 80 100 43, 47 32 43
Unknown causes : = = = ae =) 88
Other diseases - 253 565 211 14t 146 289
Deaths in 100,000 living - 5,000 8,000 5,200 5,000 2,920 3,200
REMARKS.

1. The diseases of London in the 16th century still prevail in
unhealthy climates: not only the diseases and the manner of death have
changed in this metropolis, but the frequency and fatality of the
principal diseases have diminished.

2. The reported cases of fever, plague, cholera, and dysentery,
constituted 4-10ths (*396) of the diseases: they destroyed annually, on
an average, 31 per 1,000 of the inhabitants; five times as many as are
now carried off by consumption.

3. Fever, plague, and dysentery, were most fatal to adults; but they
of course carried off a considerable number of children. Convulsions,
and other diseases of infancy, did not decline till the 18th century.
The disease of adults first diminished in violence; and as the state of
the city and medical knowledge improved, the diseases of infants
decreased.

 

* Treatise on Annuities, &c., by Mr. Milne, vol. ii. p. 428.
DEATHS. | cO5

4, Small-pox attained its maximum mortality after inoculation was
introduced. The annual deaths of small-pox registered 1760-79, were
2,323; in the next 20 years, 1780-99 they declined to 1,740: this
disease therefore, began to grow less fatal before vaccination was
discovered ; indicating, together with the diminution of fever, the
general improvement of health then taking place. In 1771-80, not less
than 5 in 1,000 died annually of small-pox; in 1801-10 the mortality
sank to 2; and in 1831-5 to 0°83.

5. Measles became gradually more general in the 18th century; but
in 1801-10, after vaccination was introduced, twice as many died of
measles as had died of this exanthem in 1771-80. If scarlet fever and
measles, however, have somewhat increased in frequency, the mortality
of the three diseases, small-pox, measles, scarlet fever, is only half as
great as the mortality formerly occasioned by small-pox alone.

6. Fever, exclusively of the plague, has progressively subsided since
1771: fever has declined nearly in the same ratio as small-pox. Jn the
‘three latter periods of the table the deaths from fever decreased as 621 :
.264: 114; from small-pox as 502: 204: 83.

4". Cholera morbus was as fatal in 1660-79 as in 1831-5: in 1831-5
out of 1,000, but 1°35 are stated to have died of cholera; in 1660-79,
the deaths from this disease were 1° 48.*

8. Other inflammations besides inflammation of the lungs unques-
tionably prevailed in London before 1704, when the word found its way
into the bills; but its present comparative frequency is not entirely due
to « change of nomenclature. Fevers were the reigning diseasos, and
an impure atmosphere communicated their character to the inflam-
mations; which are still relatively less frequent where fever and
dysentery prevail. In Corfu, 1815-21, out of 325 deaths among our
troops, 12 were attributed to inflammation, besides 10 to hepatitis ;
while 223 were ascribed to fever, plague, and dysentery. Sydenham
classes pleurisy, bastard pneumonia, rheumatism, erysipelas, and quinsy,
together, under the title “intercurrent fevers :” after distinguishing the
idiopathic from the symptomatic disease, he says, “I conceive pleurisy
“ to be only a fever occasioned by a peculiar inflammation of the blood,
“ whereby nature throws off the peccant matter upon the pleura, and
“© sometimes upon the lungs, whence a pneumonia arises.” Fever, then
involved in its vortex the comparatively rare inflammations; inflam-
mation (a vague term), now happening more frequently in a pure form,
and proved by post mortem examinations to prevail very extensively,
has apparently recovered, not only its rightful possessions, but several
of the unappropriated, unknown diseases, particularly of children.

9. Consumption was exceedingly fatal when fevers and dysentery
reigned: it is now very fatal among the British troops in the West
Indies. Its relative frequency increased down to 1810; in other words,
fever and dysentery decreased more rapidly than consumption. The
actual proportion of persons destroyed by this disease, as well as other
forms of scrofula (rickets and evil), has, except in the anomalous period

 

* Sydenham’s Works, vol. i. pp. 218-483. “Cholera comes almost as constant at
the close of summer, and towards the beginning of autumn, as swallows in the
beginning of spring, and cuckows towards midsummer.” THe closes an accurate
description by remarking, that it “often destroyed the patient in 24 hours.” Dr.
Craigie has demonstrated the antiquity and identity of cholera all over the world;
before the last eruption, it had been epidemic in India. He cites a remarkable case
from Morton. Edinburgh Journal, 1833.

U
306

[PART IV.

of 1771-80, progressively declined among the mass of the population in
London. If asthma and tisik be added, the declension will be little less

apparent.

10. Dropsy has been latterly proved to depend frequently on diseases
of the heart and of the kidneys: its connexion with agues and dysentery,
and with diseases of the liver and’ spleen, is confirmed by the table
(McCulloch’s Statistical Account of the British Empire, Vol. II.,

pp. 612-15.)

Causes of death at different ages.—The English Life Table shows how
many of a million children born are males, and how many are females;
how many of each sex will probably survive year by year until after the
age of 100 years the last life is extinguished ; how many die in each
year of age; and the mean after-lifetime at every age.

The English Life Table is constructed on the numbers enumerated at
12 periods of life in the two Censuses of 1841 and 1851; and the deaths
registered at the corresponding ages in the 17 years 1838-54* ; since
those dates two more Censuses having been taken, and the deaths registered
and abstracted at the several ages down to 1872, I thought that it might
be desirable to construct a new Life Table on the basis of the more

extended experience.

_ was based that a new construction became unnecessary.

But the mortality at the several ages having been
calculated for each of the 34 years 1838-71, the mean of the rates was
found to agree so closely with the mean rates on which the Life Table

The law of

f mortality had fluctuated from year to year, but had as yet remained
constant; so that the persistence of the force of death as it affects
different ages is beyond doubt.

Annuat Mortariry per 1,000 of Mazes and Femares in ENGLAND:

 

 

 

 

 

 

 

 

 

 

and WALEs.
Males. Females.
Ages. Ages.
1838-54. 1838-71. 1838-54. 1838-71.
(17 Years.) (84 Years.) (17 Years.) (84 Years.)

All Ages 23°38 23°3 Q1°7 21:5 | All Ages.
o— U25 72°6 62°3 62°7 o—
5— 92 a7 9°1 8°5 5—

10— 5:2 4:9 5:4 5:0 10—
15— 8-2 7°8 8°5 8:0 15—
25— 10°0 9°9 10°6 10°1 25—
35— 12°8 13°0 12°7 12°3 35—
45— 18°5 18°5 15°9 15°6 45—
55—- 31°8 32°0 28°2 28:0 55—
65— 66°9 67°1 60°0 58°9 65—
75— 147°6 i4a7*l 184°4 134°3 75—
85— 301°4 305°5 279°2 279°5 85—
95 & upwards 440°3 441°1 432°2 430°4 |95 & upwards,

 

 

 

The Life Table thus gives out of 1,000,000 liveborn children the

deaths at each year of age.

To determine all the diseases of which they

die at each year of age involves an amount of labour beyond our command,
if the whole of the distinguishable diseases recorded are taken into

 

* See Life Table, pp. xviii-xix ; Longman, 1864.
DEATHS. | 307

account. To reduce the arithmetical labour within an available compass,
I have selected certain diseases of which the diagnosis is most certain.
The other diseases are thrown into groups: the first group of all the
class of zymotic diseases of the first order not separately dealt with ; the
second group of all except the distinguished maladies, And the several
local diseases are grouped according to the affected organs. Suicide and
other violent deaths are given in two lines.

The construction of the necessary tables may be thus described. A
separate set of tables was formed for males and females, and the numbers
dying at each period of life were taken from the Life Table. The
deaths are numerous at first, and the numbers in each of the first five
years of age are distinguished ; then the numbers dying in the quin-
quennia 5 to 10, 10 to 15, 15 to 20, 20 to 25; and finally the
numbers dying in the decennia 25 to 35, 35 to 45, and so on to the
end of life.

From the returns of deaths in 1861-70 by different causes in the
same divisions of age, the proportions of males per 1,000,000 dying of
each of the 25 diseases or groups of diseases at each division of life were
determined. For the deaths according to age and sex in the preceding
10 years 1851-60 the same process was repeated; and from the mean of
the results of the two decennaids the final table was derived, which
served to distribute the deaths of the males of the Life Table
proportionally.

Thus, to take an example, in the years 1861-70 the deaths of males
at ages 25-35 were 147,734; the deaths of males by small-pox 2037, by
fever 10,513; so the proportion to 1,000,000 deaths at those ages was
for small-pox 13,788, for fever 71,162. The corresponding propor-
tions in 1851-60 were for small-pox 12,473, for fever 70,266; the mean
for the twenty years was for small-pox 13,130, for fever 70,714. Now,
by the Life Table the total deaths of males at ages 25-35 are 30,592;
so the numbers due to small-pox are 402, to fever 2163; which accord-
ingly find their places in the table. The other groups of causes were
treated in the same way. From the separate tables of males and females
the tables of persons of both sexes were framed by addition.

Knowing the deaths from each disease at each age period, the sum of
all deaths from the same disease at and after each age are obtained by
successive additions.

The Table to be complete should give the deaths from each cause in
each year of age; but that series is long, and as it can be obtained by
interpolation, I reserve it for a subsequent process.

Out of 1,000,000 children 114,417 will die of phthisis. Assume for
a moment that at any age the survivors of the 114,417 may be picked
out at that age and thrown into a class apart, then a table of the
consumptive could be contructed showing their chances of dying at each
age, as well as the premium to pay for an insurance on their lives.

Practically it is not possible to select out of a number of persons taken
indiscriminately the numbers that will die of consumption ; but it ig
considered possible by taking ancestral descent, temperament, and
premonitory symtoms—such as hemoptysis—into account, to select a
class apart, having what is technically called a consumptive tendency, and
whose mortality would approximate to that of the persons actually
dying of consumption.

And a Life Table of the class dying of consumption can be formed by
summing up the deaths by consumption in the Life Table, as in the
subjoined example, which might be completed by interpolation.

u 2
308 [PaRT Ly.

Noumeers to die of Consumption at and after each Acz out of 1,000,000
CHILDREN born.

 

 

Age x. To die. Age «. To die.
0 114,417 35 54,290

5 109,948 45 31,886

10 107,809 55 15,418
15. 104,283 65 4,973
20 95,209 75 679
25 81,424 85 52

 

 

 

 

 

 

 

(Supplement to 35th Annual Report, pp. xxv.-vii.)

Ages at Death from different Diseases.—All the deaths referred to
premature birth, and the greater part of the deaths from convulsions,
teething, atrophy, and debility occur in the first year of life. Upon the
other hand many diseases such as cancer, apoplexy, paralysis, and many
organic diseases, are fatal chiefly to people of advanced ages. Others,
such as phthisis, fever, and childbirth, are most fatal in the middle period
of life. The proportional number of the deaths from these several
diseases is altered in an increasing population such as that of England ;
where the proportion of deaths from diseases affecting the young as
those above named, for example, is overstated. The true proportions
are shown in the Life Table. Thus the proportions in 1000 deaths in
the 20 years 1851-70 were by whooping-cough 23°145, by measles
19'134, by scarlatina and diphtheria 48-427; whereas by the Life
Table the same diseases for the same period are more correctly given
as 15°161 ; 12°865 ; 34-966.

The mean ages at death by these diseases were 1°8, 2°7, 5°8 years;
and the excess over the numbers of the Life Table is due to the excess
of children of these ages in the increasing population of England. Here
are some instances :—

Mean Ace at Draru of Persons pyine from certain Causes, 1848-72 ;
also the Deatus from those Causes to 1,000,000 Deatus from all
CavseEs, 1851-70.

 

Deaths to 1,000,000
Deaths from all Causes
at all Ages, deduced

 

Mean Age £
Cause of Death. at Death, tom
1848-72.
: Registered
Life Table. Deaths.
|
Whooping-cough - 1:8 15,161 23,145
Measles - - 2-7 12,865 19,134
Scarlatina and Diphtheria 5°8 34,966 48,247
Small-pox 11°9 6,521 8,535
Fever . - - 26:0 38,107 40,170
Childbirth and Metria 31°7 6,921 7,364

 

 

 

 

 

 

 
DEATHS. | 309

Mxan Acs at Deatu of Persons DYING from certain Causes, 1848-72 ;
and AnnuaL Dearas, to 1,000,000 living, from those Causus, by
Encuish Lire Tassie, compared with the recorded Morratiry,
from the same Causgs, 1851-70.

 

 

 

Annual Rate of
Mortality to 1,000,000
Living of all Ages
Mean Age ° TB ES
Cause of Death. at Death, deduced from
1848-72.
. Registered
Life Table. Doaths.
Whooping-cough - 1°8 371 521
Measles - 2°7 315 437
Scarlatina and Diphtheria - 5°8 856 1,046
Small-pox - 11°9 160 204
Fever 26°0 933 918
Childbirth and Metria 31°7 169 168

 

 

 

 

 

The deaths by causes such as childbirth occurring in the middle of
life, are not deranged ; but the proportion of people dying of the diseases
of old age is understated.

The births in the United Kingdom now exceed a million a year; and
our Life Table shows that a constant number of a million births will,
without any increase of births, maintain 9 population of 40,858,184, if
there be no emigration. The actual population of the United Kingdom
in 1871 was 31,545,741. The defect is in the adult and advanced
ages.

~The Annual Report. of the Registrar General shows the deaths from
each disease to 1,000,000 living of all ages; and as there is an excess
of children in the actual population, the mortality deduced from the
deaths and the population of all ages by small-pox, scarlatina, measles,
whooping-cough, and all the fatal diseases of the young, are overstated ;
the mortality by fever and childbirth are undisturbed as they occur at
ages near the mean age of the living population. The constitution of
the population has to be taken into account in comparing the deaths by
small-pox in England with the deaths from the same disease in Sweden,
France, or countries where the population is nearly stationary.
(Supplement to 35th Annual Report, pp. xxxvi-vii.)

Effect of the Extinction of any Disease on the Duration of Life—
Whoever has lost a friend, a brother, a son by any disease will feel that
its extinction would be a boon to mankind which no figures can express.
Something, however, can be calculated, and that is the effect of the
suppression of any disease on the duration of life. Some diseases are
fatal to infants, some to youths, some to men in the flower of life, some
to fruit-laden patriarchs; and while the three kinds of loss differ in
degree, and differ in the economic effects, they differ also in their effects
on the mean lifetime.

The mean lifetime, it will be borne in mind, is found from a Life
Table, which shows how many of a given number born live through each
year of age, and what is the sum of the number of years they live; the
sum of these years divided by the lives is their mean lifetime. Thus
by the English Life Table 1,000 persons live in the ageregate 40,858
years; and their mean lifetime is 40°858, nearly 41 years. Of their
310 [PART IV.

number 503 live to the age of 45; and after that age they live 11,771
years, so their mean after lifetime at 45 is 23-4 years. ‘This is often
called the expectation of life. The given age plus the mean after
lifetime is the mean age at which they die.

And it is evident that in judging of the effects of the suppression of a
single disease three cases have to be considered: (1) The whole of the
lives will die of the other diseases in no greater proportion than before ;
(2) those other diseases, such as scarlet fever and measles, will grow so
much more fatal, as to make up by the loss on this head for the gain on
the other, say small-pox ; (3) the gain by the supercession of one disease
will exceed the loss by the increment of others; or the reverse; so as
to result in a partial gain or a partial loss.

It will be convenient to consider first the cases to be, by hypothesis, of
the first class; where, as for instance, when men are saved from a
violent death they live as long as other people, and the rest of the
community remain as they were. Thenif the diseases suppressed are
such as are fatal in the first vear of life, for example, such as the debility
and atrophy from premature birth or other causes, convulsions, bronchitis,
pleurisy, pneumonia, and diarrhea fatal soon after birth; then instead
of 149,493 dying in the first year, 101,147 of that number will live
through the year unless they are carried off by other diseases, Assume
for a moment that this will result in an addition to the years lived by
the million born, of the years lived by 100,000 average lives saved, then
the mean lifetime will become instead of 40°9 years, that number of
years augmented by a tenth more or 45°0 years.

Now take any other disease in the end fatal to one tenth of the living
at the age of 55, and assume that by some expedient, medical art can
prevent any death from it after that age, and what will be the effect on
the after lifetime ? It will evidently only add the years that a number
of persons of that age and upwards live when they are subject to no
attacks of the suppressed malady. No effect is produced in early life,
and no addition is made in this case to the years lived in manhood up to
the age of 55, so the expectation at birth is extended, but not greatly ;
whereas the full effect is felt by the men of the age of 55 and upwards.
They have an enemy the less to encounter through the whole of their
career to come.

There is a certain number of diseases that medical art hopes, for
various reasons, to prevent. Such are small-pox, measles, scarlet fever,
diphtheria, whooping-cough: some of these, if not of recent origin,
were not recognized by the ancients.

Small-pox is apparently referred to by Gregory of Tours (565-8) ;
and it is believed to have entered Europe through Arabia. The great
Rhazes, who died in the year 923, was physician to a hospital in Bagdad ;
and he first described measles and scarlet fever under distinct names, as
Sprengel shows, although the fact that he did so had been overlooked.
Avicenna places scarlet fever as a distinct disease between small-pox
and measles. Whooping-cough first appeared in France in 1414; and
Mezerai says it cost the life of every person it attacked. Something
very like syphilis had been known before; but true syphilis broke out
in the summer of 1493 almost simultaneously in every part of Hurope.*

 

* Sprengel’s Histoire de Ja Médicine, Ed. Littré, vols. 2,3. See pages in Index.
Rhazes on Small-pox and Measles, translated from the original Arabie by
W. A. Greenhill, M.D., 1858. This work of Dr. Greenhill well sustains the repu-
tation of English medical learning. Singularly enough Rhazes himself says that
the “excellent Galen” refers to “small-pox” four several times in his work; but
Dr. Greenhill makes it probable that Rhazes was misled by an erroneous translation
of the Greek term, pp. 141-2. :
DEATHS. | 311

Leprosy at the same time declined. Diphtheria is apparently of recent
birth. "No doubt the origin of these diseases, and of others of the kind,
is involved in as much obscurity as the origin of species; for they are
also propagated in men by low species of organic life. What is certain
is that they do not exist in every community; and that when they are
introduced among a virgin population they attack great numbers, as in
the instance of the small-pox among the Red Indians, the measles in the
Fiji Islands quite recently. The exclusion of the zymotic elements, if
it be complete, therefore saves free people from invasion.

But these diseases, as a general rule, attack the same person only
once in his life; and the great discovery that small-pox, for some reason
or other, when induced by art, assumes a milder form, led to the practice
of inoculation in the East, from which it reached England. But this
inoculated smali-pox was sometimes fatal; and it spread the disease by
infection, not in the modified, but in the pristine fatal form, To Jenner
and to England belongs the immortal honour of guarding mankind
against small-pox by cow-pox, which is neither fatal nor infectious.

No sooner had inoculation been introduced, than Daniel Bernoulli
(1760), with very imperfect data, undertook the solution of the problem*
now in hand: D’Alembert immediately attacked the hypotheses‘and the
arguments of Bernoulli in favour of inoculation: the controversy
showed the mathematical difficulties of the problem to be much greater
than was suspected. The whole question was discussed by Duvillard in
a work still classical in vital statistics, in which he endeavours to supply
the defective data by the resources of the higher analysis. He came to
the conclusion that vaccination would add 3°5 years to the existing mean
lifetime. t

As the mortality from all causes collectively, and from different
causes, at the several ages, is known in England, I propose to show
here how far the mortality is reduced by deducting from the general
mortality the mortality from phthisis, from cancer, and from ail
miasmatic diseases. And then a Tablef{ will show the number of
survivors out of a million births, in the absence of the deaths from these
three classes of causes. Precisely the same method is applicable to any
other class of diseases.

Diseases such as scarlet fever, that are exceedingly infectious, and
that attack the same life only once, will have attacked nearly every one
attaining the age of 35, and will leave afterwards very few susceptible.
Thus very few die at later ages of scarlet fever or measles, and scarcely
any of whooping-cough. These diseases have no sensible effect on the
expectation of life after young people are of age.

The labour of constructing and graduating Life Tables being con-
siderable, I have, to illustrate this question, employed the short method
I introduced in the Appendix to the Registrar-General’s Fifth Annual
Report. It is sufficiently exact for the purpose in hand.§

The male mortality for the years 1861-70 is used. The subjoined
extract. shows the rates of mortality inclusive, and exclusive of the
mortality by zymotic diseases, by phthisis, and by cancer.

The result is that if none of the males died of any zymotic disease—
Order I.—the duration of life would be raised, should they remain
subject to the existing rates of mortality from all other diseases.

 

* Analyse et Tableaux de ]’Influence de la Petite Vérole, par E. E. Duvillard.
Paris, 1806.

{ Duvillard’s Table, derived from what he ealls the Law of Mortality (in France)
in the natural state, makes the mean lifetime 28°763; whereas it would be 32°256
if no one died of small-pox. See page 143, where he states that the cessation of
small-pox would raise the population from 28,763,192 to 32,255,775.

{See Supplement to_35th Annual Report, p. clxix, Table 60.

§ See extract on pp. 465-7.
312 [PART Iv-

Of the 510,622 boys born, no less than 411,350 wili live to the age of
5; 408,871 to the age of 10; 343,674 to the age of 35; the mean after
lifetime at birth would be raised from 39°68 to 46°77.

Applying the same method to the effect of the suppression of phthisis,
which produces its maximum effect later, the mean after lifetime at
birth is raised to 42°96, at 35 to 30°77.

The suppression of cancer would raise the mean after lifetime at birth
to 39°88; at the age 35 to 29°01; at the age 55 to 16°25.

The same method will show the effect of tle suppression of any other
disease,

Small-pox is the only disease which can practically be superseded to
a great extent by a disease itself not mortal. But the opponents of
vaccination contend, that so far from leaving other diseases as they were
it increases their rates of mortality. Of course, as more live more are:
attacked by other diseases; but this proves nothing, so long as the lives
saved from small-pox only die from other diseases in the same proportion.
as the rest left before small-pox reigned. There can be no doubt that
cow-pox is a variety of small-pox, and is induced by transmitting small-
pox lymph through the cow. Small-pox, if not fatal, does not exempt
any one from measles or scarlet fever. To contend that small-pox in its
severe form, if it do not kill the patient, renders him less, while the
milder form renders him more, susceptible of other diseases, derives no.
support from analogy.

Efforts should be made to reduce all the contagious recurrent diseases.
to a minimum, by placing the whole population in as favourable a
sanitary condition as possible, so that these diseases may be taken, as
they are then, in the mildest form. The effect of favourable sanitary
conditions is seen in the healthy districts, from which neither measles
nor scarlet fever are excluded. They are both less fatal.

The Lire Taste Deatus to 1,000,000 CuitpReN born alive are—

 

 

In Healthy :
—- Districts. In England. | In Liverpool.
From Small-pox 2,359 6,521 8,141
» Measles 6,912 12,865 26,973
yy Searlatina 2 21,403 30,021 38,302
» Whooping-cough - — - 10,234 15,161 34,021
» Fever (Typhus, Enteric,
and Sealey ? } 28,146 38,107 76,563

 

 

 

 

If every child is attacked by scarlatina at some time of life, then there
are 1,000,000 cases, and by the English Life Table 30,021] deaths: so
the mortality of the cases is 8 per cent. The mortality of cases is at the
rate of 2 per cent. in the healthy districts; 4 per cent. in Liverpool.
This is the minimum mortality of cases, for thousands die young of other
diseases before they can be attacked by scarlatina. By measles,
whooping-cough, and fevers (typhus, typhoid, and typhinia) the variation
of mortality is still greater in healthy and unhealthy conditions.

Dr. Watt showed that while the sanitary conditions of Glasgow were
deplorably defective, the exclusion of small-pox had not the effect of
reducing the general mortality ? as in those years the fatality of other
diseases increased.* And further observations tend to show that healthy

 

* See Registrar-General’s 30th Annual Report, Appendix, p. 213, and Treatise on
Chin-cough, by Robert Watt, M.D. (1813), pp. 875-9.
°

DEATHS. | 318

sanitary condition as to food, drink, and cleanliness of person, house, and
city, stands first in importance; after it, but subordinately, come
quarantine, vaccination, and other preventives, as means of subduing
mortality ; for the mere exclusion of one out of many diseases appears
to be taken advantage of by those other diseases, just as the extirpation
of one weed makes way for other kinds of weeds in a foul garden.

The effect on the lifetime of extinguishing each separate disease in
England may be determined by the same method, from Tables giving
the deaths of males, and of females, from every cause of death
distinguished in the tabular returns for the 25 years 1848-1872.

The effect of the subtraction of the early fatal zymotic diseases, and of
phthisis, fatal in middle life, is to leave greater numbers alive at the
advanced ages,—greater numbers therefore to die of the diseuses attendant
on advancing age. As fatal consumption is developed later in life than
scarlatina,* so cancer sets in after consumption . thus we find that of a
million born in the healthy districts, 21,403 die of scarlet fever, 108,481
of consumption, and 27,495 of cancer: whereas out of the same number
in Liverpool, 38,302 die of scarlet fever, 96,676 of phthisis, and 9,992
of cancer. In Liverpool, and in the unhealthy districts, the children do
not live to encounter the diseases of old age. As men die everywhere,
the great difference consists in this—that in one set of circumstances a
small part, in another a large part, of the cycle of life is accomplished.
(Supplement to 35th Annual Report, pp. xxxviii—-xli.)

Economic effect of Deaths by different Diseases—Life has a
pecuniary value. In its production and education a certain amount of
capital is sunk for a longer or shorter time, and that capital, with its
interest, as a general rule, reappears in the wages of the labourer, the
pay of the officer, and the income of the professional man. At first it is
all expenditure, and a certain necessary expenditure goes on to the end
to keep life in being, even when its economic results are negative.

The value of any class of lives is determined by valuing first at birth,
or at any age, the cost of future maintenance, and then the value of the
future earnings. Thus proceeding, I found the value of a Norfolk
agricultural labourer to be 246/. at the age of 25: the child is by this
method worth only d/. at birth, 562. at the age of 5; 117/. at the age of
10; the youth 192/. at the age of 15 ; the young man 234/. at the age
of 20 ; the man 246/. at the age of 25, and 2414. at the age of 30, when
the value goes on declining to 138/. at the age of 55, and only 1J. at the
age of 70; the cost of maintenance afterwards exceeding the earnings,
the value becomes negative ; at 80 the value of the cost of maintenance
exceeds the value of the earnings by 41/. These values may be compared
with the former cost of slaves in Rome, in the United States, and in
the West Indies.

The amount of capital sunk in the education of professional men is
not only greater, but it is probably at greater risk, and it has to remain
longer under investment before it is returned. The maximum value
of such a man is attained later in life, probably 40; and in the highest
orders of the church, law, and politics, where experience and great
weight of character are requisite, the life still increases in value at higher
ages.

The causes that destroy the greatest number of lives in their prime —
and are therefore first in importance—are fever, consumption, violence ;
plagues, cholera, and war, where they prevail. Small-pox, too, where

 

* Phthisis and scarlatina are synonyms of consumption and scarlet fever.
Scarlatina was used in the Office Tables until the year 1869, when scarlet fever was
substituted for it.
314 [Part IV.

there is no vaccination, is fatal to large numbers of grown-up people.
Many Englishmen are drowned at sea; and this will be considered here-
after, for it is only one example of the deaths of men resulting from
their pursuits, not only in the army and navy, but in civil life.

The greatest occupation of women, as on that the continuance of the
human race depends, is at the prime of life,—zhildbirth, childbreeding ;
up to that time all their force accumulates. Of a million children born,
488,255 of them being girls, 6,921 will die of childbirth, They die at
the average age of 32. If this generation exactly reproduces its own
numbers, it gives birth to a million children, neither more nor less; but
it does more than this, for the births in that case would be 144 to 1
death from childbirth, whereas the facts show that the mortality in
childbirth is in the proportion of 1 mother to 211 children born alive.
Consequently the 6,921 deaths of mothers imply that this generation
represented in the Table gave birth to 1,458,190 children to constitute
the generation to follow. The increase of numbers thus deduced is
4°58 per cent. in 32 years, or 1°18 per cent. annually.

If English women only bore children enough to keep the population
stationary, the tabular deaths by childbirth would be 4,746 instead of
6,921; so 2,175 devoted mothers die of what some might call overwork ;
but it is work by which new nations are founded. And happily it is
work the dangers of which can be incalculably diminished by medical art.

Enough has been established to prove the supreme importance of
making renewed efforts to save the most precious of precious lives from
fever, consumption, cholera, violence in all its forms, and childbirth.
(Supplement to 35th Annual Report, pp. xli-ii.)

Statement of the Particulars published from Year to Year in the
Registrar General’s Aunual Reports in connection with the ABSTRACTS
of Causes of Deata in ENGLAND and Wates, 1837-75.

 

No. of
Registrar
General’s | YEAR, PARTICULARS PUBLISHED.

Annual

Report.

 

1st. 1837 | Causes of Death of Males and of Females without distinction of Age in
England and_in 25 Territorial Sub-divisions, from 1st July to 31st
December. Causes of Death in Town and Rural Districts compared.
Deaths from Epidemical Diseases in first and second quarters in
Districts where these Diseases principally prevailed.

2nd. 1838 | Causes of Death of Males and of Females without distinction of Age in
England and m 25 Territorial Sub-divisions. Causes of Death in Town
and Rural Districts compared, Deaths from Classes of Diseases in 11
Divisions. Causes of Death of Persons in 324 groups of Districts and
in 11 Divisions.

8rd. 1889 | Causes of Death of Malesand of Females without distinction of Age in
England and in 25 Territorial Sub-divisions. Causes of Death at
different Ages (0, 1, 8, 5, 10, 15, 20, and decennial Ages up to 100) of

*Males and of Females in Manchester, Liverpool, and Birmingham.
Deaths of Males and of Females from Classes of Diseases in 11 Divi-
sions. Causes of Death of Persons in 324 groups of Districts and in
11 Divisions.

4th. 1840 | Causes of Death of Persons in England in each of three years 1838-40.
Causes of Death of Males and of Females in England, in 11 Divisions,
and in Counties (for Persons_only in London). Causes of Death of
Persons in 324 groups of Districts. These abstracts are without
distinction of Age.

5th, 1841 | Causes of Death of Persons, of Males, and of Females without distine-
tion of Age in England and in 11 Divisions (for Persons only in Lon-
don) ; and of Males and of Females in Counties and in 3824 groups of
Districts, Causes of Death of Males and of Females in combination
with Ages (0-1, 1-3, 3-5, 5-10, 10-15, 15-20, aud decennial Ages up to 90
years and upwards), in 24 Town Districts in the year 1840. Deaths
from Small-pox, Measles, Scarlatina, and Typhus in each quarter of
1841 in Divisions, Counties, and 324 groups of Districts.

 

 

 

 

 
.

DEATHS. | 815

Sraremenr of the Particulars published from Year to Year in the
Registrar General’s Annual Reports in connection with the ABSTRACTS
of Causes of Deara in Encianp and Watss, 1837—75—continued.

 

 

 

 

No. of
Registrar
General YEAR. PARTICULARS PUBLISHED.
ual
Report.
6th. 1842 | Causes of Death of Persons, of Males, and of Females without distine-
tion of Age in England, and of Males and of Females in 10 Divisions
(London not given in this Table), in Counties and in growns of Dis-
tricts. Deaths from Small-pox, Measles, Scarlatina, and Typhus in
each quarter for 1842, as in previous Report. Causes of Death in each
of the years 1833-42, and Annual Mortality from each Cause to
1,000,000 Persons living. Violent Deaths in 11 Divisions, clissified
according to Occupations, Nature of Violent Death, and Age. eee
1843)
rth, (a) ; |
1844 :
. +| The Causes of Death were not abstracted for England in these Years.
8th. 1845 |
9th. 1846.

(a) In the 7th Report were published the Causes of Death in each of the years 1838-42, as
in previous Report; also Causes of Death of Males and of Females without distine-
tion of Agein grouped Districts of Kent; ani Causes of Death, in combination
with Ages, of Males and of Females in the county of Kent (Ages 0, 1, 2, 8, 4, 5, and.
quinquennial Ages up to 100).

10th. 1847 | Causes of Death of Males and of Females in combination with Ages (0,
1, 2, 3, 4,5, and _quinquennial Ages up to 95),in England and in 11
Divisions (107 Causes of Death). These are the first Abstracts of Ages
and Diseases for all England.

11th, 1848 | Causes of Death of Males and of Females without distinction of Age in
England in 11 Divisions, and in Counties.
12th. 1849)

18th. 1850
14th, 1851
15th. 1852,
16th. 1853 | Ditto,and Specimen Table of Causes of Death and Ages of Females in

Englaud, classified according to the arrangement proposed b:
Dr. Farr to the Statistical Congress. \ P y

Same Tables as in Report for 1848.

17th. 1854 | Same Tables as in Report for 1848.

18th. 1855 | Causes of Death (107) of Males and of Females, in combination with
Ages (0,1, 2, 3, 4, 5-10, 10-15, and. decennial Ages up to 95), in England.
Diseases, without distinction of Age, of Males and of Females in Eng-
land in 11 Divisions and in Counties. Supplementary Table for
England of certain Causes of Death of ‘Mules and of Females at
different Ages, classed for sake of abbreviation under some of the 107
heads in the Grand Table, but which are nevertheless distinct Causes
of Death, though fatal to few persons. Causes of Death, ix combina-
tion with Ages, of Males and of Females in England in the 7 years
ee ae in each of those years (Causes of Death and Ages the same
as for 1855).

19th, 1856 | Causes of Death of Males and of Females, in combination with Ages, in
Ene lant Causes of Death without distinction of Age in England in
11 Divisions and in Counties. Supplementary Table for England, as
in previous Report. The Table of Deaths from several Causes (chiefl
zymotic diseases) in Divisions, Counties, and Districts was publishe
for the first time in this Report,and has been continued in all
subsequent Reports.

20th-38th, | 1857 | The arrangement adopted in the Report for 1856 has been adhered to up

and to the present time, excepting that a new classification of Causes of
1858-75.; Death was introduced in the 2lst Report for 1858; and in that for
1859 the group of Ages 15-25 was divided thus : 15-20, 20-25, The same
classification, with slight variations, of Causes of Death in combination
with Ages was published in all subsequent, Reports, until that for
1880, inclusive. In the Report for 1881 considerable changes in the
classification of Diseases were introduced.

— 1869 / The new nomenclature of Diseases by the Committee of the College of
Physicians was distmbuted gratis among the legally qualified medical
practitioners, and among the registrars, of England and Wales.

 

 

 

 
316 [PART ly.

SrateMENT of the Particulars published from Year to Year in the
Registrar General’s Annual Reports in connection with the ABsTRACTS
of Causes of Deatu in Enaranp and Wates, 1837-75—continued.

 

 

No. of
Registrar
General’s | YEAR. PARTICULARS PUBLISHED.
Annual
Report.
36th. 1873 | A Table was published of the Deaths by different Diseases in England
classified according to the new nomenclature. It includes Deaths for |,
the years 1866-73, and the series has since been continued.
88th. 1875 | In this Report the Supplementary Table of certain Causes of Death,

explained above in connection with the 18th Report for 1855, will be
found incorporated with the Grand Tadle for England and Wales.
The numerous diseases hitherto forming the Supplementary Table are
now generally bracketed with those allied Diseases, the names of
which were, for sake of brevity, intended to include them. In the
oe of oe and Counties, however, the classification remains
unaltered.

 

 

 

 

 

 

Note.—The deaths from scarlet fever and diphtheria were separately returned in 1855, having
been previously to that date shown under the heading of scarlatina. The various forms of fever
were not distinguished until 1869, but were all included under “typhus.” In the Report for
that year and in subsequent Reports, the deaths from fever were classified under the three
distinct forms of typhus, enteric, and simple continued fever.

Lonpon.—StaTemMEnT of the Particulars published from Year to Year
in the Registrar General’s Annual Reports in connection with the
Apstracts of Causzs of Deatu in Lonpnon, 1837-75.

 

No. of
Registrar
General’s | YEAR. PARTICULARS PUBLISHED.

Annual

Report.

 

1st. 1837 | Causes of Death of Males and of Females without distinction of Age
tom es July to 31st December. Deaths from Epidemical Diseases in
istricts.

and. 1838 | Causes of Death of Males and of Females without distinction of Age, and
ditto in Districts. Causes of Death of Males and of Females in London
and in rural Counties compared.

3rd. 1839 | Causes of Death of Males and of Females without distinction of Age,
and in combination with Ages, for the Hospitals. Table of Causes of
Death in each of 52 weeks, 1840, and Table of Causes of Death in com-
bination with Ages (0-15, 15-60, 60 and upwards) in each week May
1840 to May 1841 (reprint from Weekly Tables). Causes of Death of
Persons in Districts.

4th. 1840 | Causes of Death of Persons in each of the three years 1838-40, from sum-
mary of 52 weeks. Causes of Death and Ages for Hospitals. Causes
of Death of Persons in the two years 1840-41, at the Ages 0-15, 15-60,
60 and upwards.

5th. 1841 | Causes of Death of Persons from summary of 52 weeks, adjusted. Causes

of Death and Ages (0-1, 1-3, 3-5, 5-10, 10-15, 15-20, and decennial Ages

up to 90) of Males and of Females in each of the four quarters of 1842,

and similar Table for the whole year. Causes of Death at Ages 0-15,

Aer 60 a upwards, in the two years 1849-41. Summary of Weekly
‘ables, 1842.

6th. 1842 | Causes of Death of Persons without distinction of Age.

1943 | Causes of Death and Ages of Males and of Females (Ages 0, 1, 3-5, 5-10,
10-15, 15-20, and decennial Ages up to 90). :
7th.
1844 | Causes of Death of Males and of Females (same Ages as in previous
Report), 52 weeks.

8th. 1845 | Causes of Death of Males and of Females (Ages 0,1, 2, 3, 4, 5, and quin-
gennial Ages up to 95), 52 weeks. Ditto for the year 1846.

 

 

 

 
DEATHS. | 317

Lonpon.—StTatTemMeEnt of the Particulars published from Year to Year
in the Registrar General’s Annual Reports in connection with the
AxBstTRacts of Causes of DeaTH in Lonpon, 1837-75—-continued.

 

 

No. of
Registrar
General's | YEAR. PARTICULARS PUBLISHED.
Annual
Report.
9th. 1846 | Causes of Death of Persons without distinction of Age in cach quarter
of each of the years 1840-47.
10th. 1847 | Causes of Death (107) of Malesand of Females in combination with Ages

(0, 1, 2, 3, 4, 5, and quinquennial Ages up to 95).
11th. 1848),

12th, 1849

18th. 1850

14th. 1851 +| Same particulars as in Report for 1847.
15th. 1852 |

16th. 1853 |

17th. 1854)

18th. 1855 | Causes ‘of Death (107) of Males and of Females in combination aith
Ages (0,1, 2,2, 4, 5-10, 10-15, and decennial Ages up to 95).

19th. 1856 | Causes of Death of Males and of Females in combination with Ages.

20th-88th. | 1857 | The arrangement adopted in the Report for 1856 was adhered to up

and to 1880, inclusive, excepting that a new classification of Diseases

1858-75.) cumprising Classes and Orders was introduced in the Report for 1858;

and in that for 1859 the group of Ages 15-25 was divided thus : 15-20,

20-25. The same classification, with slight variations, of Diseases in

combination with Ages was published in all subsequent Reports up to

and inclusive of that for 1880. In the Report for 1881 considerable
changes in the classification of Diseases were introduced.

 

 

 

 

 

Note.—The first Weekly Table for the Metropolis appeared for the week ending Saturday,
the 11th January 1840. This publication, with numerous improvements, has been continued
ever since. From 1840 to 1850, inclusive, the ceaths classified according to diseases, were
obtained for the Annual Reports from the 52 or 53 weeks of each year; in 1851 and in subsequent
years, however, the deaths were abstracted a second time for the Annual Reports.

(38th Annual Report, pp. 272-4.)

6.—Cavusres or DeatH: Epmemic, Inrectious, anp Zymoric
DISEASES.

Laws of Epidemics.—Epidemics appear to be generated at intervals
in unhealthy places, spread, go through a regular course, and decline; but
of the cause of their evolutions no more is known than of the periodical
paroxysms of ague. The body, in its diseases as well as its functions,
observes a principle of periodicity ; its elements pass through prescribed
cycles of changes, and the diseases of nations are subject to similar
variations.*

 

* The hypothesis that the causes of epidemics are generations of minute insects
transmitted from one individual to another, through the medium of the atmosphere,
has been ingeniously put by Dr. Holland in his “ Medical Notes and Reflections.”
Henle, of Berlin, has supported the theory by new facts and analogies. The diffusion
of contagion has a close analogy with fermentation; and Cagnard-Latour and
Schwann have shown that fermentation is the decomposition of organic fluids by
minute vegetables of the lowest class. Putrefaction is a destruction of organic
matter effected by infusoria, and not a mere decomposition into elements. Qne
contagious disease, the muscardine of the silkworm, is known to depend on the
development of a vegetable parasite. The germs are innumerable, and spread with the
greatest rapidity. In mixtures, certain genera of infusoria appear, and then give
318 [PART IV.

If the latent cause of epidemics cannot be discovered, the mode in
which it operates may be investigated. The laws of its action may be
determined by cbservation, as well as the circumstances in which
epidemics arise, or by which they may be controlled.

Amidst the apparent irregularities of the epidemic of small-pox, and
its eruptions all over the kingdom, it was governed in its progress by
certain general laws. The deeths in the early stage of the epidemic
were not registered. To avoid circumlocution, it will be convenient to
call the ten quarters in which the deaths were registered the ten periods,
the first quarter the first period, the second the second period, &c. &c.
The mortality increased up to the fourth registered period; the deaths
in the first were 2,513, in the second 3,289, in the third 4,242; and it
will be perceived at a glance tbat these numbers increased very nearly
at the rate of 30 percent. For, multiply 2,513 by 1°30 and it will
become 3,267 ; multiply 3,267 by 1°80, and it will become 4,248. The
rate of increase is retarded at the end of the third period, avd only rises
6 per cent. in the next, where it remains stationary, like a projectile at
the summit of the curve which it is destined to describe.

The decline of the epidemic was less rapid than its rise, and the
mortality was somewhat greater in the autumns of 1838 and 1889 than
in the semmers. But by taking the’ mean of the deaths in the third
and fourth period, the mean of the deaths in the fourth and fifth period,
&e., &., a regular series of numbers is produced.

Deatus observed in the decline of the Epidemic.

1 2 3 4 5 6 1
4,365 4,087 3,767 3,416 2,743 2,019 1,631
DeaTHSs in a regular series.

1 2 3 4 5 6 7
4,364 4,147 3,767 3,272 2,716 2,156 1,635

The 4,365 may be considered to represent the deaths that happened
between the middle of February and the middle of May. The regular
series of numbers has been calculated upon the hypothesis that the fal]
of the mortality took place at a uniformly accelerated rate.

The calculated numbers are sometimes a little too high, and sometimes
too low ; but, on the whole, the agreement is remarkable. The second
number (4,147) is nearly 5 per cent. lower than the first; and the
decrease is successively 5, 10, 15, 20, 26, and 32 per cent. The rates
of decrease are 1°052, 1°101, 1°152, 1:205, 1°260, 1°318. ‘The
division of 4,364 by 1°052 reduces it to 4,147; the division of 4,147, by
1°101 produces 3,767, &c. The mortality decreased at accelerated
rates; and the rate of acceleration was 1°046, which, by successive

 

place to new genera. Individual cases of disease may be caused by one generation
of parasites ; an epidemic by successive generations. Each epidemic disease bas its
specific animal contagion, its specific genera of infusoria. Henle has proved the
existence of this cause, and the truth of the theory in every way but one; he has
never seen the epidemic infusoria. The omission is, no doubt, important; and the
more so on the part of Henle, who is justly considered one of the best microscopic
observers in Germany. ‘The infusorial hypothesis does not satisfactorily explain the
cause of epidemics; it accounts for them by the creation of animalcules, but does
not show why the animalcules are created at distant times in swarms, The
phenomena of swarms of insects, of blight, and of infusorial generation, may suggest
investigation ; but in the present state of pathology they cannot supply its place—
Pathologische Untersuchungen. Von Dr. Henle, Berlin, 1840. British and
Foreign Medical Review, April, 1840.
DEATHS. | 319

multiplications, will reproduce all the rates, 1052, 1°101, &., &¢. The
rate 1°046 may be called the constant.

The mortality from small-pox was greater in the metropolis than in
all the other parts of England: and the rate of increase in the second,
third, and fourth periods was 1°50, the deaths having been 506, 753,
and 1,145. The rate of increase in the first and second periods was
1:97, the deaths were 257 and 560.

The decline of the epidemic in the metropolis is shown by the following
numbers :—

METROPOLIS.
1 2 3 4 5
1. Mean quarterly Deaths
registered = 1,103 959 611 240 91
2. Calculated series - 1,108 967 611 278 91

The number 1,103, in the upper line, was the mean of the deaths
registered in the fourth and fifth periods; 959 was the mean of the
deaths in the fifth and sixth periods; the other numbers were obtained
in the same manncr. The first rate of the calculated series was 1°14,
and the other rates were obtained by multiplying 1:14, four times in
succession, by 1°39, the constant.

I subjoin one more comparative series, deduced by the same
methods :—

Watts and the WEsTERN CouNTIES of ENGLAND.

2 3 4 5 6 7 8

7
1. Mean:quarterly } ans 813 621 489 304 194 116 81

Deaths registered
2. Calculated series 1157 858 621 440 304 206 1386 88

The first rate was 1°35; the constant, 1°023.

The rates vary with the density of the population, the numbers
susceptible of attack, the mortality, and accidental circumstances ; so
that to obtain the mean rates applicable to the whole population, or to
any portion of the population, several epidemics should be investigated.
It appears probable, however, that small-pox increases at an accelerated
and then a retarded rate ; that it declines first at a slightly accelerated,
then at a rapidly accelerated, and lastly ut a retarded rate, until the
disease attains the minimum intensity, and remains stationary. The
degrees of acceleration, and certain corrections, have been neglected in
the previous calculations, and the neglect of them produced a little
Giscrepancy between the observed and calculated facts; but it may be
well to give one example in which all the corrections are made.

The quarterly rate of mortality by small-pox is obtained by dividing
the deaths in a quarter by the population existing in the middle of the
quarter ; by dividing 4364, for instance, by the population of England
on the 31st March, 1838. The annual rate of mortality is expressed by
four times the quarterly rate (‘00028 x4=:'00112, the annual rate of
mortality by small-pox). The quarters vary in length, from 90 to 92
days ; their mean duration is 91} days; and to be strictly accurate, the
mortality of the March quarter must be raised in the proportion of 90°5
to 91:25. The rates of mortality in England in the following table
have been corrected in accordance with these principles.
320 [PART Iy.

SMALL Pox.

 

1838. 1839.

 

March a| June m0, | Sept. 30. | Dec. 31, | March 31.) June 30.

 

Annual rate of mortality per
cent. in England (observed) “114 "105 “096 “086 *070 *051
Annual rate of mortality per
cent. (calculated) - - “lt 105 “096 “086 “070 “050

 

 

 

 

 

These two series of numbers exactly agree; the rates of decrease in
the six periods were 1°08, 1:09, 1°11, 1°24, and 1°39. The first
three were produced by multiplying by 1°011, the two last by 1°12.
The first constant 1°011, extended over the year 1838; the second,
nearly the tenth power of the first, over the first half of the year
1839.

The small-pox would be disturbed, and sometimes arrested, by vacci-
nation, which protected a part of the population, and by inoculation,
which there is reason to believe led to the extension of the epidemic
by diffusing the infection artificially —(2nd Annual Report, pp. 95-8.)

Cause and Effect of Zymotic Disease—To prevent the ravages of
zymotic diseases we have to go beyond their pathological phenomena ;
and it must be recollected that every death represents several occurrent
‘cases, varying with age, with hygienic condition, and with medical treat-
ment. The exact determination of the factors of mortality in the
several types of disease lies at the foundation of therapeutics, yet it has
been strangely neglected. The new Clinical Society might well take
this in hand. To illustrate what is here meant Dr. Murchison shows
that in the ten years, 1848-57, at the London Fever Hospital the
mortality of cases of continued fever was at the rate of 10 per cent. at
the age of 15-25, and 15 per cent. at the age of 25-35; so to 10 and to
15 deaths at the two ages there were 100 cases of fever. Proceeding
further in the analysis of the three forms of such fever he shows that
the mortality from typhus at the same two ages is 7 and 16, from enteric
fever 18 and 22, from relapsing fever next to nothing. ‘That is in the
London Fever Hospital.* The rates vary in private houses according
to the condition of those houses; and we may assume that the danger
varies under different lines of medical treatment. Here is a wide field
for interfering with the operation of pathological causes of death. It is
the great function of the medical profession. They arrest, they render
zymotic diseases less lethal by drugs, diet, and hygienic regulation. The
force Physic has at its command is undetermined, but it will increase
as the science and the art increase, and as the distribution and the
organisation of the profession are improved.

Intermittent and remittent fevers are known to be generally induced
by marshes. Dr. Salisbury endeavours to trace ague to the pollen of a
palmella. Whatever tie direct agent may be we know that the danger
from these diseases is obviated in two ways; (1) by avoiding marshy
tracts altogether, and (2) by draining and converting the marshes into
cultivated land, as has been done partially in England. On the
the undrained lands of the lower valleys of the Thames and of other
English rivers, where their waters are slow, sluggish, thrown out of
their channels by milldams, thousands of the population suffer from ague,
rheumatism, and neuralgia, while many die of these and of other diseases.
Drainage of the marsh land, removal of obstructions to rivers, and

 

* Murchison on Fever, pp. 221, 369, and 531.
DEATHS. | 321

engineering improvements of the water channels, will obliterate countless
evils.

The mere aggregation of people together in close apartments generates
or diffuses the zymotic matter. Thus, place lying-in women in close
proximity to each other, or mix them up with the patients of a general
hospital and they die of puerperal fever; place many wounded men in a
ward where cleanliness is neglected, and erysipelas, pyzemia, gangrene
spring up; imprison men within narrow walls, or crowd them in rooms
and typhus breaks out. The general and special hospitals of the
country have been, until quite recently, erected without any special
reference to the dangers accruing from the assemblage of great masses
of sick people within the walls of one building, so that the efforts of the
most skilful medical officers are frequently defeated; but a better
system of hospital construction, with more cubic space, is likely to
prevail, with due provision for effective changes of air, and then the evils
of agglomeration will be mitigated. It is only recently that the subject
has attracted the attention of surgeovs,* who will no doubt anxiously
watch the results of the new arrangements. Sir Henry Thompson and
Sir James Simpson will, we may hope, continue their researches so
as to determine accurately the mortality after the various kinds of
amputation in hospitals and in private houses.

To limit the operation of zymotic diseases overcrowding in towns must.
be absolutely prohibited: the mere accumulation of masses of living
people within narrow limits either generates or insures the diffusion of
epidemic disease. The plague which almost destroyed Athens was
aggravated by the policy of Pericles when he brought the outlying
country population within the walls. It is now as then a conflict of
difficulties ; for the question arises, where can the people live if you
turn them out of cellars or garrets; and the alternative is in appear-
ance cruel. But asa healthy city of a limited number of inhabitants
enjoys life and fulfils the destiny of its race, while a crowded,
suffering, sickly, degenerated city of twice the population only drags on
a wretched existence in violation of the principles of life and the
operations of nature, laws against over-crowding musi be rigorously
enforced.

SMALL-POx.—To render the body insusceptible of one zymotic disease
of a disfiguring and distressing nature is in itself a good thing, and there
is no evidence to show, nor is it likely, that pure vaccine lymph induces
any other disease than cow-pox. The number of deaths due to vacci-
nation is inconsiderable. It bears no comparison with the number of
deaths by natural small-pox. And the opposition to vaccination on any
of these grounds is irrational.

It is, however, by no means proved that the general mortality under
unfavourable sanitary conditions is much reduced by rendering a child
insusceptible of one type, while he remains exposed to all other types of
zymotic disease. This was clearly poiuted out in a remarkable treatise
by Dr. Robert Watt, lecturer on the theory and practice of medicine in
Glasgow. ‘The work was dedicated to Sir Gilbert Blane. Dr. Watt

 

* Sir Astley Cooper, in his lectures as reported in the Lancet, refers to cold and
other causes of gangrene, but has no reference, as far as I can find, to its origin in
the poison of hospitals. Under erysipelas this passage occurs : “In hospital practice
surgeons were “formerly exceedingly afraid to operate in autumn and spring, for it
“has often happened that the stimulating effects of udhesive plaster have produced
“ this disease, and have led to the death of the patient. Sometimes it is epidemic
** and sometimes contagious.” Lancet, Vols. I., IL. edited by T. Wakley, surgeon,
1826, p. 247. Pyamia is not referred to specifically by the great surgeon.

x
322 [PART Iy.

found that, in accordance with his own experience, the Glasgow burial
registers showed a decisive decline of the deaths by small-pox after the
introduction of vaccination. His researches extended over the 30 years
1783-1812,* which he divided into five equal periods of six years each.
In the first three periods (1783-1800), before “ vaccination could have
“‘ had any influence,” the deaths by small-pox in 100 deaths from all
causes were 20, 18, 19; in the fourth period (1801-6), vaccination had
nearly reached its inaximum, and the deaths by small-pox fell to 9; in
the fifth period (1807-12), when vaccination had “been pretty fully
“established, perhaps as much so as in any other city in the empire,” the
proportion fell to 4. ‘Lhis gratifying result was to some extent counter-
balanced by a slight increase in the proportion of deaths by whooping-
cough, and a great increase in the deaths by measles. What was still
more strange, Dr. Watt found that the proportion of deaths under
10 years of age, to the deaths at all ages, was rather greater in the last
than in the first 6 years. He does “not see the smallest ground for the
“ hypothesis that vaccination does positive harm” “by infusing some
“ peecant . . . . humor into the constitution.’ But in the first period,
“ when a third of all the deaths under 5 years of age were caused by
‘“* small-pox,” a child had the best chance of reaching its tenth year.
Dr. Watt was far from expecting this result. He had found that
“ more than 50 per cent. of the human species died before they were
“ 10 years of age,” and that 20 out of 100 born, excluding still-born,
“ perished by this dreadful malady.” t

This is an important. point in pathology; and it must be admitted that
although there were defects in his data Dr. Watt succeeds in showing
(1) that small-pox was one of the great causes of death in Glasgow
down to the year 1800, (2) that the deaths by small-pox were reduced
toa fifth of their original number by vaccination, and (3) that the
children died in nearly the same numbers as before, but of other forms
of disease.

Glasgow was then rapidly increasing, and it is possible that the births
were then increasing, the mortality is therefore less than it appears 1o
be by Dr. Watt's method. But this does not invalidate his induction.

* Appendix to Treatise on Chincough, by Robert Watt, M.D. (1813),
pp. 375-379.

¢ Dr. Watt describes vividly his astonishment, pp. 334-336 :—

“T began to reflect how different the case must be now! In eight years little more
than 600 had died of the small-pox ; whereas in 1784 the deaths by that disease
alone amounted to 425, and in 1791 to 607, which on both occasions exceeded the
fourth of the whole deaths in the year.

“To ascertain the real amount of this saving of infantile life, I turned up one of
the later years, and by accident that of 1808, when, to my utter astonishment, I
found that still a half or more than a half perished before the tenth year of their
age ; I could hardly believe the testimony of my senses, and therefore began to turn
up cther years, when I found that in all of them the proportion was less than in
1808; but still in taking an average of several years it amounted to nearly the same
thing as at any former period during the last 30 years. ‘This was a discovery I by
no means expected, and how it could have come to pass appeared to me
inexplicable.

“ From every circumstance which had come under my observation, the efficacy of
vaccine inoculation appeared certain. The experience of 13 years’ pretty extensive
practice had confirmed me fully in this opinion. But still the question recurred,
how are we to account for the same or nearly the same number of deaths under
10 years of age? As no new disease has appeared, the deficiency occasioned by the
waut of the small-pox must have been made up by a greater mortality among the
other diseases of children. Tas it been equally divided among them, or has a
greater share fallen to some than to others? [* An inquiry into the relative
“ mortality of the principal diseases of children in Glasgow. Appendix to Treatise
on Chincough, pp. 334-336. By Robert Watt, M.D, (1813).’’]

 
DEATHS. | 323

Glasgow has always been famous for its statistics, and these unfortu-
nately show an increase of the mortality of children. Thus in the five
years 1821-5 the mortality of boys under five years of age was 8°08, in
1831-5 it was* 9°78. In the year 1865 the mortality of boys in
Glasgow was 11°48, of girls 10°36.t These recent returns confirm
the principle. Small-pox is no longer so fatal as it was before vacci-
nation was introduced; in Glasgow it caused in the year 1854 no
longer 20 but 2 in 100 deaths; only 180 in 6,054 deaths, that is 3 per
cent. of the deaths under 5 years of age; yet the mortality of children
is certainly as high, probably higher, than it was in the last 18 years of
the last century.

The compulsory vaccination in England has reduced further the
fatality of small-pox, but since 1853 other diseases have so prevailed as
to counterbalance the gain under this head. The mortality of children
has not declined in a corresponding degree.

It is singular that Dr. Watt, evidently a practitioner of great sagacity,
and a philosophical professor of medicine, does not at all advert to the
wretched sanitary condition in which the increasing population of
Glasgow lived at the time he was writing. Yet a part of Glasgow, so
late as 1841, is thus described by McCulloch.t “It consists of a
“ labyrinth of narrow lanes or wynds, whence numbetless entrances lead
“ off to small squares, courts, or closes, which usually have a dungnill
[human] in the centre. These wynds and courts are formed of
old, ill-ventilated, and mostly dilapidated houses, varying from two
to four stories in height, without water, and let out in stories or flats ;
one of the latter often serving for the residence of twe or three
families. Frequently, however, the flats are let out in lodgings, as
many as 15 or 20 individuals being occasionally found huddled
together in a single room. . . . Filth, destitution, and misery prevail
to a frightful extent.” I cite this passage to show under what circum-
stances the suppression of a most fatal type of disease did not diminish
the mortality in Glasgow. And it is under unfavourable conditions of
the same kind, although less in degree, that the mortality is now
sustained in England, where the town populations constantly increasing,
without equivalent arrangements for drainage and for accommodation in
dwellings, are every year exposed to increasing dangers.

There are two diseases, scarlatina and diphtheria itself a new type
of disease, which have been exceedingly fatal since the year 1855,
when diphtheria was first distinguished in the returns. Up to 1857
it was apparently confounded with cynanche maligna; but in 1858
it became popular, and in that year 4,836 deaths, in 1859 no less
than 9,587 deaths were ascribed to diphtheria. In 1858 and 1859 the
deaths from scarlatina and diphtheria together were 30,317 and 29,494;
in the two years 1863-4 the deaths from the same causes rose to
36,982 and 85,164. The mortality in 1858-9, from small-pox, had
fallen to 3°35 and 1:97 annually in 10,000 living, while from scarlatina
and diphtheria the mortality had risen in the two years to 15°72 and
15°13. In 1863-4 the mortality from small-pox was 2°93 and 3°73,
from scarlatina and diphtheria 18°18 and 17-08, While small-pox
dwindled, these two zymotic diseases flourished at the expense of the
growiuvg population.

‘
rt

“
“cc
‘

6e
‘

«

a

 

* M’Culloch; Statistics of British Empire, Vol. II. p. 547. Lancet, 1825-6,
No. 12., paper by Mr. Edmonds.

ft Report by Dr. Stark, F.R.S.E., 10th Report of Registrar General of Scotland,
p. Xxxiy.

{ Geographical Dictionary, Vol. J. pp. 904-5, Art. Glasgow.
x 2
224 [PART Iv,

Small-pox, as a general rule, occurs only once in life; some children
enjoy immunity against attack ; they cannot be vaccinated, they cannot
be inoculated ; others are infected by the slightest exposure; and
under infection some take the disease slightly, some mwalignantly, fatally.
So it is with scarlatina, which now sweeps away a family of children,
and is then slight or even unperceiyed in other families during the same
epidemic ; epidemics, however, varying in intensity and character from
time to time, from place to place.*

It is impossible, in the present state of science, to reduce under any
simple law the phenomena of disease development; but disease
development is evidently associated with the life development of
species, and has with it some analogies. It is, for instance, found by
the English Life Table that of 1,000 children born alive, 708 live to
the end of the tenth year, 297 die in the 10 years of current life;
and the deaths, frequent at first, become less frequent as the age of
puberty is approached. The deaths run down ri tpidly from 149 in the
first year to 5 in the tenth year of life ; and they are the results of many
types of disease, springing up in a certain order. The rate of death is,
under the same conditions over a series of years, nearly constant.
There is a determinable law of morbility, as there is a determined law of
mortality,

While the living units of the generation have fallen in the proportion
of three tenths, their constituent elements have augmented by growth:
thus while, according to the determinations of M. “Quetelet, the weight
of 708 children of the age of 10 years is 17,702 kilograms, f the w eight
of 1,000 children at bir ‘th is only 3,055 kilograms ; and going back to
the ova, of which 1,000,000 would not be of the bulk of a cubic inch, or
still further to their germ cells and sperm cells, which are microscopic
points, we arrive at the elementary units of which these 1,000 live-born
children are the survivors. The embryo in its development is subject
to casualties which probably increase as we approach its origin. But
with this we have nothing to do. It contains in little elements which it
has derived from both its parents, and which will or may reproduce
their nature, the nature of their ancestors, and what is more immediately
to our present purpose, the diseases by which they perished. ‘To
explain various phenomena in repruduction hitherto inexplicable,
Mr. Darwin advances the theory of Pangenesis, in which he assumes
that all the organs of the parent are represented by gemmules in the
embryo.f It is a species of atomic theory in biology. Adopting the
hypothesis for the moment, let us suppose that certain gemmules or
corpuscles, or “ germinal matters,” are, in the system of a child, capable
of becoming the small-pox “ granulations” of Chaveau, alone or after
coalescence with the granulations of a small-pox patient, then it is
conceivable that their metamorphosis, having exhausted the material,
may leave the system insusceptible of any further invasion. The same
reasoning will apply to measles, scarlatina, typhus, and other types of
disease not recurrent.

 

* Sydenham describes simple scarlatina distinctly : he does not refer to the throat
affections, and says the patient can only die by the doctor’s default. Joseph Frank
describes the disease now as the most dreadful scourge in Europe. See Muladies
Geintes et maladies nouvelles, par C. Anglada, 1869, pp. 304-50.

f Quetelet sur Vhomme, Vol. II. p. 37, 1 kilogram = 2-2 Ibs. avoirdupois.

{ Animals and Plants under Domestication. Darwin, Vol. II., pp. 357-404.

§ Mr. Darwin gives a correct and succinct account of the current doctrine of the
functional independence of the elements of the body :—

* Physiologists agree that the whole organism consists of a multitade of elemental
parts, which are to a great extent independent of each other. Lach organ, says
DEATHS. | 825

The human frame is built up of molecules passing through the
evolutions which constitute the various phases of human life. But
these molecules are completely deranged by other molecules of lower
forms of life, such as the small-pox “ granulations,” variolads as they
may be named, which convert variable quantities of the substance of
the child’s body into their forms, to be finally transferred into pus or
into other corpuscles according as the child’s life survives or succumbs
in the struggle. Each zymotic disease is generated, we may conceive,
by species of living molecules, which may be of a twofold nature, bearing
some such relation to each other as the germ and sperm plasms of plants
and animals, and becoming proliferous after coalescence, give rise to the
various forms of epidemic disease. The danger of bringing great
numbers of people into close proximity is well known; it evidently
increases the chances of the coalescence, propagation, and diffusion of
the various active disease molecules.

The life of these zymotic generations is the death of the elemental
part of the human organism, and yet their development depends on its
existence. This to some extent limits epidemics. The black death
destroyed according to some accounts half the population of England;
and the very force of its zymotic principle destroyed the pasture on
which the death fed; it put an end to a mass of the people living; and
to this extent at least it diminished its own mass; it burnt up in
a few years its elements in those surviving; and it encountered other
organisations, whose career it could not arrest. So every year recent
epidemics subside on this ground ; or they are limited by the operation
of conflicting disease molecules. Jor if there is a struggle for existence
among the visible forms of life, and if the struggle is the severer, the
nearer these forms are allied, is there not also the same struggle among
the elementary independent particles of life, to which epidemics are due ?
Theirs is also a struggle for subsistence.*

 

Claude Bernard, has its proper life, its autonomy; it can develop and reproduce
itself independently of the adjoining tissues. The great German authority, Virchow,
asserts still more emphatically that each system, as the nervous or osseous system, or
the blood, consists of an ‘ enormous mass of minute centres of action Bt sce rataeh
« Every element has its own special action, and even though it derive its stimulus
‘ to activity from other parts, yet alone effects the actual performance of its duties
oa cows Every single epithelial and muscular fibre-cell leads a sort of
‘ parasitical existence in relation to the rest of the body . . . . . Every single
‘ bone-corpuscle really possesses conditions of nutrition peculiar to itself.’ Each
element, as Mr. Paget remarks, lives its appointed time, and then dies, and after
being cast off or absorbed, isreplaced * * * * Whether each of the innumerable
autonomous elements of the body is a cell or the modified product of a cell, is a more
doubtful question, even if so wide a definition be given to the term, as to include
cell-like bodies without walls and without nuclei. * * * * * Physiologists
maintain, as we have seen, that each cell, though to a large exteut dependent on
others, is likewise, to a certain extent, independent or autonomous. I go one small
step further, and assume that each ccl! casts off a free gemmule, which is capable of
reproducing a similar cell. * *% * Anatom of small-pox matter, so minute as to
be borne by the wind, must, multiply itself many thousandfold in a person thus
inoculated. It has recently been ascertained that a minute portion of the mucous
discharge from an animal affected with rinderpest, if placed in the blood of a healthy
ox, inereases so fast that in a short space of time ‘ the whole mass of blood, weighing
‘ many pounds, is infected, and every small particle of that blood contains enough
* poison to give, within less than 48 hours, the discase to another animal.’ ”
[Animals aud Plants under Domestication. By C. Darwin, M.A., F.R.S. Vol. iL.
pp. 368-9-70-77-78.

* Thucydides notices that during the plague of Athens other diseases declined :
« Aad besides this, none of those diseases to which they were accustomed afflicted
“them at that time; or whatever there was ended in this.” Hist. L.1151. He
refers to this twice, and it has been since matter of common observation.
326 [PART IV.

The constituent units of the body, however independent they may be
in their action, are not independent in the same sense as infusorial units,
but form parts of one whole, of one microcosm, on whose life they
depend, As the one may be called the corpuscular life the other may
be called the cosmical life of the species: and each species has condi-
tions favourable to its own existence, unfavourable to other existences ;
alter these conditions essentially, and the life of a given species gains or
loses its ascendency; the matter of which it disposed, no longer
employed in its further development towards perfection, is abstracted
and appropriated by other forms of life. The Glasgow victims were
gathered together from all quarters, from the Highlands, from Ireland,
and from elsewhere ; they were lodged in conditions unsuitable to human
life; but excessively favourable to the gencration of disease molecules,
which abounded in the air, water, and food, as well as in their own
structures. To render them unassailable by variolads—the matter of
smull-pox—was not enough, for it left them exposed to the other
forms of disease. Thus in a garden where the flowers are neglected,
to keep off thistle-down merely leaves the ground open to the world of
surrounding weeds.

The spread of small-pox, scarlet-fever, and diseases of that kind is
analogous to many chemical and natural phenomena. Thus a spark
falls, the fire spreads, and a city is in flames. The process of combus-
tion, like a plague, is propagated. Atoms of hydrogen and oxygen
combine the instant they touch a kindred flame, and combustion goes
on self-sustained so long as those elements are supplied. Water is the
product. But the flame may be kindled by other elements in combus-
tion; and water will not generate waler ; not so with fermentation. A
little leaven leavens the whole lump; and the leaven left propagates
other leaven. Yeast in wort converts its sugar into alcohol; wines
ferment and undergo various changes; so do milk, butter, cheese, and
other animal products; each fermentation has at Icast one specific
chemical product, be it alcohol, acetic acid, lactic acid, or butyric acid;
and also one ferment. Jt is the great merit of Pasteur to have
established by ingenious and experimental research, that all these
ferments consist of organic molecules, propagated from previous mole-
cules of the same kind. He has shown not that spontaneous generation
is impossible, on the confines of the three kingdoms, under every
possible condition, but that the fermentations in all the cases he
examined were set in motion by specific pre-existing germs; multiplying
indefinitely by reproduction under given conditions.

Through self-propagating chemical action, as instanced in combustion,
we enter the region of fermentations, where there is also chemical com-
bination, but in dependence on the action of living corpuscles on lifeless
matter of organic origin.

Again, we find living molecules in living animals inducing series of
changes in the cosmical life, as for example in the ox or in the silkworm.*
This differs from fermentation ; it isa case of strange corpuscles at work
in the midst of the constituent corpuscles of a living being. The
struggle and the reaction of the conflicting elements produce the
phenomena of diseases, such as small-pox. Granules of vaccine lymph,
for example, iuserted in the arm of a child, give rise to heat, swelling,
redness, pustules, maturation, cicatrix ; in cows they produce a disease
of another form, cow-pox; in horses they give rise to grease. The
corpuscles are specific in their nature, as is shown by the reactions,
nearly uniform, which follow in the same animals; reproducing them-

 

* See Pasteur on Silkworm disease.
DEATHS. | 327

selves in the same structures; and giving rise to indelible modifications
of the corpuscles (biads) of which individuals affected are built up. The
diseases of this nature are called zymotic diseases; the peculiar pro-
cesses zymoses; to distinguish them from fermentations, ‘with which
they have more points of contact than they have with combustion, or
any common propagated chemical action. This class of diseases ay
be designated by a letter; or by an arbitrary word invented for the
purpose ; and so may the process; but it is quite in accordance with
English practice to designate a class of phenomena by a name derived
from the Greek, without thereby implying that the new name is either
limited or defined by the Greek root.*

Each disease has its peculiar germinal matter ; which can sometimes
be isolated, as in the case of small-pox, cow-pox, syphilis, glanders,
purulent ophtialmia, cholera; while in other cases, as in influenza, its
existence is assumed by analogy and hypothesis. It is useful for the
sake of explanation and discussion to give these various matters names ;
thus the vaccine lymph is called vaccinine ; the granulations of Chaveau,
vaccinads ; variola lymph, varioline ; and its corresponding elements,
variolads, Instead of cells, globules, germs, granules, gemmules,
protoplasm, germinal matter, or other descriptive names which have
been given to the organic units, it will be convenient to adopt some
such generic word as the “atom” of chemists. Monad has been appro-
priated in another sense, and “ biad ” from bios (Glos, life, evidently allied
to Aid, force) the root of biology, may be conveniently employed. ‘The
ultimate organic atom of chemists, like the inorganic atom, is beyond
the reach of the microscope; but these diads may be, or become visible.
Physically they are like blood-corpuscles (Aemads).

The zymotic elements differ essentially in their powers, but it is not
likely that they can all be distinguished by the microscope. They are
known by their effects. By them and by other causes out of 1,000 born
in Liverpool, 518 childrea were destroyed in the first ten years of their
life; some by small-pox, many by measles, scarlatina, whooping-cough,
many by typhus and enteric fever; one disease prevailing in one year,
another disease prevailing in another, but still yielding the like fatal
results. This represents what Dr. Watt found at Glasgow long ago.
Out of 1,000 children born in London, 351 die under 10 years of age
by zymotic diseases and other causes; the deaths are less by 167 than
the deaths in Liverpool. How much less is the loss of life by these
diseases in the healthy districts of England! There, out of 1,000, only
205 children die in the first ten years of life. The enormous difference
cannot be ascribed to vaccination, as common in town as in country;
the protection of life against small-pox alone leaves it still at the mercy
of the other dangerous diseases of the insalubrious city. There the
conditions are in favour of disease-life, and in the highest degree
unfavourable to human life.

 

+ Lavoisier called a well-known gas oxygen, on the ground that it forms in
combination all the acids with which chemists were then acquainted. ‘ Ogos is
“sour wine,” “ vinegar”; and “ vinegarmaker” would be a tolerably literal
translation of “ oxygen,” but by no means a good definition of that wouderfal
element. Some writers have foolishly objected to the name, since the discovery of
hydrochloric, and other acids containing no oxygen. So when zymosis derived
from the Greek root (dun, leaven, is employed to designate a series of disease processes
jn men and animals, it is not intended to confound these processes with fermenta-
tion. If fermentation expressed the idea, that word would be used. (dun is
probably drawn by a similar process from ZEQ, to boil, secthe, bubble; the bubbling
of boiling water, and fermentation presenting some points of resemblance ; intestine
motion and heat.
328 [PART Iv.

Protection against small-pox, and against all forms of imported disease,
if that were practicable, should not be neglected; the isolation of the
invaded individual; the destruction of the secretions by chemical
agencies; chlorine, ozone (permanganate of potash), carbolic acid,
sulphurous acid, vinegar, camphor, and other substances, found by
experience tv be destructive, or prejudicial to the zymotic elements,
should all be brought into play. ‘These elements are causes of death,
but an order of causes lies still higher.

The primary object to aim at, is placing a healthy stock of men in
conditions of air, water, warmth, food, dwelling, and work most favour-
able to their development. The vigour of their own life is the best
security men have against the invasion of their organisation by low
corpuscular forms of life; for such the propagating matters of zymotic
diseases may be held to be. Vaccinate by all means; but at the
same time provide streets, spaces, dwellings, water, drainage. Do not
leave the dirt in rookeries, in pits, in dunghills. What are municipal
bodies, town councillors, aidermen, mayors, provosts, good for, if they
cannot by administrative measures displace rookeries by healthy habita-
tions, supply the people with water, and with the means of ‘“ cleanliness,”
which stands proverbially “next to godliness” ?

If we ascend from zymotic disease to its generating element, and
from this to bad dwellings, bad habits, and bad municipal organisation,
causes are often found lying beyond these in bad laws. A city becomes
the seat of trade and manufactures, in which many workmen from the
country are required: families are brought together, and are crowded
in existing houses; and it is found impossible to extend the house
accommodation by building new houses, on account of the existing land
tenures. The owners, whether corporations or individuals, hold on
limited tenures, and as they cannot sell the freehold, or grant leases for
long terms of years, the land is unavailable for building purposes.
Houses are not built to meet the demand, and the ‘rink: of decent
dwellings is inevitable. To abolish all the rookeries is possible now, with
free and cheap locomotion, if the law give facilities to the acquisition of
that necessity of healthy life—sites for dwelling houses. A bad land
tenure is a cause of death.

Again, as properties are often let on lease for terms of years at
stipulated rents, under covenants by tenants to pay rates and taxes, the
tenant cannot justly be called upon to pay within his term the cost of
permanent improvements, which will pass into the landlord’s hands
when the lease expires; the landlord should by law pay the capital, the
tenant the interest.

The study of the causes of death in the zymotic class enables us to
lay down some rules for the limitation of their ravages.

1. This is a primary rule: place the population in the sanitary con-
ditions found by experience to he most favourable to health. Without
this preliminary, all the other measures are futile. The elements of the
body fall into decay and degeneracy of themselves, under unfavourable
conditions, without any external infection.

2. Fortify the body by a mild disease, if any such is known, against a
severe disease. Vaccination, or even inoculation, if vaccination had not
been discovered, is properly practised under this rule. But it should
be universal to be really successful. The inoculation of a few spreads
small-pox among the many. To operate on the mortality, protection
against every one of the fatal zymotic diseases is required ; otherwise
the suppression of one disease-element opens the way to others.

3. The suppression of zymotic action by specific applications in
the earliest stage of invasion is sometimes possible as in the diarrheal
DEATHS. | 329

stage of cholera. Careful experiments on this matter are required ; for
the prodromal stage is not always detected, and treatment is either
not tried, or, if successful, the existence of the disease itself is
questioned.

4. The suppression of the generating beds of disease in unhealthy
populations can scarcely fail to be efficacious. ‘To suppress plague,
suppress the wretched sanitary conditions of Egypt; to suppress
yellow fever, go to St. Thomas, New Orleans, and its other breeding
grounds; to put a stup to pandemic outbreaks of cholera, cleanse
the waters of India, and improve the condition of the population ;
to extinguish enteric fever and typhus in our cities, extinguish the
rookeries.

5. Syphilis is dealt with on this principle under the Contagious
Diseases Act. The forcible detention of infecting women in hospitals
is humane and justifiable ; but why is the principle not extended to
both sexes? Here, to be successful, all the ascertainable sources must
be stopped.

6. The destruction of the zymotic germs by chemical agents, by fire,
and by disinfectants should in all cases be enforced.

7. Water in rivers charged with sewage, or shallow wells, conveys the
germs unchanged (zymads) of some zymotic diseases, as it conveys
animalcules and the ova of worms. The pure water of the hills is the
safest.

8. The diffusion of several zymotic diseases, among them small-pox,
measles, and scarlet fever, is probably effected by detached flakes floating in
the air. This danger is lessened by some such treatment as Dr. W. Budd
has suggested.*

 

* The following is a summary of the precautions reeommended by Dr. W. Budd:

1. The room [in which the patient is detached] is dismantled of all needless
woollen or other draperies which might possibly serve to harbour the poison.

1*, Thorough ventilation of the room to be maintained by an open fire and other
means added.

2. A hasin, charged with chloride or carbolate of lime or some other convenient
disinfectant, is kept constantly on the bed for the patient to spit into.

3 A large vessel, containing water impregnated with chlorides or with Condy’s
fluid, always stands in the room for the reception of all bed and body linen immediately
on its removal from the person of the patient.

+. Pocket-handkerchiefs are proscribed, and small pieces of rag are used instead
for wiping the mouth and nose. Each piece, after being once used, is immediately
burnt.

5. As the hands of nurses of necessity become frequently soiled by the specific
excreta, a good supply of towels and two basins, one containing water with Condy’s
fluid or chlorides, and another plain soap and water, are always at hand for the
immediate removal of the taint.

6. All glasses, cups, or other vessels used by or about the patient are scrupulously
cleaned before being used by others.

7. The discharges from the bowel and kidney are received on their very issue
from the body into vessels charged with disinfectants.

8. About the fourth day of the eruption the surface of the body, scalp included, to
be anointed twice a day with olive oil slightly impregnated with camphor ; the oilin:
to be continued until the patient is well enough to take a warm bath, in which the
whole skin is well scrubbed, disinfecting soap being abundantly used. The baths to
be repeated every other day until four have been taken.

9. ‘Ten days after health is quite re-established the patient may, in new clothes,
without risk, re-enter his family.

10, The children of the poor, who have no means of isolating their children, to
be treated in small model hospitals or houses set apart by towns or parishes for the
purpose. , .

11. The sewers to be kept in a state of permanent disinfection where the
disease prevails. This is done in Bristol under the direction of the Health Officer,
330 [PART IV.

The chemical destruction of the dejections in these diseases, and
especially in enteric fever and cholera, are measures of precaution which
should never be neglected.

Earth is a great disinfectant, and the changes going on in the soil soon
convert the excreta into harmless manures. There is no evidence to show
that the disturbed cemeteries of the dead in past plagues have ever given
rise to new outbreaks; and the dry earth applied on Mr. Moule’s system
is as safe a disinfectant as can be used, but in epidemic seasons the stuff
should be buried and not bescattered on the ground. It would be well,
too, as in dangerous times such precautions cannot be adopted in dealing
with sewage, to disinfect it in the houses and in the sewers on its way
to irrigation fields.

9. The assembly of large masses of men in pilgrimages, or in any
way, produces often coalescences of zymotic elements, which thus
acquire intense activity, and spread far and near: conditions for the
regulation of such assemblages may be therefore fairly enforced.

10. The vessels which place distant shores in communication should
be under strict sanitary regulation, to intercept the transit of epidemics.

11. The interception of the intercourse and commerce of nations
by quarantine is injurious to their vital interests. It should be
kept within the narrowest limits; and England should carefully
abstain from treading in the steps of the fanatical populations of
the Mediterranean. They should be invited to fullow her example by
its success.

12. As zymotic diseases of domestic animals are governed by the
same general laws as the corresponding diseases of men, similar methods
of prevention should be pursued in dealing with live stock.

By observing these simple rules we shall limit the ravages of
common epidemics, and perhaps avert those secular plagues which
have several times depopulated Europe. New species of diseases,—
of zymads, may be generated, and these may under unfavourable
conditions spread with destructive virulence among men, but never,
we may hope, so as to recall the ravages of the Athens plaguc, of
the Antonine plague in the second century, of the Gallus plague in the
third century, of the dreadful Justinian plague of the sixth century, of
the devastating black death of the fourteenth century, of the sweating
sickness so fatal to Englishmen, and, still more recently, the great
plagues of the seventeenth century. Cholera has been virtually
subdued, and we have no reason to despair of success in the future
encounters of science with these impalpable but fell destroyers.—
(80th Annual Report, pp. 212-221.)

Effect of Epidemics on Mortality in Subsequent Years—It has
been stated that an epidemic is invariably followed by a period of
low mortality, which is again accounted for on the supposition that the
weakly die of the epidemic, who under ordinary circumstances would
die a year or two years subsequently of some other disease. This,
however, requires further investigation. In the former epidemic of
cholera (1832) the declinc of the mortality in the subsequent year was
inconsiderable ; but in that yeur the epidemic had not completely
subsided. (13th Annual Report, p. 3.)

Influenza Epidemic, 1847.—It was shown in the last Quarterly Report
on the State of the Public Health, that if the chance that a child in
Dorsetshire under 15 years of age will die in the summer quarter
be represented by 1, the chance that a child under 15 in London will
die in the same time is represented by 2. It was also shown that
the chance of dying among men above 85 in London, is to that in the
DEATHS. | 331

country as 3 to 2: and it was remarked that “ if the chance of dying
“is increased from 2 in the country to 3 in London, the liability to
“ suffer rRoM upIpemics ts raised still more.” The truth of this pro-
position has unfortunately been too soon exemplified. The population
was inadequately supplied with potatoes, and scurvy was prevalent in
the beginning of the year. Meat and bread were dear, distress was
rife; vagrants flocked in from the country, the poor Irish came to their
kindred, the workhouses were crowded. In April and May fever
became epidemic; instead of the average of 34, jifty died weekly
in London; it steadily spread and burnt on until it killed a hundred
and eleven victims in a single week. Diarrhoea, dysentery, and cholera
had been a little more fatal than usual throughout the year: 17,
however, only died of these diseases in the first week of July; the
mean temperature of the air was above 60°; the number of deaths rose
to 38, 47, 67, 125, 128, 188, by the middle of August, and then
gradually subsided. Notwithstanding the continued prevalence of
typhus and scarlatina, the deaths in the last week of October were only
945; one person died of influenza, 36 of bronchitis (inflammation of the
air-tubes), and 62 of pneumonia (inflammation of the substance of the
lungs). In the three weeks following, ending November 20, the total
deaths were 1,052, 1,098, and 1,086; of which 2, 4, and 4 were by
influenza; 49, 58, and 61 by bronchitis ; 68, 79, and 95 by pneumonia.
The wind had generally been blowing 8.S.W. and S.W. since the first
week of October; the weather was unusually warm; a brilliant aurora
was observed, and shook the magnets on October 24th ; it appeared eight
times during the quarter; on Tuesday, November 16th, there was a
remarkable darkness; the wind changed to N.W., and amidst various
changes still blew from the north over Greenwich at the rate of 160,
and 250 miles a day. The mean temperature of the air suddenly fell
from 11° above, to 10° below the average; on Monday it was 54°,
Friday 32°; the air on Friday night was 27°, the earth was frozen ;
the wind was calm three days, and on Saturday evening a dense fog
lay over the Thames and London for the space of five hours. No
electricity stirred in the air during the week. All wus still: as if
Nature held her breath at the sight of the destroyer, come forth to
sacrifice her children. On Sunday the sky was overcast, the air damp,
the wind changed in the night to S. by E., and passed for four days over
Greenwich at the rate of 200 and 300 miles daily; the temperature
suddenly rose, and remained from 2° to 9° above the average through
the week ending November 27th: when the deaths of 1,677 persons—
819 males, and 858 females—were registered in London; 771 persons
under 15 years of age, 518 aged 15-60, and 388 of the age of 60 and
upwards. Influenza was epidemic. In the first week of December two
thousand four hundred and fifty-four persons died: 1,141 were males,
1,313 females ; 1,012 children, 712 persons in the prime of life, 730 of
the age of 60 and upwards. In the week following éwo thousand four
hundred and sixteen persons diced: 1,175 males, 1,241 females; 1,016
under the age of 15 ; 698 at the age of 15-60, and 702 at the age of 60
and upwards. The deaths in the weeks ending Saturday, December 18,
December 25, and January 1, were 1,946, 1,247, and 1,599. 11,339
persons died in six weeks, and altogether the epidemic carried off more
than 5,000 souls over and above the mortality of the season. The
epidemic attained the greatest intensity in the second week of its
course; raged with nearly equal violence through the third week;
declined in the fourth, and then partly subsided; but the temperature
falling, the mortality remained high not only through December, but
through the month of January.
322 [PART Iv.

The epidemic was most fatal to adults and to the aged: thus in the
three weeks ending November 13, the deaths under 15 years of age
were 1,553 ; in the three weeks of the epidemic ending December 18,
the deaths under the age of 15 were 2,846. In the same two periods
the deaths at the ages 15-60 were 966 and 1,970; at the age of 60 and
upwards, 576 and 1,999. ‘The mortality in childhood was raised 83 per
cent., in manhood 104 per cent., in old age 247 per cent. From the age
of 4 to 25, however, the mortality was comparatively not very much’
increased ; at the age of 10 to 15, the healthiest period of life, it was
scarcely increased at all in girls.

During the seven years 1838—44 the deaths of males in London were
more numerous than those of females in the proportion of 1749 males
to 1,677 females; in the second week of the influenza epidemic the
proportions were reversed, for 1,141 males, and 1,313 females died; in
the six weeks ending January 1, the deaths of 5,580 males and 5,759
females were registered. Looking, however, at particular ages, the
deaths in the six weeks under 5 years of age were—2,321 males, 2,009
females; from 5 to 55, males 1580, females 1,507; 55 and upwards
1,678 males, 2,241 females. At all ages there are more females than
males Jiving in London; at 55 and upwards the males in 1841 were
71,021, the females 90,143; at 75 and upwards, males living 6,754,
females 11,124. A disease much more deadly in the old than in middle-
aged and young people, therefore necessarily increases the total deaths
ot females more than the total deaths of males, without for that reason
being more fatal to the female than to the male sex. ‘The difference in
the mortality of males and females from the epidemic is but slight, and
can only be determined by nice caiculation—into which I shall not
enter here.

Influenza attacked those labouring under all sorts of diseases, as well
as the healthy. The vital force was extinguished in old age and chronic
diseases. ‘The poison, permeating the whole system, fastens chiefly on
the mucous membrane lining the sinuses of the face and head, and the
air-tubes of the lungs. Hence it is fatal to the asthmatic; the deaths
directly ascribed to asthma in October and November were 12 weekly ;
in the six weeks of the influenza epidemic, 77, 86, 78, 52, 14, 26,
besides the numerous cases classed under influenza. 36 deaths were
ascribed to bronchitis in the week ending October 30th, and 49, 58, 61,
196, 348, 299, 234, 107, and 1388 in the nine following weeks. 62
deaths were ascribed to pneumonia in the same week, and 68, 79, 95,
170, 806, 294, 189, 131, 148, in the nine weeks following, In some of
these cases the inflammation specified was the primary disease, in others
secondary, and in many it was purely influenza—mis-reported. There
isa strong disposition among some English practitioners, not only to
localize disease, but to see nothing but a local disease; hence although
it is certain that the high mortality on record was the immediate result
of the epidemic of influenza—the deaths referred to that cause are only
1,157; namely, in the first week of November, 2, and in the eight
wecks following 4, 4, 36, 198, 374, 270, 142, 127; and these include
nearly all the cases in which influenza was returned, whether as primary,
or secondary in conjunction with other diseases. A similar defect has
hitherto been found in the returns of all great epidemics; in 1665, the
great plague year, 97,306 burials were returned in the London Bills of
Mortality, only 68,596 of which were ascribed to plague. Influenza
attacked persons labouring under other zymotic diseases : thus the deaths
from whooping-cough rose from 12 and 25, to 65 and 71 during the epi-
demic; the deaths from measles rose from 43 to 96, 89, 69, 75, during
the first four weeks of the epidemic, und then subsided to 37 and 58,
DEATHS. | 333

Fever, which had been fatal to 70 and 80 weekly, rose to 132, 136,
and 131, in the second, third, and fourth week of the influenza
epidemic, and then fell to 83 and 74. Although influenza is not
mentioned in these cases, it is in others, and there can be little doubt
that two or more zymotic processes do often go on simultaneously in
the blood and body; a fact of profound interest to the pathologist,
and worthy of attentive investigation.

The epidemic was much more fatal in some districts of London than
in others. ‘T'o show this, I take the deaths in each of the London
districts during the six weeks from November 21st, 1847, to January Ist,
1848—and, comparing them with the population, obtain the relative
mortality. It wasat the rate of 46 per annum to 1,600 living in London ;
the mortality in the seven years 1838-44, was at the rate of 25 annually
to 1,000 ; the mortality was consequently raised for 6 weeks, by the
epidemic, about 80 per cent. above the average. Lewisham, including
Blackheath, Sydenham, and Eltham, is one of the healthiest districts in
London; the ordinary rate of mortality is 17 annually, during the
epidemic it was 27. St. George in the East is one of the unhealthiest
districts ; the ordinary rate of mortality is 29 in 1,000, the rate of
mortality during the epidemic was 73: the increase in Lewisham was 10,
in St. George in the Hast 44; the latter district suffered four times as
much from influenza as the former. Excluding districts which contain
hospitals or the workhouses of other districts, we have the following
result :—

Dearus to 1,000 annually.

 

 

Annual Rate of Difference
eee a Cente Mortality during| in the Mortality
1838-14. the last 6 weeks | ascribable to
oe of 1847. the Epidemic.
Least UNHEALTHY DIsTRICTS OF
DON.
6 Districts of London in_ which the
ordinary mortality of Females is} 20 38 18
low.
UNNEALTHIEST DISTRICT OF
Lonpon,
6 Districts of London in which the
: eudianny mortality of Females is 27 61 34
high.

 

 

 

 

 

 

The epidemic of influenza killed twice as many people in the insalu-
brious parts of London as it did in those less unhealthy: its fatality
in Lewisham and St. George in the East was, as we have seen, 1 to 4.
‘The annual average rate of mortality for London, in 1730-39, was 41 in
1,000; the rate in the six weeks of the epidemic of 1733 was 72 in 1,000;
the increase was 81 in 17333; the increase in 1847 was 21. (10th
Annual Report, pp. xxvii-xxx.)

Cholera Epidemic, 1848-9.—If a Foreign army had landed on the
coast of England, seized all the seaports, sent detachments over the
surrounding districts, ravaged the population through summer, after
harvest destroyed more than a thousand lives a day for several days in
succession, and, in the year it held possession of the country, slain fifty-
three thousand two hundred and ninety-three men, women, and children
—the task of registering the dead would be inexpressibly painful ; and
the pain is not greatly diminished by the circumstance that in the
calamity to be described the minister of destruction was a pestilence
that spread over the face of the island, and found in so many cities quick
poisonous matters ready at hand to destroy the inhabitants.
384 {PART Iv.

In following cholera through its fatal way, however, the inquirer
meets with some grounds of consolation. He sees places on every side
which the epidemic passed over, leaving the inhabitants in the serene
enjoyment of health and complete immunity. And the hope is perhaps
not fallacious, that an examination of the results of the second may be
the means of mitigating, if not preventing a third invasion; for what-
ever may be the immediate cause of cholera, it will appear evident that
in England it is only seriously fatal under certain known physical
conditions, which admit to a great extent of remedy.

It is not necessary to describe here the nature of the disease. The
task devolves on others of analysing the changes which the frame suffers
under cholera ; of investigating the effects of medicine ; of relating the
steps which were taken to relieve the population attacked in various
places ; of discussing in detail the various theories which have been
produced to explain the phenomena; and finally of portraying in this
epidemic the moral effects, which, as historians have not failed to
perceive, possess the highest interest in the great catastrophes of
mortality.*

Under the Act for the Registration of Births, Deaths, and Marriages,
the name, sex, age, and occupation of every person who dies in England
—as wellas the time, place, and cause of death—are registered. ‘The
whole of this system of observation and record was in operation when
cholera broke out. The quarterly abstract of deaths for the whole
kingdom, and the London tables which are published weekly—presented
notices of its rise, progress, and decline in particular districts. When
the epidemic was over, it appeared desirable to give a complete abstract
of the facts. Accordingly a list of every case of death from cholera and
diarrhoea, in 1849, was transcribed from the registration volumes which
for that year contained 440,853 deaths. The roll of deaths was in the
following form :—

 

 

 

 

 

Population.
: g Fare ay
No. District. Sub-district. 1831 1841
458;2 Nantwich. Nantwich. 8560 9434
Date of Place Sex.) A . Profession Cc f Death
Death. ace. x.| Ag | ssion, ause of Death.
1849,
July 10 | Wych House Bank, Nantwich | M. 6 | Salt-boiler’s Son - | Cholera, 13 hours.
» 9] Welsh Row 43 F, 5 | Confectioner’s
Daughter - - | Cholera, 6 hours.
» 10] Vauxhall 5 M. | 72 | Labourer” - - | Cholera, 28 hours,
» $8 | Wood Street 35 F. | 48 | Basketmaker’s
Wife - - - | Cholera, brought
on by want of the
common ___neces-
saries of life—In-
quest.
» 10 | Wood Street ” M. | 67 | Shoemaker - - | Cholera.—Inquest.

 

 

 

 

 

The whole forms a large mass of manuscript, which contains the
particulars of 72180 deaths. Upon inquiry it was found that the list of

 

* See the report of the Board of Health ; and the appended Reports of Dr. Suther-
land and Mr. Grainger, whose active and arduous labourer in the epidemic deserve the
highest praise. The College of Physicians has, it is understood, appointed a learned
committee to report on the subject. The chemistry of the disease is ably discussed
by Dr. R. D. Thomson, Trans. of Royal Medical and Chirurgical Society vol. xxxiii.
The disease is well described by Dr. Budd, in the Cyclopedia of Practical Medicine,
and sketched in the lectures of Dr. Watson, with his accustomed felicity and accuracy,
DEATHS. | 335

persons who died of the two diseases would fill a thick octavo volume of
about 2,500 pages. Three courses were open: (1) to publish these
facts simply ; (2) to publish the tabular abstracts in detail ; or (8) to
publish the abstracts and the salient facts relating to each locality in a
condensed form. ‘The publication of the cases in detail would have
heen attended with several advantages ; it would have enabled the
medical men of the country to study the particular facts in their
respective districts, surrounded by the circumstances which affect and
modify the mortality; and the publication of an extended tabular
summary of the daily deaths in each of the 2,189 sub-districts of the
country would also have possessed interest. As the work on either
plan would, however, have been exceedingly voluminous, the third
course was adopted: in the meantime the manuscript list of the 72,180
cases, and the extended tabular abstracts, are preserved among the
records of the (seneral Register Office, and will always be accessible to
the local inquirer, as well as to the general student of this great and
extraordinary epidemic.

It appears that 1,057 males and 877 females died from cholera during
the year 1848, and that of those numbers 612 males and 493 females,
died iu the three months of October, November, and December.

The tables in the report show of the 53,293 deaths from cholera, and
18,887 from diarrlicea during the year 1849, how many occurred in each
of the 11 divisions, 44 counties (or groups of counties), and 623 districts
of England. The districts are arranged in the same topographical
order as is adhered to in all the reports of this office. Each district
stands in its place, although nv death from cholera was registered
within its limits; the population of 1841 is set forth in a distinct
column, and shows the lowest numbers that could have been exposed to
the attacks of the disease. In the towns, and in the manufacturing and
mining districts, the population was, of course, much greater in 1849
than in 1841.

Another series of tables shows the number of deaths from cholera and
from diarrhoea on each day of the year 1849,in all England, in 11
divisions, and in 44 registration counties. Thus the march of the
epidemic through every county can be followed day by day.

In the reiurns that have previously been made of the mortality of
cholera in this and in other countries, only the deaths from that disease
in parts known to be severely infected have been inserted, and it is
evident that under such a system—based on imperfect registration—
many deaths must have escaped observation. But the causes of nearly
all the deaths in England are registered, and all the deaths of 1848 and
1849 are recorded in the volumes from which the present return is
derived ; so that the reader can now trace the progress in place and time
of the great epidemic through 17 millions of people, settled over a wide
extent of country, in all the various circumstances of life. And the
difference in the time of invasion, as well as the absence or the incon-
siderable mortality of the epidemic in places lying by the side of districts
overwhelmed by its effects—is undoubtedly one of the circumstances
which most deserve attention in the study of cholera.

A fourth series of tables shows how many males and females died at
various ages of cholera and diarrhea in the divisions and counties of
England. Taking 100 years as the limit, the lifetime is divided into
twenty equal quinquennial periods; and the tables show that the deaths
were distributed unequally over the whole of these periods. The deaths
in each of the first five years of life are separately given; as in that
short interval of age a remarkable change takes place in the form and
fatality of the disease,
836 [PART Iv.

A swift and precipitate course ending in dissolution, is a characteristic
of all plagues, and fixes attention in cholera. The duration of 39,468
fatal cases of cholera, and of 7,896 fatal cases of diarrhoea, is shown in
a fifth series of tables. The duration in hours and days is exhibited at
the quinquennial ages that have been already named. Tables are given
for all England, for England exclusive of London, and for each division
of the country. The 623 districts of England are divided into 2,189
sub-districts. The population (1841), the deaths from cholera, and the
deaths from diarrhea in each sub-district, are given in the notes which
close the volume. The London Registrars returned every case of death
from cholera or diarrhoea weekly, and, in the height of the epidemic,
daily, accompanied by any information which either the informants, or
their own observation, supplied, respecting the state of the streets or
houses in which the deaths occurred. This information was necessarily
collected in haste ; but was found to be substantially correct, and had
an excellent effect at the time, in directing the immediate attention
of the authorities to some of the most crying evils that induced and
aggravated the disease. A digest of these Registrars’ local reports is
embodied in the notes, which contain many curious and suggestive facts ;
and the gentlemen who abstracted the cases were requested to compile
from the transcripts short notices of the first and last deaths, distinguish-
ing the dates of such deaths; as well as the professions of the persons
who died, and the localities which suffered most in every sub-district.
The local inquirer is requested not to accept any opinions expressed in
the notes, or the summaries of the facts themselves, as ultimate results ;
but to consider them only as indications of the direction in which
investigation may be advantageously employed. Upon the number of
deaths returned, and the tabular results, full reliance may be placed ;
as they have been derived directly ‘from returns, and have been duly
checked. (Cholera Report, 1848-9, pp. i-iii.)

Sea mortality from Cholera, 1848-9.—The deaths from cholera, in
1849, among males were 26,108, females 27,185; it consequently
destroyed 1,077 more females than males. The proportions were
reversed in diarrhea, which was fatal to 9,637 males, and to 9,250
females. The population of England and Wales returned at the Census
without revision was,on March 381, 1851, males 8,762,588; females
9,160,180. And correcting for increase of population, the mortality
from cholera at all ages in 1849 was—

Males 30:2 to 10,000 living, or 1 in 331.
Females 30:0 to 10,000 living, or 1 in 333,

The mortality is thus a shade less among females that it is among
males ; but the difference is much less than it is from all other fatal
diseases in ordinary years; when the total deaths among males is
invariably greater than the deaths among females. Thus in the year
1848 the deaths of males from all causes amounted to 202,949, of females
to 196,851; and in the seven years 1838-44 the annual rate of
mortality among males was 2°270, females 2° 104 per cent,

It is worthy ofremark, that at the beginning of the epidemic the deaths
of males exceeded the deaths of females very considerably ; the numbers
in the months of October, November, and December, 1848, were males
612, females 493; or in the proportion of 100 to 80. In the prior nine
months of that year before the great epidemic had set in, the deaths of
males in England ascribed to cholera were 445, of females 384, numbers
in the proportion of 1C0 and 86.
DEATHS. | 337

Asa general rule, when the mortality from cholera attained a very
‘high rate, the number of deaths among females exceeded the deaths
among males.

In London a remarkable change was observed in the proportion of the
‘sexes affected in the course of the epidemic. In four weeks of October
1348 the deaths of 80 males and of 42 females by cholera were regis-
tered ; in the thirteen last weeks of the year the deaths of 258 males and
210 females were registered, and there was an excess of males at all
ages, but particularly in the ten years of age 15-25. In th2 quarter
ending March 1849, the deaths of males amounted to 250, of females to
266; at the age of 25 and upwards the excess of deaths among females
was considerable. In June, at the commencement of the great outbreak,
the males again furnished the most numerous victims. At the close of
July the females died in greater numbers than males, and continued to
‘do so to the end. In the week that the mortality was highest the deaths
of 895 males and of 1,131 females were returned. In the September
‘quarter the deaths of males under the age of 25 exceeded the deaths of
females, but after that age the proportions were reversed. (Cholera
Report, 1849, pp. xxxix—xl.)

Cholera Mortality at different Ages, 1848-9.—Cholera was fatal to
persons of all ages: it carried off 3,866 boys under 5 years of age;
3,837 men of 25 and under 35; and 2 old men of the age of 95 and
upwards. Dividing the lifetime into 3 stages, the disease carried off
7,673 boys and 7,045 girls under 15 years of age, 14,861 men and
15,767 women of 15 and under 60 years of age, 3,546 men and 4,355
women of the age of 60 and upwards. The deaths were thus most
numerous in the middle and most active period of life. The proportions
of deaths at the several ages are different in diarrhcea, the deaths of
children and of old people being much more numerous than the deaths
of persons in the middle period of life. Thus the deaths of 6,794 boys
and 6,058 girls under 15, of 1,235 men and 1,398 women of the ages
15-60, of 1607 men and 1791 women of the age of 60 and upwards,
were referred to diarrhea. It appears to be exceedingly probable that
the cases of diarrhea in 1849, barring a certain deduction, are cases of
cholera, with the striking but not essential symptoms suppressed. And
it is worthy of observation that this suppression of morbid action occurs
at the ages when the organisation is most feeble, either because the
- system is not fully developed, or because it is worn out. Treating the

mortality from diarrhoea as complementary to the mortality from cholera,
it appears that under 5 years of age boys died in the proportion of 88,
and girls in the proportion of 78, to 10,000 living; the rate of mortality
then rapidly declines to the ages of 10-15 and 15-25; in the next
decennial period 25-35, the mortality is of 31 males and 32 females to
10,000 living of each sex. At the period 35-45, the mortality to the
same numbers living is 41 males and 44 females. Thus at the child-
‘bearing age the mortality is rather greater among women than among
men. From the age of 45 through the subsequent decennial periods of
life, the mortality to 10,000 men living increases in the ratios 54, 70, 92,
114, 135, which is the maximum at the ages 85-95. The mortality of
females increases in somewhat different ratios.
338 [PART IV.

AnnuaL Rate of Mortariry, at 12 Age-periods, from Cholera and
Diarrhea in England, in the Year 1849, compared with the Mortality
from all Causes in the Years 1838-44.

 

 

 

 

 

 

ea aoe
Deaths to 100 Males living, Deaths to 100 Females Te eee
at each Age, from living, at each Age, from tGeeeee
each Age.
Age. ae =
ps a3
ge|3g| 28s] #8 |2s|8s|2ig| | 2 | 2
ee gc a eo ed s
Zz | 62/882 | og | 22) 22 /5b2/ oe] a | &
oF le" | ga | ge |e 1a | gan | ae E
0— *332 | °549 “881 7°072 |) °295 | *480 °775 6°0387 | 12°458 | 12°838
5— *232 | °028 *260 “926 || °223 | *028 *251 "900 | 28°078 | 27°889
10— °188 | ‘011 "149 504 |) "128 | °012 "140 “548 | 29°563 | 25°547 |
15— “154 | °011 °165 °805 |) °142 | °012 *154 *833 | 20°497 | 18°487
25— *293 | *O18 “311 °968 |) °303 | °021 *324 | 1°009 | 32°128 | 32°111 F
s— °383 | °027 “410 | 1°249 || °405 | *032 °437 1'242 | 32°826 | 35°185 F
45— "495 | *048 *543 | 1°776 || “467 | *046 °513 | 1°648 | 30°574 | 33°140
55— “587 | ‘114 °701 8°141 |) °604 | °106 “710 | 2°782 | 22°318 | 25°521
65— "644 | °272 °916 6°613 || °678 | *268 "946 5°885 | 13°852 | 16°075 |.
75— “597 | °540 1°137 | 14°394 || °717 | °521 1°238 | 13°201 | 7°899 | 9°378
asd °498 | °847 | 1°345 | 29°646 || °487 | 623] 1°110 | 27°553 | 4°537 | 4°029 F
an % 4 ‘ ‘ his ‘i % ‘
upwards ; 311 | *777 | 1°088 | 42°697 830 | *742 | 1°072 | 40°795 | 2°548 | 2°628
All Ages - | 73802 | "111 °413 | 2°270 || *300 | °102 °402 | 2°104 | 18°194 | 19°106 }
No.of Col. + 1 2 3 4 5 6 7 8 9 10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The above table is obtained by dividing the deaths from cholera and
diarrhea respectively by the numbers living at the corresponding ages
in 1841; and further dividing the whole of the results by 1-11169,* as
a correction for the probable increase of population in the 8 years
1841-9. This gives an approximation to the exact result.

It may be fairly inferred from the table that men of the age of 26-35.
are in a cholera epidemic twice as likely to die as men 10 years younger
(15-25), and that from this period the danger increases with age. The
table does not express the liability to an attack of cholera, nor the attack
having supervened, does it express the chances of recovering or of dying.
The attacks of disease are not registered, consequently there are no
means of throwing light on this question, which falls particularly within
the scope of medical inquiry.

If persons are equally liable to attack at all ages, or if the same pro-
portions of the living are attacked, the table shows the relative mortality
of those attacked at different ages. If more than an equal proportion of
the living are attacked in the early, and less than the due proportion are
attacked at the later ages, the mortality of the table does not represent
the mortality of attacks, but overstates the mortality of attacks at the
earlier ages.

The mortality from all causes at the same ages, in the 7 years 1838-
44, is inserted in the table. Upon comparing this mortality with the
mortality from cholera, it will be seen that the epidemic did not prove
fatal to life at different ages in the same degree as other diseases. Ifwe
divide the numbers in column 3 by the numbers in column 4, the ratio.
of the two rates of mortality is obtained; it varies at different ages.
Thus under 5 years of age in males the mortality from cholera is equal
to 12 per cent. of the mortality from all ordinary causes; and the

 

* The derivation of the value r in r§ = 1'11,169 is given in the Ninth Annual
Report of the Registrar General, 8vo., p. 168.
DEATHS. | 339

greatest relative effect is attained at the age of 35-45, when the mor-
tality from cholera is equal to 33 per cent. of the mortality from all
ordinary causes. At the advanced ages, when the absolute mortality
from cholera is highest, its relative effect is least, for the mortality from
other diseases increases much faster than the mortality from that malady.
This is shown in the columns 9,10, (Cholera Report, 1849, pp. xli-
xlii.)

Duration of Cases of Cholera, 1848-9.—All diseases have natural
stages in which they develop their phenomena, and either obstruct and
destroy life, or give way before its regular healthy processes. The sick
may therefore be classed together, and traced, like the living in a life
table, through all the stages of the malady, until it is extinct, either by
the death or recovery of the patient. Upon this basis a form of sickness
table has been constructed, which shows the probability of death or
-recovery at every period of disease. The half of sucha table for cholera
has been framed from the returns of death, which in 39,468 instances
state the duration of the cases in hours and days. If we assume that
100,000 persons are attacked by cholera, that 60,532 recover, and that
39,468 die at the several periods of the disease indicated in the table,
some of the properties of the complete tables become immediately
apparent. Thus the probability that a person attacked will die in
20,684 _ .90.684; the
100,000
chances are, therefore, nearly 4 to 1 that he will not die in 24 hours.
39,468 — 8,282

100,000
31,186; and the chance that he will not die before but after 3 days is
‘08,282. The chance that, having survived the dangers of the first 3

8,282 _ 8,282
100,000 — 81,186 68,814"
is 60,532 10 8,282, or more than 7 to 1, that the patient will recover if
he does not die in 3 days after the first attack.

The table* supplies a ready means of calculating the future duration
of fatal cases of cholera at any stage of the disease. Thus it is found
that the mean duration of the fatal disease in females is 2°102 days, in
males 2°060 days; or 50°44 hours in females, and 49°44 hours in
males. The woman attacked lives on an average an hour longer than
the man. The duration of life, after well-marked symptoms of a fatal
attack of cholera have set in, appears to diminish as age advances.
Dividing the cases into three groups, the following results are.
obtained :—

less than 24 hours is expressed by the fraction

The chance that he will die in 8 days is expressed by

days, he will yet die of cholera, are

Duration of Farat Cases of CuoLErs at various Ages.

Mean Duration.

 

Days. Hours.
Persons of the age of 15-35 2°121 = 50°904
Persons of the age of 35-55 - 1°954 = 46°896
Persons of the age of 55 and upwards - - 1°973 = 47°352

The stated duration differs more than 4 hours, and is in excess in the
first 20 years of adult age.

Fatal diarrheea is a disease of much longer duration; and it agrees
with cholera in being of somewhat longer duration in females than in
males, and in both sexes, at the age 15-35, than at ages further advanced.

 

* See Cholera Report, 1848-S, p. xiiy.
340 [PART lV.

Duration, in Days, of Farat Cases of DiARRuEA at various AGES.

Males, all ages - 16°044
Females, all ages - 16°692
Males and Females, age 15-35 18° 668
Males and Females, age 35 and upwards - 17°544

The fatal cases of cholera were preceded frequently, if not invariably,
by a stage of diarrhcea, which attracted little or no attention. That
stage is, it is believed, not included in the cholera duration, which was
reckoned, by the medical attendants wiio made the returns, from the
manifestation of the first characteristic symptoms of the epidemic.
(Caolera Report, 1848-9, p. xliii.)

Cholera Epidemics of 1831-2 and 1848-9 compared.—The Board of
Health in 1831-2 collected much information respecting the epidemic
which it was their office to combat. A table was prepared showing the
names of places attacked, the date of the first case, the date of the last
case, the number of days’ duration, the total deaths, the total recoveries,
the proportion of deaths to cases, the population, the preportion of popu-
lation attacked, and the proportion of deaths to population; and all
the places were numbered on one of Arrowsmith’s large maps. The
table and map are now in the library of Her Majesty the Queen. At
the instance of Sir James Clark copies have been made of these valuable
documents, and are deposited in the General Register Office. According
to the returns the deaths from cholera in “ London and its vicinity,”
between February 14th and December 18th, 1832, were 5,275 ; the
deaths in “the country ” were 26,101; the total deaths in Great Britain,
31,376. The deaths in Ireland up to March Ist, 1833, were 21,171,
making the deaths in the United Kingdom 52,547. The deaths of the
year 1832, in England and Wajes, amounted to less than half the num-
ber which were registered in 1849. But the returns which the Board
of Health in 1832 procured were voluntary, partial, and evidently
defective. The population of the places in Great Britain which made
returns was 5,223,657; so it would appear that a majority of the
places in the country altogether escaped attack or notice.

Notwithstanding the defects of the returns of 1832, they furnish us
with the means of satisfactorily showing that the epidemic generally
followed the same track in 1848-9 as it did in 1831-2, but that it
was much more fatal in some places, and less fatal in others at the
two periods. Thus, in the following districts the mortality from
cholera was greater in the year 1849 than in the year 1832. The

Districts in which CHOLERA was more fatal in 1849 than in 1832.

 

 

 

1832. 1849.
Place or District.
Population, te roms Population, Deaths from
3831. olera, 1851 Cholera,

1832. 1849.
London -| 1,424,896 5,275 2,361,640 14,137
Portsmouth - 46,282 86 72,676 568
Bristol and Clifton - 132,331 694 148,704 1,154
Shrewsbury - 21,277 75 23,095 116
Wigan - 20,774 30 77,545 563
Liverpool - 165,175 1,523 255,055 4,173
Leeds, &e. 123,393 702 189,987 2,323
Hull 28,591 300 50,552 1,178
Merthyr Tydfil 22,083 160 76,813 1,682

 

 

 

 

 

 

 
DEATHS. | 341

places for 1832 are towns ox cities, and do not often include all the
same parishes as the districts of 1849, but as the populations at the
two nearest Censuses are given, the rates of mortality during the two
epidemics can be fairly compared.

In the following places the mortality was much less in 1849 than

in 1832, and there can be no doubt about this result.

Districts in which Cuorera was less fatal in 1849 than in 1832.

 

 

 

 

 

: Deaths from i Deaths from
Place or District. ae rag Cholera, =e Cholera,
7 1232, : 1849.
Exeter - 28,201 347 32,810 44
Plymouth 31,080 702 52,223 830
Gloucester 11,933 123 32,062 119
Kings Lynn 13,370 49 20,528 2
Norwich 61,110 129 68,196 38
Nottingham 50,680 296 58,418 18
Sheffield 59,011 402 103,602 114
Carlisle - 20,006 265 41,566 51
Newcastle-upon-Tyne - 42,760 801 89,145 295
Sunderland 17,060 215 70,561 363

 

following districts :—

The difference in the rates of mortality was not considerable in the

 

 

 

 

 

 

 

: Deaths from * Deaths from
Place or District. rau os Cholera, ee ‘ida Cholera,
1832. : 1849.
Manchester and Salford 182,812 890 815,951 1,115
South Shields - 19,756 147 35,787 201

 

 

 

From Salisbury, Southampton, and some of the other districts in
which the cholera was most fatal in 1849, no return was procured in
1832. (Cholera Report, 1849, pp. xlv—vi.)

The Thames, the Water Supply, and the Cholera Epidemic, 1848-9.
—Before proceeding further in this branch of the inquiry, the effect.
of the River Thames and of the water supply on the health of London
must be noticed. The Thames collects the waters of 6,160 square miles
of country, extending from the Cotswold Hills in Gloucestershire to the
eastern coast; and the great body of this water flows and reflows
through London in tides, which carry the matter below London Bridge,
a mile and a half above Battersea Bridge twice a day, and ascend as
high as Teddington. The contents of the greater part of the drains,
sinks, and water-closets of this vast city and of the 2,360,000 people on
its sides, are discharged through the sewers into its water’ ; which,
scarcely sullied by the primitive inhabitants, have now lost all their
clearness and purity. ‘The dark, turbid, dirty waters from half-stagnant
sewers are agitated by the tides, but are not purified until they reach
the sea.

The Thames presents a large evaporating surface which must be
taken into account, and it gives off vapours day and night in quantities
which the phenomena of a “London fog” reveal. The still air then
condenses the matter which at other times enters the atmosphere
invisibly, and escapes observation. ‘Che mean lowest night temperature
342 [PART ly.

of the Thames from May 27th to September 15th, 1849, was 64°; the
mean lowest night temperature of the air was 52°; so that the wide
simmering waters were breathing incessantly into the vast sleeping
city tainted vapours, which the temperature of the air at night would
not sustain.

It is a fact well worthy of attention, that after the temperature of the
Thames has risen above 60°, diarrhcea, summer cholera, and dysentery
become prevalent, and disappear as the temperature subsides. The
cholera reached London in the new epidemic form about October, 1849 ; it
prevailed through the winter, and destroyed 94 lives in the second week
of January, when the temperature of the Thames was 37°; it declined
rapidly through April and May; the night temperature of the Thames
then rose to 62° in the week ending June 2nd ; with some fluctuations
it went up to 68° in July, and remained above 60° until the middle of
September (week ending September 15th). The deaths from cholera
registered during each of the 16 weeks were 9, 22, 42, 49, 124, 152,
339, 678, 783, 926, 823, 1,230, 1,272, 1,663, 2,026, 1,682. The mean
night temperature of the Thames fell to 56°; the deaths from cholera to
839 in the week September 16~22 ; the temperature gradually fell to
38° on the last week of November, when there was only one death from
cholera registered.

The mortality from cholera increases generally in descending the
river on the south side, in Wandsworth it was at the rate of 100 in
10,000 inhabitants, in Lambeth 120, St. Saviour 153, St. Olave 181,
Bermondsey 161, Rotherithe 205, where the water was perhaps most
impure, Greenwich 75, where it had lost some of its impurities.

On the north side, commencing at the highest part of the river, the
mortality from cholera was, in Kensington 33, Chelsea 46, Belgravia 28,
Westminster 68, St. Martin-in-the-Fields 57, Strand 35, West London
(on the old Fleet ditch) 96, London city 38, Hast London 45, White-
chapel 64, St. George in the East 42, Stepney 47, Poplar 71. The
mortality from cholera in the three sub-districts of Stepney, adjoining
the Thames, was twice as great asin the two districts away from the
river. The result is here disturbed by elevation. No good analysis has
been made of the Thames water at different points of its course; but
the matter in suspension is perhaps greatest between London Bridge
and Limehouse Reach, against Rotherithe.

The seven districts of London in which the mortality is highest from
ordinary causes are, the West London District (between Smithfield and
the Thames), St. Saviour, Whitechapel, St. George-in-the-East, Chelsea,
St. Olave, and Rotherithe. They all adjoin the Thames.

Mr. Glaisher, of the Royal Observatory, Greenwich, was requested
to make an estimate of the amount of vapour raised by evaporation from
the Thames in London, and favoured the Registrar-General with the
subjoined statement :—

« For some years past I have made daily experiments upon the amount of water
evaporated from a surface of water, and the amount exceeded 30 inches annually.

«A depth of water of fully 30 inches must evaporate from the surface of the
Thames annually; indeed, the quantity must be larger than this from the cireum-
stance of its relative high night temperature. Take it, however, at 30 inches, and
we shall have—

2°5 x 9 x 4840 = 108900 cubic feet evaporated in a year from an area of water
of one acre.

Se = 678505 gallons of water evaporated in one year from an

acre of water.
108900 x 2245 = 244,480,500 cubic feet of water evaporated from a surface
of 2245 acres of water in one year,

 

244480500
0°1605
a surface of water of 2,245 acres in extent, or more than 1,523 millions of gallons.

= 1,523,242,991 gallons of water evaporated in one year from
DEATHS. | 343

The salt water affects the water at Woolwich : it is usually what is termed brackish
there. Lieut, Sanders states that at Greenwich, at high-water spring tides, the
water is frequently brackish. ;

“The dirt and filth in solution must be very Jarge. The ‘ Dreadnought’ experi-
ments are made under my direction chiefly, and I can assure you that to read the
instruments is a serious aflair, owing to the filth of the waters; on first pulling them
up they are covered with a slimy adhesive mud; they first have to be wiped, and if
the wind is blowing strongly, this muddy water is blown about and over the
observer. A new trunk is now being made, with a perforated copper bottom turning
downwards upon hinges, so as to get rid of the enormous deposit.’

Upon Mr. Glaisher’s estimate, 678,505 gallons evaporate from an
acre of water in a year, which is at the rate of 1857°6 gallons daily.
The bed of the Thames in London is estimated approximately at 2,245
acres; consequently 4,170,000 gallons are raised from the Thames on
an average daily through the year. The quantity evaporated at low
water is, perhaps, much less than this; on the other hand, the evapora-
tion in summer is more active than in winter; and the proportion of
decomposing organic matter in the water, and on the banks exposed
to evaporation, is greater at low than at high water. Hence, it is
probable that in summer 4 million gallons, or about 18,000 tons of
water, are raised from the polluted Thames daily and discharged into,
the atmosphere which is breathed by the inhabitants of London. It
remains to determine how much of the organic matter in the water is
raised with the vapour at different temperatures. (Cholera Report,
1848-9, pp. lix—lx.)

Elevation and Cholera Mortality in London, 1848-9.—The eleva-
tion of the soil in London has a more constant relation with the
mortality from cholera than any other known element. The mortality
from cholera is in the inverse ratio of the elevation. The mortality of
the 19 highest districts was at the rate of 33 in 10,000, and of the
19 lowest districts 100 in 10,000. The elevation in the two groups was
as 71 to 10 feet above the high-water mark of the Thames, or as 7 to
1; while the mortality was as 1 to 3, or in the inverse ratio. In the two
groups of the 6 districts, supplied with the waters of the Thames at
Kew and Hammersmith, the mean elevation was 35 and 175 feet, the
mortality from cholera 19 and 11 in 10,000. In the two groups of 12
districts, supplied with the Thames water between the Battersea and
Waterloo Bridges, the mean elevations were 4+ foot and 10 feet; the
mortality 168 and 77 in 10,000. In the two groups of 20 districts,
supplied with the waters of the New River and the Lea, the mean
elevation was 24and 59} feet; the mortality from cholera was 59 and 37.
While the effects of the water and of the wealth of the districts are
apparent, they do not, in this analysis, conceal the effects of elevation.

 

 

 

 

 

LONDON Deaths from Density of | Elevation in_| Annual Value
z oon ee to fee ge Or High ( a, Houses
, ersons ersons to ater Mark ear ending
Grovur oF Districts. Living. an Acre). (Trinity). April 5th, 1843.)
6 Districts supplied with £
Water taken from the 15 72 s
THAMES above BATTER- 5 i 105 82
SEA - - -
20 eet: pupae Joh
ater om he NEW
RIVER, the LEA, and ast 48 137 42 da
RAVENSBOURNE -— -
12 Districts supplied with)
Water taken frow_ the ||
THAMES, between Bat- 123 73 5 81
TERSEA and Wareioo |
BRIDGES - © -

 

 

 

 
344 [Part Iv.

Cholera was excessively fatal in all the four districts which lie on a
level with or below the Trinity high-water mark; it destroyed 144,
161, 164, and 205, in 10,000 inhabitants. In the five districts which
lie 2 to 4 feet higher, on an average, the mortality from cholera was at
the rate of 68, 97, 120, 153, and 181 in 10,000. Westminster expe-
tienced the lowest mortality (68) in the 9 low districts, and it is
supplied with water by the Chelsea Company; while all the other
districts are supplied by the Lambeth and Southwark Compavies. In
10 districts, of an elevation of 50 feet and upwards, the mortality from
cholera was at the rate only of 8, 8, 17, 19, 22, 22, 25, 35, 35, and 53.
The mortality from cholera was not higher than 35, except in the
district of St. Giles, which is an exceptional case: its elevation being
68 feet above the Thames, and the mortality from cholera at the rate
of 58 in 10,000. It is a mixed district, and contains in near proximity
the British Museum, Bedford Square, Russell Square, and Great
Russell Street, where no death from cholera occurred; and Church
Lane,—a low, damp, dirty Jane, generally covered with decaying
vegetables, and filled with a wretched population, where thirty deaths
from cholera happened, in addition to its quota of 109 patients who
from all parts of the district, were sent to, and died from cholera in,
the Union workhouse.*

Notwithstanding the disturbance produced by the operation of other
causes, the mortality from cholera m London bore a certain constant
relation to the elevation of the soil, as is evident when the districts are
arranged by groups in the order of their altitude. We place the
districts together which are not on an average 20 feet above the
Thames, and find that on this bottom of the London basin the mortality
was at the average rate of 102 in 10,000; in the second group, at 20
and under 40 feet of elevation, or on the second terrace, the mortality
from cholera was at the rate of 65 in 10,000; in the third group or on
the third terrace, 40 to 60 feet high, the mortality from cholera was at
the rate of 34 in 10,000; in the fourth group, 60 to 80 feet high, the
mortality from cholera was at the rate of 27 in 10,000; in the fifth
group, 80 to 100 feet high, the mortality was at the rate of 22 in
10,009; in a district 100 feet high, the mortality was 17 in 10,000;
in Hampstead, about 350 feet high, the mortality was 8, or deducting a
stranger infected at Wandsworth, but who died there, 7 in 10,000.

 

 

 

 

Number of Deaths from
Elevation of Terrace Cholera in Calculated
Districts in feet. from 10,000 Series (1.)
bottom. Inhabitants.
Feet.

Under 20 1 102 102 = 102
20—40 2 65 192 = 51
40—60 3 34 102 = 34
60—80 4 27 292 = 26
80—160 5 22 192 = 20

100—120 6 17 1925 17

340—360 18 7 2 = 6

 

 

 

 

 

* See Report on Church Lane and its vicinage in the Jourual of the Statistical
Society of London, Vol. xi., p. 4, 1848. See also in the same volume a valuable
paper on St. Giles’s district, by Horace Mann, Eeq., Barrister-at-Law.
DEATHS. | 345

By ascending from the bottom to the third terrace, the mortality is
reduced from 102 to 34; by ascending to the sixth terrace it is reduced
to 17. It will be observed, that the number representing the mortality
on the third terrace is one-third of the number 102, representing the
mortality on the first, and that the mortality on the sixth terrace is
one-sixth part of the mortality on the first. And a series approximating
nearly to the numbers representing the mortality from cholera, is
obtained by dividing 102 successively by 2, 3, 4, 5, 6.

A comparison of the numbers of this series with the actual mortality
experienced in each district, will serve to indicate roughly as much of
the effect as is due to elevation; and the deviations from the scale
are generally explained by the other clements of the problem.

The mortality from cholera on the ground under 20 feet high being
represented by 1, the relative mortality in each successive terrace is
represented by 3, 4, 4, 4, 4: or the mortality on each successive
elevation is 4, 2, 2, +, 2, &c. of the mortality on the terrace immediately
below it.

The elevation of the five terraces may be represented by 10, 30, 50,
70, 90 feet. The elevations of the two higher districts are 100,
and 350 feet. It will be observed that the mortality at 100 feet is
17, at 50 feet 834 in 10,000; consequently at half the elevation the
mortality is doubled. The half of 50 feet is 25 feet; and the double
of the mortality, 34, is 68. Now observation gives 65 in 10,000 as
the mortality at 30 feet of elevation. As the processes of dividing the
elevation, and of multiplying the mortality by 2, may be carried on ad
infinitum, it is evident that the mortality is not strictly in the inverse
ratio of the heights of the soil; otherwise at the elevations 12°5, 6°25,
8:125 feet, the mortality would be 136, 272, 544.

Let e be any elevation within the observed limits 0 and 350, and ec be
the average rate of mortality from cholera at that elevation; also let e’
be any higher elevation, and c’ the mortality at that higher elevation.
Then if the mortality from cholera is inversely as the elevation, we
shall have the proportion

/

'
je tage ee ol:
é

e@e.es3e€

By adding a constant element, a, the velocity at which the mortality
increases, particularly at the lower elevations, can be retarded to any
eta
: e+a
The value of a can be most readily obtained by taking e' = 90, where
the mortality was 22; and e = 0, where in three districts on a
level with the Thames at high water the mortality was 177 in 10,000
on an average.

extent. The equation then assumes the form (1)

 

-c =e.

From Eq. 1 the value of @ in general terms is found to be

ec’ —ec
=
ec —e.

Inserting the above numbers, we have

_ 90 x 22—0 x 177 1980 _

a peat
177 — 22 ~ 155

12:8,
346 [PART Iv.

Lonpow Districts, arranged according to the Elevation of their Soil.

 

 

 

 

 

 

 

 

 

OBSERVED AVERAGE.
Elevation in /Annual Mortality to Number of Average Annual
Number Feet 10,000 Persons living.| Persons to Value of Poor Rate
0 above Trinity in the £
Districts.| High-water of Rous
Mark. us AN , a House and} eat
olera n op room
Causes Houses. 1842-43,
(1849). Acre. | House. to each
(1838-44). Person.
£ £
16 Under 20 ft. 102 251 74 6°8 31 4°645 “072
7 20 — 40 65 237 105 7°6 56 7°358 “O71
8 40 — 60 34 235 184 85 64 7°342 056
3 60 — 80 27 236 152 8's 52 6°374 *049
2 80 —100 22, 211 44 77 38 5°183 *036
A. 100 17 227 102 9°8 71 7°586 043
1 350 8 202 5 72 40 5° 804 =
Mean of 38 Districts - 66 240 107* 76 46 5° 985 “064
AllLondon— - - 62 252 29* 7 40 | 5°419 “063

 

 

 

 

 

 

* The difference between the number of persons to an acre in the mean of 38 districts, and in
all London, as separately calculated, arises in consequence of several districts of large area
being thrown into the divisor in the latter case, while the effect of taking the mean of 38
districts is to render the population of each district of equal amount,

As the series is not perfectly uniform, different values of a@ are
obtained from the formula; and 13 is an intermediate value of a, which
has been employed in the construction of the annexed Table, by making
e successively 0, 5, LO, 15,. . . 110, 150, 200, 250, 300, 350, in
the equation—

_ 90 + 138
Re Ae TB

Upon comparing the numbers of this series with the mean mortality
observed in the districts at eight different elevations, it will be observed
that the only considerable discrepancy is at the mean elevation (20-40)
assumed to be 30 feet. The excess of mortality is in Wandsworth,
West London, and Bethnal Green.

103 x 22 2266

22S) ee Se
e+ 13 e+ 13

Mean Elevation

of the ground Mean Mortality Calculated
above the High- from Cholera. Series.
water Mark.
0 177 174
10 102 99
30 65 53
50 34 34
70 27 27
90 22 22
100 17 20
350 7 6

The houses necessarily raise the people of London above the ground ;
and if their habitat, day and night, is on an average 13 feet above the
ground level, it is evident that the mortality within the limits observed
is in the inverse ratio of the elevations at which the people live. The
causes of the discrepancies in particular districts are partly explained
by differences in the wealth of the people and other causes.
DEATHS. | 347

Loxpon.—Mean Mortality fron Cholera at different Elevations ;
reduced from the observations to a regular series.

 

 

 

 

Elevation Deaths from Cholera to | Increase of Mortality in

in feet 10,000 Inhabitants. descending five feet.

above Trinity
High-water e+ 18 7

Mark on the Calculated Chserved Rate of In- | Increase
‘Thames. c. (average).* | crease = 7. | per cent.

100 113 20 17 1°0463 4°6

95 108 21 _ 1°0485 48

90 103 22 22, 1°0510 51

85 98 23, _ 1°0538 Bide

80 93 24 1°0568 57

75 88 26 = 1°0602 6°0

70 83 27 27 1°0641 64

65 78 29 | = 1° 0685 6°9

60 73 31 on 1°0735 74

55 68 33 a 10794 79

50 63, 36 34 170862 86

45 53 39 | =— 1°0943 9°4

40 53 43, = 171042 10°4

35 43 47 | aa 171163 11°6

30 43 53 | 65 1°1316 13°2

25 38 60 = 1°1515 15°2

20 33 69 a 1°1786 17°9

15 28 8L — 12174 21°7

10 23 99 102 1°2776 27°8

5 18 126 = 1°3846 38°5

0 13 174 177 _ _

 

 

 

 

 

* The observed average is obtained by taking the mean height of districts at the elevation
20-40 feet at 30, those at 40-60 at 50, &c. &e.

The relation discovered between the elevation of the soil and the
mortality from cholera is so important, that it was thought right after
the above calculations were made to submit the principle to another
test, by comparing the elevation and the mortality from cholera of
each sub-district. The population of the sub-disiricts in 1851 having
been enumerated, it became possible to construct Tables; which,
although they make the mortality on the lowest level less, and although
the results are deranged by the deaths in hospitals and workhouses,
entirely confirms the announced law.—(Cholera Report, 1848-9,
pp. Ixi-lxvi.)

Conditions under which Cholerais most fatal_—It has been shown
in the general analysis-cf the returns from the whole kingdom, that
cholera has not only been most fatal in the low, and least fatal in the
high parts of the country, but that the fatality has diminished propor-
tionately as the dwellings of the population have been raised above the
sea level. The epidemic began and was most fatal in the ports on the
coast; and in ascending in the rivers step by step, we saw it grow less
and less fatal. It became probable that a certain relation existed
between elevation and the power of cholera to destroy life. The more
exact information which we possess respecting the London districts
establishes this connexion beyond doubt. The relation may not be
expressed by the same figures in other places, or in London at other
times, but it will always be the general rule that the mortality of
ett is inversely as the elevation of the people assailed above the sea
evel,

Mere density of population had not the same direct effect of increasing
the mortality in this disease as in others; for in many inland towns,
and in high, dense parts of London, the mortality was slight or incon-
siderable. Neither does the mortality from cholera vary in the London

t See Cholera Report, 1848-9, pp. elxvi-ix.
348 [PART lv.

districts in any ratio of the density. Still density and numbers of people
are not to be lost sight of; fur the cholera was not fatal to many
inhabitants of thinly peopled, though low and marshy parts ; while in
such localities it was very fatal in nearly all towns. The law is, that
the mortality in towns of some extent and density is inversely as the
elevation.

The wealth of different places differs in amount and distribution.
The differences in wealth and poverty probably have an effect on the
mortality. But abstracting the indirect effect through the selection
of sites and the supply of water, the great differences in the wealth
cf the London districts do not enable us to detect a very marked or
constant influence of this element on the mortality from cholera. In
the country at large there is no reason to believe that the wealth of the
inhabitants increases as we ascend the high grounds which the cholera
left unscathed. ‘The reverse is probably the fact.

Elevation of the land involves several conditions which have an
important effect on life and health. As we ascend, the pressure of
the atmosphere diminishes, the temperature decreases, the fall of water
inercases, the veyetation varies, and successive families of plants and
animals appear in different zones of elevation. The waters roll along
the surface of the rocks, or filter through them and the porous strata of
the earth to burst out below—the sources of rivers, or of tributaries
which carry disintegrated rocks, with the remains and excretions of
vegetables, animals, or men, in every stage of decomposition. The
deposits in stagnant places, and at the estuaries, show the kind and
quantity of mixed matter which the laden rivers carry down and deposit
on the iow margins of the sea at the tidal confluences of the fresh and
salt waters.

If we take a series of towns on ariver it is evident that the refuse
matter of the first town will pass through the second ; of the first and
second through the third; of the first, second, and third through the
fourth ; and so on to the lowest town, which will be traversed by all
the unevaporated and unwasted organic matter that has found its way
into the waters on their way to the ocean. As the transformation of
decaying organic matter into inorganic and innoxious elements is
constantly going on, it will be in many cases completely decomposed
in its course. What has been said of the refuse of towns will apply
to the leaves of the forests, and to vegetable remains of all kinds.

As the rivers descend, the fall of their beds often grows less, and
the water creeps sluggishly along, or oozes and meanders through the
alluvial soil. The drainage of the towns is difficult on the low ground,
and the impurities lie on the surface, or filter into the earth. The wells
and all the waters are infected. Where the houses are built on hill
sides and elevations, as in London, the sewage of each successive terrace
flows through the terrace below it, and the stream widens, the ground
becomes more charged, every successive step of the descent, until it is
completely saturated in the parts lying below the high-water mark.

The river, the canals, the docks, and the soil of a port may be viewed
as a large basin full of an almost infinite variety of organic matters,
undergoing infusion and distillation at varying temperatures; and as
the aqueous vapour which is given off ascends, it will be impregnated
with a quantity of the products of the chemical action going on below,
variable in amount, but necessarily greatest in the lowest and foulest
parts. The emanations, mixing with the superincumbent atmosphere,
ascend like smoke; but at the same time become less and less dense by
dilution and by the gradual destructive decomposition. A glass vessel,
perforated by small holes filled with pure water, and dipped into a
DEATHS. | 349

coloured solution, might give a good idea of the atmosphere of such a
“town; the coloured solution flowing down the sides would grow thicker
by every accession of colouring matter as it descended, and at the same
time colour the water above with a tint deepening in intensity. Or if
the river basins of the country were quite smooth and even, the sides
descending rapidly at first and then slowly, the fall over the whole face
of the country of rain flowing in thicker and thicker sheets as it
descended, would present a good image of the phenomena; but perhaps
not so vivid as the vapour which, when the rain ceased, would arise
from the wet and saturated soil in every degree of density, from the
thickest fog round the marshy bottom to the thinnest mist upon the hills.

From an eminence on summer evenings when the sun has set,
exhalations are often seen rising at the bottoms of valleys, over rivers,
wet meadows, or low streets; the thickness of the fog diminishing and
disappearing in upper air. The evaporation is most abundant in the
day ; but so long as the temperature of the air is high, it sustains the
vapour in an invisible body, which is, according to common observation,
less noxious while penetrated by sunlight and heat than when the
watery vapour has lost its elasticity, and floats about surcharged with
organic compounds in the chill and darkness of night.

The amount of organic matter, then, in the atmosphere we breathe,
and in the waters, will differ at different elevations, and the law which
regulates its distribution, will bear some resemblance to the law regu-
lating the mortality from cholera at the various elevations. It has
been seen how rapidly in London the mortality from cholera diminishes
a few feet above the low ground on a level with the Thames, while
several feet of elevation in higher regions produces no sensible effect.
The same thing holds in drainage. The ground on a level with the
outlet cannot be drained at all, while a few feet of elevation make
drainage practicable, efficient, and easy. And the law holds that while
a few feet of elevation are so important near the outlet, they are of
little or of no importance on the higher lands of the country. The
diagram* represents roughly the facilities of drainage, as well as the
mortality from cholera at the several elevations.

It is established by observation that cholera is most fatal in the low
towns, and in the low parts of London; where, from various causes,
the greatest quantity of organic matter is in a state of chemical action ;
and it may be admitted that cholera, varying in intensity with the
quantity, is the result of some change in the chemical action of this
matter ; leaving it open for further inquiry to determine whether, in
England, that charge is spontaneous, or the result of the introduction of
a zymotic matter from beyond the seas; whether the poison enters the
human frame in air or water, through the skin, the mucous membranes,
or the air-cells of the lungs.

If the facts are so, it follows, that cholera will not only be fatal on
low ground, but on high ground, if, from any concurrence of circum-
stances, the conditions exist there which are so constantly found in
alluvial soils, lying on a level with or below the tidal waters. Now
these conditions did exist in nearly every place severely visited by
cholera on ground much above the sea level: in Salisbury, Merthyr
Tydfil, Bilston, Newcastle-under-Lyme, and Church-street, St. Giles,
London.

The atmospheric pressure and the temperature diminish with the eleva-
tion ; and it is easy to conceive that either may exercise considerable

* * See Cholera Report, 1848-9, p. Ixx.
¢ See Table relative au Mouvement de l'eau dans les Canaux et Rividres: in
Legons de M¢canique Pratique, par A. Morin, 2° Partie Hydraulique, p. 71.
350 [PART IV,

influence when the elevation is considerable. The rarity of the atmo-
sphere, or the perpetual snow on the Himalaya and the Alps, may be
alleged as the causes why the epidemic never crossed their passes.
But the barometric column is depressed little more than 1-10th of an
inch for an elevation of 100 feet; the atmospheric pressure therefore is
not 1-300th part less at that elevation in London than it is at the water
level. The difference in mean temperature, produced according to the
ordinary computation by that elevation, does not exceed 4-10ths of a
degree of Fahrenheit’s thermometer.* Both these changes of tem-
perature and pressure affect the organisation, and they may be greater
in summer than in other seasons; but when it is found that great
and sudden chanyes of heat and pressure are borne with impunity, and
moreover, that cholera has prevailed at different latitudes in different
seasons, it does not appear probable that here these physical changes
had much effect on the fatality of the disease. Besides this, it has been
shown that an elevation of 10 feet above the water level diminishes the
mortality from cholera very considerably ; while a difference of ten feet
at the higher elevation of a hundred feet, has little effect on the
mortality of that disease. The variations of temperature and of pressure
follow laws entirely different, and are too slight at elevations differing
only ten feet to be the direct cause of the great difference in the
mortality of cholera.

Certain diseases arise when men are crowded together in close dirty
gaols, camps, or hospitals; when they inhale morbid exhalations, or are
placed in contact with others labouring under such zymotic diseases as
small-pox ; and when they reside in marshy countries. The explanation
of the diffusion of cholera by an organic matter is therefore consonant
with what is known of the etiology of other diseases.

It has been shown already that when the cholera invades a place, it
generally advances slowly at first; then that great numbers are attacked :
and at the same time that many have all the symptoms of Asiatic
cholera, others have cholera of a milder type: a class still more numerous
have choleraic diarrhcea; and great numbers have disorder of the
bowels, sickness, indigestion, and slight cramps. ‘The stated proportion
of deaths from cholera, out of a given number of cases, varies not only
with the malignity of the form and with the medical treatment, but with
the definition of the disease: some taking as cholera only cases in
collapse, others including the mildest forms: the lighter forms of
diarrheea are seldom noticed in medical registers, and rarely come under
medical observation.

Cholera has rarely been fatal in England to more than 1 in 2 attacked;
and it may be laid down, that for 1 death not more than 3 persons
were attacked in the severer way.f The deaths from cholera in the
last 8 months of 1848, and in the year 1849, were 54,398; the deaths
from the disease in 1849 were 53,293; which may be taken to represent
the deaths in the two years from the Asiatic type, leaving 1,105 as
from the common variety. About 160,000 persons then may have been
attacked by cholera in England. The population was about 17,541,000 in
the middle of 1849; so that 17,381,000 of the population escaped attack.
The deaths from diarrhcea in 1849 were 18,887; 3,887 may be set down
as the result of common diarrhea, leaving 15,000; and if there are

 

e

"f= 951-5 + -005¢
temperature in degrees of Fahrenheit.

+ The cases of cholera reported to the Central Board of Health in England,
1831-2, were 82,528, the deaths 31,376; the mortality was consequently at the rate
of 38 deaths to 100 casey,

where e is the elevation in feet, and / the change of
DEATHS. | 351

100 cases to 1 death, the cases induced by the epidemic must have been
1,500,000. Less than 1 in 10 of the population were attacked by
cholera or diarrhea. By the Table* it will be seen that in all
England 30 died of cholera, 11 of diarrhcea to 10,000 living; of whom,
by the previous estimate, 90 must have sustained an attack of cholera,
and 1,100 an attack of diarrhcea. In London, upon the same basis, it
may be estimated that 1,886 in 10,000 inhabitants had an attack either
of diarrhoea or cholera. In Hull, the district in which the mortality
was highest, 241 died of cholera, 40 of diarrhea, in 10,000 inhabitants,
of whom 4,723 must have been attacked either by cholera or diarrheea.
If an exact return of every shade of the disease could be procured, it
is probable that it would be found over a great part of the country
in one form or other— differing not in nature but in intensity; never in
any place attacking all the inhabitants, and, as we have seen, leaving
few districts without one or more deaths to mark its presence.

Under any circumstances it is certain that in this, as in other zymotic
diseases, great multitudes of the people who in one way or other take
an average dose of the poison resist its influence: and it may be
admitted that the numbers attacked bear some proportion to the
quantity of the specific matter in the air, water, or earth of the place
where they dwell. This specific matter is known only by its effects;
but it has been shown that the deaths from cholera vary in some
proportion to the quantity of organic matter in the state so commonly
observed in the low parts of low towns. Our generalization then goes
to this extent, that the cause of cholera is some chemical modification
of organic matter: and here is the great practical fact—that although
elevation of habitation, with purity of air and purity of water, does
not shut out the cause of cholera, it reduces its effects to insignificance.
(Cholera Report, 1848-9, pp. Ixix—lxxii.)

Rise and Progress of the Cholera Epidemic, 1853-4.—The epidemic
which in the year 1849 destroyed 53,273 lives by cholera, subsided,
and in the year 1850 the deaths by that disease were 887; in the next
two years the deaths by cholera rose to 1,182 and to 1,881; until in
1858 it appeared again in the epidemic form, attacking London and
some other places slightly, and ravaging Newcastle-upon-Tyne. The
disease remained torpid for a season, and then it broke out, as in former
times, in a second eruption, which was in the course of the year 1854
fatal to 20,097 persons of all ages.

But it is impossible to overlook the diarrhcea which has gone on
gradually increasing in fatality since the year 1838, when 2,482 deaths
were referred to that cause; while in 1847 the deaths by diarrhcea were
11,595, in 1848 nearly the same number; in 1849 the deaths by
diarrhea were 17,831; thus making the deaths by cholera and diarrhoea
in the epidemic year 71,104, or 72,180 if we add the cases of persons
attacked while labouring under other fatal diseases.

Diarrhoea did not discontinue its ravages after 1849; the deaths in
the three following years were 11,468, 14,728, and 17,617; in 1853,
when cholera appeared in the epidemic form, the deaths from diarrheea
fell to 14,192; but in 1854 the number was 20,052. Thus the deaths
by cholera and diarrhcea in this year were 40,149, exclusive of a certain
number of deaths which epidemic diarrhea caused in conjunction with
other diseases.

 

* See Cholera Report, 1848-9, p. cxxx.

+ The deaths by cholera and by diarrhea in 1849, as returned in the Cholera
Report, were 53,293 and 18,887 ; but as a certain number of these persons had also
other fatal diseases at the time of death, the general abstracts refer only 53,273
deaths to cholera, and 17,831 to diarrhea: 20 and 1,056 deaths having been referred
to the other heads, The epidemic was one of the causes of death ; it killed sick and
dying men.
352 [PART IV.

Diarrhea is often a symptom of other well-marked diseases ;* and it
*3 also the effect of a class of medicines; but this diarrhoea which
always prevails in hot weather, and has been so common since the
year 1816, is evidently a variety of cholera, proving fatal chiefly to
young children and to old people, who do not so commonly exhibit the
spasms of cholera, but have nearly all the other symptoms.

Cholera itself has probably always existed in England, and it was
well described by Sydenham in the seventeenth century; but the
epidemic form presents some differencesf in the symptoms, as well as
in the extent of its ravages. The chief characteristic is found in the
duration of the fatal cases, half of which terminate within one day
(24 hours) of the first appearance of decisive symptoms, while half of
the cases of common cholera terminate in three days, and half the cases
of diarrlicea extend over six days.

If the deaths from cholera and diarrhcea in the two years 1848-49,
and in the two years 1853-54 be added together, they will amount to
84,079 and 58,760 respectively, which, after subtracting 4,000 from
each number for the ordinary deaths from diarrhcea and cholera, will
leave about 80,000 and 55,000, or 135,000 deaths by the two epidemics
which occurre? in the brief period of seven years. This was in England
and Wales, and it is probable that the epidemic attacked in the two
forms little less than jive millions, and killed a quarter of a million of
the people of the United Kingdom.

The creat bulk of the deaths from cholera occurred in 1849 and in
1854; it is therefore proposed to make the deaths in these years the
basis of the calculations which follow; and it will only be necessary to
bear in mind that the mortality from cholera in the epidemic of 1848-49
is slightly understated, while the relative mortality of 1853-54 is
obtained by adding the deaths in Newcastle-upon-Tyne and in Gates-
head. As a set-off against the above restrictions in the numbers, may
be placed the deaths from cholera and diarrhcea counted in 1849 and
1854, of the ordinary form, and which would have occurred if the years
had not been epidemical.

The mortality from cholera and diarrhea in 1849 was at the rate of
41 in 10,000, while the mortality in 1854 was at the rate of 22 in 10,000
of the population. If the 22 is made 28, on account of the earlier
attack on Newcastle-upon-Tyne in 1853, still the rate of mortality,
taking the inerease of population into account, will be in the last
epidemic little more than half (23) the rate (41) in the former
epidemic.

The rates of mortality by diarrhea in the. two epidemics were equal ;
11 and 11 in 10,000 of the population.

And in 1854 the rate of mortality by cholera was also 11; that. is
equal to the mortality (11) by diarrhea; while in 1849 the rate of
mortality by cholera, that is, by the severe form of the epidemic, was
30 in 10,900, or nearly three times as high as the rate of mortality by
diarrhcea, and three times as high as the rate of mortality by cholera
in 1854.

The epidemic of 1853-54, which broke out with so much violence
at Neweastle-upon-Tyne, was of the same character as the previous

 

* See Report to Registrar General on Cholera, 1848-49, p. xi.

+ See Report to Registrar General on Cholera, p. xvi.

t The deaths returned to the Board of Health in Scotland from cholera alone
were 6,848 from 3ist August 1853 to 17th November 1854, The deaths by cholera
in Ireland during the year 1849 were 30,156. Hence it may be inferred that the
deaths by cholera in Scottund and Ireland together cxeeeded the deaths by the
epidemic in England.
DEATHS. | 353

epidemics; and its intensity apparently depended chiefly on the local
and meteorological circumstances.

It will be seen that the rates of mortality by diarrhoea were nearly
equal in the two epidemics, and that the great differences arise under
the head of cholera.

The zymotic matter of cholera—or cholerine as it may be called, is
evidently generated or distributed at different degrees of strength, and
there is a point of strength at which it strikes down all resistance,
and overwhelms a population with destruction. The causes of this
destructive form of the disease fluctuate much more than the causes
of the diarrhea. I shall therefore direct special attention to the
development of cholera. (17th Annual Report, pp. 75-7.)

Local Fatality of Cholera, 1853-4.—In the first report on cholera
it was shown that the great ravages of the cpidemie of 1848-49,
occurred within vine well defined regions, which were designated
cholera fields ; and named from the towns which were the great centres
of the attack, These cholera fields will be sufficiently indicated here
by the names of their chief towns: London, Portsmouth, Plymouth,
Bristol, Merthyr Tydfil, Wolverhampton, Liverpool, Hull, Tynemouth.
Only the cholera fields of London and of Tynemouth (including New-
castle-upon-Tyne und Gateshead), were revisited with great severity
in 1853-54. ‘The districts of Oxford, Brackley, Towcester, Potterspury,
Norwich, Milton, Thanet (containing Margate and Ramsgate), and the
marshy parts of Essex and of Cambridge—all within the cholera field
round London—suffered in many instances more heavily in the epidemic
of 1853-54 than in the epidemic of 1848-49. The mortality in New-
castle and Gateshead by cholera was higher than it had been in either
of the epidemics 1831-32 or 1848-49. Liverpool suffered to some
extent in 1853-54.

Arta, Porutation, and Morrarity from Crorera in 136 Districts of
England, comprising the 9 CnoLera Frerps of 1849,

 

|
Persons Deaths from

 

Population Deaths from to One Cholera to
Area enumerated. Cholera. Square — | 10,000 Persons
en in | mile. living.
Square! 4
Miles. |

Ist. | 1851. 1si9 | 1854 ‘reto| 1854 1849 | 1854

4

 

136 Districts, com-
prising the nine $1 9.393 | 6,161,162 | 7,448,015 °

 

 

46,502 | 16,295 915 | 955 G5 21

 

|
tricts of England |

1849.
The 491 other imu
6,701 | 3,802 211] 215 6 4

and Wales. 4 :

50,017 | 9,7&2,986 10, £78,994

 

England and Wales | 58,520 |15,914,148 17,927,609 |

 

 

 

 

 

 

|
| | z
53,203 | 20,097 | 308 | 319 30 u

 

In 1849 the deaths of 46,592 persons by cholera occurred in 136
districts, on an area of 8,303 square miles, having in 1851 a population
of 7,448,615; while 6,701 died in the rest of the country on an area
of 50,017 square miles inhabited by 10,178,994 people. The chief
mortality in like manner in 1853-54 took place within the same regions :
16,295 died there of cholera, while 3,802 dicd in the rest of England
and Wales. Thus the mortality hy cholera was at the rate of 65 in
10,000 in the year 1849, and 21 in the year 14, in the distriets of
the cholera fields; in the other districts the rates in the two years
were 6 and 4. :

Zz
35+ [Part Iv.

As a general rule, the mortality by cholera in the same large portions
of the country was low in the two epidemics; in the last epidemic it
fell to two thirds (4) cf the rate (6) of 1849 within these regions,
whereas it fell to one third (21) of the former rate (65) in the district
of the cholera fields.

In the 47 districts, including the principal seaport towns (population
2,156,625), the mortality rate by cholera in 1854 was 23; in +1 of the
principal inland town districts (population 2,240,192), 6; in the remain-
ing 503 districts of the country 2, in 10,000. ‘The mortality rates in
these districts were as 23, 6, and 2 in 1854; and as 85, 38, and 12 in
1849. London, which partakes of the characters of both classes of
towns, exhibited in 1849 an intermediate cholera mortality rate of 62 in
10,000, but in 1854 the cholera mortality rate of London was 43, while
that of the seaport towns was 23.

Diarrheea in the year 1854 was more fatal (20) in the principal inland
towns than it was in the principal seaport towns (13); while in 1849
it was nearly equally fatal in the two kinds of towns—18 and 17 in
10,000 inhabitants.

The mortality of the 41 large inland towns by cholera both in 1849
and in 1854 was higher than the mortality of the rest of the inland
districts; and it fell in 1849 chiefly on six of those town districts:
Wolverhampton, Merthyr Tydfil, Manchester, Salford, Leeds, and
Hunslet, where the mortality rate by cholera was 98 in 10,000 living,
while in the 35 other town districts it was 11. In 1854 the cholera death
rate was 9 in 10,000 living in the six districts ; 5 in 10,000 in the other
85 town districts.

The 42 districts on the coalfields of England and Wales suffered
severely from the epidemic in 1849, where to 10,COO living the deaths
were 46 by cholera, and 13 by diarrhvea; while in 1854 the deaths to
10,000 were 12 by cholera and 14 by diarrhcea. The latter rates include
the deaths from cholera and diarrhea in Neweastle and Gateshead
during the year 1853.—(17th Annual Report, pp. 77-85.)

Sex and Age Mortality from Cholera, 1853-4.—Males suffered more
than females from cholera and diarrh@a at all ages under 25; at the
ages of 25 to 45 the females suffered more than the males; at 45 to 55

 

 

Ansvuat Rare of Morrariry at different Ages from CHOLERA and
Diarrna@, in Exepanp in the Years 1849 and 1854, compared
with the Mortarity from Art Causrs in the Years 1838-44 and

 

 

 

 

 

 

 

 

 

 

 

1845-54.
Annual Deaths to 10,000 Males living} Annual Deaths to 10,000 Females
at cach Age, from living at each Age, from
| |
Ages. Choleraand | Cholera and
3 Diarrliaa: | All Causes. Diarrhoea. All Causes.

7 |

1849 | 1854 1838-44 | 1845-54] 1849 | 1854 S88 jrs45-s4
All Ages - -} 41°3 22°0 | 227°0 236 "4. 40°2 21°2 210°4 220°5

0— * -; 881 81'1 |} 707°2 735°C 97°5 713 603°7 634°3
5 - | 26°0 a9 |, 92°6 91°6 25°¢ 9°30 II 90°0 89°5

10— . = 14°9 51 50° 4 §2°3 14°0 “402 |! 548 54°6
15— = =m | 16°83 6°3 80°5 83°93 | 15+4 GO || 83°83 86°3
25— -!| 381°l 10°2 96°83 101°5 32° 4 117 100°9 108°3
35— 7. -| 41°0 1 124°9 130°9 43°7 161 124°2 129°3
45— - |) 543 17°"7~«|i) ~=«4177°6 189°5 51°3, 17°8 154'8 161°7
55— -| 701 24°99 FBLA L 822°6 71°0 21 278°2 285°5
65— -| 916 39°6 |) 661°8 675°6 94°6 42°2 588°5 610°4
75— - | 113°7 72°6 || 1489°4 1499°1 | 123°8 75°5 132071 1865°2
85— - = | 13845 102°9 || 2964°6 3029'4 J 111°0 9672 |) 275573 2807°6
95 and upwards | 108'S | 126°1 4269°7 4521°9 | 107°2 95° 4079°5 4522°6

 

 

 

 
DEATHS. | 355

the mortality rate of males was greater than the mortality rate of
females in 1849, but in 1854 the rates were nearly equal; from the ages
of 55 to 85 the old women suffered more than the old men; at the age
of 85 and upwards the facts become too few to yield certain results, but
they seem to show that proportionally more old men of 85 and upwards
die of cholera and diarrhcea than old women at the same advanced age.
It will be observed that the mortality of males and of females under
5 years of age was nearly as high in 1854 as it was in 1849; and at
the age of 75 and upwards the numbers that express the mortality in
the two epidemics do not greatly differ. rom the ages of 10 to 65 the
mortality of 1849 was to the mortality of 1854 nearly as three to 1 in
both sexes.—(17th Annual Report, pp. 87-8.)

Elevation and Cholera Mortality, 1853-4.—It was shown by the
investigations in the former report that the mortality of the cholera
epidemic is highest on the land at the low mouths of rivers, and
generally on the low ground of towns. It was also shown that in
London the mortality increases as the ground on which the houses
stand falls from Hampstead and from Norwood to the Thames. ‘This
important principle is confirmed by the observations in the present
epidemic. I extract from the Weekly Report (December 2nd, 1854,
No. 48.) a short account of the results :—

It would be out of place, however, to discuss here fully the circumstances to which
the decrease of mortality may be referred, or to attempt to resolve that important
question,—perhaps the most important of the day,—‘ What is the cause of epidemic
“ cholera?” Is it the effused flaky matter—from the Indian population on the
delta of the Ganges, driven about like the clouds of a leavening dust in the air and
in the waters,—that has reproduced itself, and has destroyed men, all over the
world, either dwelling quietly in their houses, or encamped on hostile battle fields ?
Is it ozone, electricity, volcanic, or any other agency? None of the facts in the
Weekly Tables affords a solution of these questions. But in the Report that was
prepared at this office on the epidemic cholera of 1848-49 in England, certain

 

Morrauiry by Cuorera in 1849 and in the 1} years 18534-1854 of
Six Portions of the Poputation of Lonpon living in Sup-
Districts at Six different Elevations; and other Conditions.

 

 

 

 

 

 

 

 

a Mortality by Cholera} Mortality by
Elevation above Den- 2 and Diarrheea, Cholera,
Trinity High-water | sity. 5 18534-1854.
Mark of the q Annual |
Thames, Rate of Deaths to
No. of S| Increase Deaths to 10,000 Persons
Sub- ____| Per- 2 |perCent.| 10,000 Persons living, living.
Districts. sons | | jon Popu-
toan | lation 3
Extreme Acre | ~ | 1841-51 | 3 8 | Cholera Mean in
Elevation of |Mean.| in S 5 a and In _ | the two
Sub-districts. 1851. 5 3 & | Diar- | 1849.} Epi-
= =
a a A rhoea, demics.
Feet. Feet. | Feet. £
6 100 — 350 | 137 13 40 5761 13 21 34 12 13
5 80 — 100 88 37 45 3°496 10 21 31 20 15
24 60 — 80 69 48 60 *893 28 19 47 25 26
24 40— 60 48 47 45 1°689 17 21 38 45 31
23 29— 40 31 81 41 1°527 32 24 56 65 49
49 Under 20 - 5 27 32, 2°178 88 81 119 103 96
All Peosso tt} 39 | 30 | 41 | 1982 | 46 | 25 m | 62 54
0. A "982
London. ‘above.
1 2 3 4 5 6 7 8 9 10 11

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The column 2 shows that the mean elevation of the sub-districts ranges between 100 feet and
350 feet ; and the 3d column, that upon multiplying the population of each sub-district into its
clevation, and dividing all the sums thus obtained by the sum of the population, the mean
elevation at which the people lived in the six highest sub-districts is about 137 feet.

z2
356 [PART IV.

conditions in which cholera is fatal were brought to light; and we have now in this
second epidemic an opportunity of re-examining and testing those results.

And, first, with reference to the localities in which men live. The vast population
of the Metropolis is diffused over 78,029 acres of ground, which is sub-divided into
36 districts and 135 sub-districts. The sub-districts vary in size from 25 acres to
5,057 acres; in population from 1,632 persons to 47,881 persons; and. in every
one of these distinct sections of the population deaths from cholera occurred in 1849
and in 1854, except in the smallest, Dulwich, where, however, one person died of
cholera in 1849.

The cause of cholera in its epidemic form was therefore some matter diffused over
the 78,029 living acres of which London is composed ; and no parish enjoys in the
epidemic immunity from death by cholera, much less from the attacks either of
severe cholera or of simple diarrhoea, which attend the deadlier forms of the
disease.

But the fatality differed exceedingly ; for iu some sub-districts it destroyed 2, 4,
5, or 6 in every 10,000; in others it was fatal to 201, 206, 208, 211 or more in every
10,000 of the inhabitants.

The population of London is not homogeneous; in cach sub-district the people, as
the returns show, differ from the rest of the population in wealth, ranging from
penury to abundance, and implying great variations in food, lodging, clothing,
firing, medical aid ; in density ; in the elevation of the ground on which they live
over the water-mark of the Thames; in the drainage; in the water with which
they are supplicd; in the exposure to contamination; in the nuisances and church-
yards which surround them; in the temperature, moisture, electricity, and other
atmospherical conditions.

After arranging the several districts in the order of the n.ortality that they suffered
from cholera, in the order of the deusity of population, in the order of the elevation
of the ground, in the order of the house rent per head,—which is one of the best
gauges of the wealth of the people that statistics furnishes,—it was found that
the variations of density had some connexion with the mortality,—that wealth and
poverty exercised more influence,—-that unclean water was pernicious, and that in
dealing with large numbers and many districts there was a certain relation between
the diminution of the mortality of cholera and the elevation of the ground on which
the people lived.

Lonilon is built, like ancient Rome, upon several small hills, and upon low reclaimed
and imperfectly drained marsh ground, which extends from Fulham to Westminster,
and again to Loplar on the north side of the Thames; and on the south side, from
Battersea to Lambeth, Southwark, Newington, Camberwell, Bermondsey, Rotherhithe,
Deptford, and Woolwich. From the river, covering 2,245 acres at the bottom of the
great valley and from this low ground, the houses rise over undulating slopes,
northwards to Hampstead Heath, which is 404 feet above the Thames, and southwards
up to Norwood and Sydenham.

From the new Ordnance map of London, which was prepared at the instance of
the Commission of Sewers, Colonel Dawson, in 1850, estimated, for the Registrar
General, the mean elevation of the 36 district of London; and subsequently the
elevation of the ground of the 135 sub-districts has been estimated approximately.
The population in 1851 was ascertamed at the Census; the deaths by cholera were
returned each week by the Registrars; and the following resulting facts show
distinctly the inverse relation that the mortality of cholera bears to the elevation of
the ground.

182,560 of the people of London in 1851 lived upon sub-districts covering 2,849
acres of the marsh ground, ranging from 3 feet below to 1 foot above the high-water
mark ; 2,693 died there of cholera in 1849, and 2,686 in 18533-1854, or 5,379 in the
two epidemics.

263,914 of the population, in sub-districts on 13,146 acres of ground of 80 feet of
elevation and upwards, lost 398 persons by cholera in 1849, and 356 in 1854, or 754
in the two epidemics.

13,569 persons died of cholera in the years 1849 and 18533-1854, on the 18,429
acres of low ground under 10 feet of clevation, out of a population of 595,119;
while in the same years, out of the more numerous population, 682,705 persons
living on 21,909 acres of the higher ground of 60 feet and upwards, only 3,008
persons died of cholera, including all the deaths in the district of St. James.

On the lowest ground, taking the mean of the two epidemics, nearly fifteen in
1,000 of the population,—on the highest ground one in 1,000 of the population, —
were destroyed by cholera.

At the intermediate stages of elevation was the danger of dying by cholera inter-
mediate? To solve this important question, as regarded the epidemic of 1849,
DEATHS. | 357

London was first sub-divided into terraces differing 20 feet in elevation; and if the
same course is pursued now it 1s found thatin the two epidemic years 16,416 persons
died of cholera on the first terrace under 20 feet of elevation ; 3,771 on the second
terrace of ground, 20 and under 40 fect high; 2,371 on the third terrace, 40 and
under 60 feet ; 2,254 ou the fourth terrace, 60 to 80 feet high; 424 on the fifth
terrace, 80. to 100 feet ; 330 on the higher terraces of 10u feet up to 350 feet. The
population was 850,000 on the lowest terrace; and about equal, or 400,000, on the
second, the third, and the fourth terraces; while it was 142,000 on the fifth, and
121,000 on the higher terrace or terraces.

After correcting for the increase of population, it is found that in 1849 the deaths
by cholera in every 10,000 inhabitants were 108, 65, 45, 25, 20, and 12, on each
terrace respectively, commencing at the lowest ; while on the same sites in 1853}~54,
the mortality was 68, 32, 17, 28,10, and 13. If the mean mortality is taken, the
series becomes 96, 49, 31, 26,15, and 13; which corresponds nearly with a series
calculated on the hypothesis that the mortality by cholera in any two districts is, on
the large scale, inversely as their elevation, to the numbers expressing which a
certain constant number is added.

If we divide the mean mortality on the first or lowest terrace by 1, 2, 3, 4, 5, and
7 respectively, this series is obtained, 96, 48, 32, 24, 19, and 14; which represents
closely the series exhibiting the mortality on the second, third, fourth, fifth, and
the seventh terrace, each rising 20 feet in elevation. The housc-ground from 100
to 350 feet is on an average about 137 feet high, and may be fairly represented
by a seventh terrace,—120-140 feet. The sum of the hypothetical serivs is 233 ; of
the other 230.

By applying this rule to the mortality of 1854 the series becomes 88, 44, 29, 22;
18, and 13. ‘The mortality on the first and seventh terraces is in the relation of
land 3; in the others there is «a disturbance; the mortality on the fourth terrace
is above, on the second, third, and fifth, below, that indicated by the elevation. The
deviations from the law are in opposite directions ; and in this single year nearly
counterbalance each other.

It will be observed in the Table, that, besides the elevation, the density of the
population in 1851, the annual value of houses, the rate of mortality from all causes,
and the rate at which the population increased from 1841 to 1851, are given. But
no such fixed relation is found between the density of population or the annual value
of their houses as is observed between the mortality by cholera and the elevation
of the ground on which the people dwell.

(17th Annual Report, pp. 88-90.)

Water Supply and Cholera Mortality, 1853-4,—The cffect of impure
water has also been determined.

Independently of any regard to theory, it appeared to be desirable
to determiue the effects of the different waters on the population of
London during the impending cholera epidemic; accordingly, the
following circular was addressed to the Secretaries of the several
Water Companies :—

Sir, General Registrar Office, 15th October 1853.
The Registrar-General will feel obliged if you will answer the accompanying
inquiries for the public information. :
I have the honour to be, Sir,
Your obedient servant,
To the Secretary of Water Company. (Signed) T. Mann,

1, What is the source from which the Water Company obtains the water for the
supply of the London districts? If wholly or partly from a river or running
stream, state at what point the supply is taken.

. Is it the same as it was in 1849 ?

. Are the methods of filtration and purification the same as those in use in
1849 ?

. Is the area of supply the same ?

» If any changes have been made in either of the above particulars, what are
the date and nature of those changes ?

6. If any change is contemplated in the existing arrangements, what is its nature

and when is it likely to come into operation ?

ee)

oe
358 [PART Iv.

A detailed abstract of the answers of the secretaries was published in
a supplement to the Weekly Return, No. 47, November 19, 1853; and
the general result was thus summed up :—

From the returns received from the Water Companies it appears that cholera finds
London, as regards water, in the situation in which it left it. This holds true with
reference to all except the Lambeth Waterworks Company, who changed their source
of supply nearly two years ago from Lambeth to Thames Ditton ; and from a Table
subjoined it will be seen that the results of the present epidemic in the districts
supplied by that company, as compared with some others, are rather more satis-
factory than they were in 1849, un improvement which, it is hoped, in the further
course of events will be maintained. But new works undertaken by other companies
in accordance with recent legislation are in progress. The return of cholera at an
earlier period than was anticipated furnishes a motive for increased activity in their
operations. With capital, public spirit, and natural advantages of locality, London
may enjoy a pure and copious supply of this first necessary of life, as well as country
towns and villages, and more than some towns with municipal institutions where the
burgesses are too idle, or too busy, or too poor to bring it from surrounding springs
to their doors. Manchester has set a good example, and it is only necessary that
the national intelligence should be generally awakened to the question, for this great
end—a good water supply—to be accomplished both in town and country.

 

 

 

gsregate of Districts supplied
chiefly by the respective
Water Companies.
, Deaths to
Water Companies. Sources of Supply. Elevation Deaths 100,000
in feet Popula- from | Inhabi-
above tion enue Cholera in tants.
Trinity | yerated | 12 Weeks
High: Tee ending
water a Noy. 12,
Mark. 1853.
Loypon - -|- - . - 2,362,236 626 27
Hampstead and | Springsat Hampstead and 80 166,956 6 4
New River. Kenwood, two artesian
wells, and New River.
New River - | At Chadwell Springs in 76 634,468 50 8
Hertfordshire, from
river Lee, and four wells
in Middlesex and Herts.
Grand Junction - | The Thames, 369 yards 38 109,636 14 13
above Kew Bridge.
Chelsea + - | The Thames, at Battersea 7 122,147 22 18
Kent - i Se NOUrES: in 18 134,200 27 20
ent.
West Middlesex - | The Thames, at Barnes - 2 277,700 72 26
East London -/ The river Lee, at Lee 26 434,694 12t 29
Bridge.
Lambeth and | The Thames, at_Thames 1 346,363 193 56
Southwark. Ditton, and at Battersea
Southwark - | The Thames, at Battersea 8 118,267 100 85
Southwark and | The Thames, at Battersea, - 17,805 18 101
Kent. the Ravensbourne in
Kent, and ditches and
wells.

 

 

 

 

 

 

 

 

It is believed that through nearly the whole of this Table the impurity of the
waters with which the inhabitants of the several districts are supplied is in nearly a
direct proportion to the mortality from cholera.

The water at St. Thomas’s Hospital is thus described by Dr. R. Dundas Thomson,
the Professor of Chemistry :—

The water as delivered at the pipe in the Laboratory of St. Thomas’s Hospital on
the 11th November was quite turbid, as it usually is, and contained diffused through
it 1+16 grains of vegetable matter, dried at a steam heat, consisting principally of
silica, the chief constituent of the shields of the lower class of plants. But as in its
moist state it contained at least two-thirds of its weight of water, we cannot estimate
the filth in the water, which could be removed by filtration, at less than 3} grains
per gallon.
DEATHS. | 309

The influence of the water became more evident; and was discussed
in the supplement to the Weekly Return (December 3rd, 1853), from
which the following Table is taken :—

Mortatiry from Cyorrra in Districts supplied by different Water

 

 

 

 

Companies,
Aggregate of D'stricts supplicd
chiefly by the respective
Water Companies.
5 Deaths to
Vater ni ee 7 Elevation Deaths ,
Water Companies. Sources of Supply. im fect} porutas Feat cat
above tion enn. | Cholera in tants.
Trinity merated | 14 Weeks
High- = ending
water Ds Nov. 26,
Mark. 1853.
: \
London - - - - 39 ' 2,362,236 744 32
| 1
*(1) _ Hampstead | Springs at Hampstead and 80 |: 166,956 8 5
and (2) New Kenwood, two artesian |
River. wells, and New River. ‘
New River At Chadwell Springs in 76 634,468 | 56 .
Hertfordshire, from
river Lee,and four wells '
in Middlesex and Herts. :
Grand Junction - | The Thames, 360 yards 38 109,636 16 15
above Kew Bridge. i
Chelsea - - | The Thames, at Battersea 7 122,147 99) 18
Kent - - ae ja vepsDonene in 18 134,200 él 28
ent. i
West Middlesex - | The Thames, at Barnes - 72, 277,700 89 32
East London - The : iver Lee, at Lee 26 434,694» 162 7
ridge. j
*(1) Lambeth and | The Thames, at Thames 1 346,363 220 64
(2) Southwark. Ditton and at Battersea. i
Southwark - | The Thames, at Battersea 8 118,267 ° 121 102
* (1) Southwark | The Thames, at Battersea,| = — 17,805 | 19 107
and (2) Kent. the Ravensbourne in
Kent, and ditches and
wells.

 

 

 

 

 

 

 

* In three cases (marked with an asterisk) the same districts are supplied by two companies.

After correcting the above Table and the tables of cholera 1848-49, for the effects
of elevation, it is found that a large residual mortality remains, which is fairly
referable to the impurity of the water ; for it is least where the water is known to be
sweetest, greatest where the water is known to be the most impure.

After the great loss of life in 1849, and the patient investigations of two able
committees of the House of Commons, the present Water Companies were left in the
undisturbed possession of the monopoly, which they enjoy, of selling the people of
London water. In the present state of engineering and sanitary science, purer
waters from gathering grounds, or from springs, could probably be procured, and be
supplied at cheaper rates by new companies, or by the incorporated rate-payers.
But this would disturb the values of large masses of invested capital. To avoid
such a result, always undesirable, the supply is left in the hands of the existing
companies ; but by Act of Parliament they are prohibited from obtaining supplies
from the tidal waters of the Thames and Lee, after certain fixed dates.

It is enacted, that it shall not be lawful “after those dates” to distribute the
pernicious waters over London. it unfortunately happens that in the invasion of
cholera with which we are threatened next year (1854), every parish, except those
which the Lambeth Company supplies, may receive waters as bad as those of 1849
without a direct violation of the Act of Parliament.

But the Water Companies will do well to bear in mind that the dates in the Act
are the extreme limits of time beyond which they can supply London with impure
water without a direct violation of the law. They may complete the works in half
the time. They can accelerate their progress. And the returns which they have
furnished will enable us to appreciate their zeal and spirit in the public service under
an extraordinary emergency.
360 [PART Iv.

Instead of the distant dates of 31st August 1855, 1856, and 1857, which were fixed
when the return of cholera was not contemplated, the companies should aim at
supplying London with the water which they are then bound to furnish, at a date
not later than the first of July 1854. This would probably be the means of saving
thousands of lives, and entitle the directors to the public gratitude.

The cholera broke out again in 1854: the effects of the bad water
were watched during the epidemic ; and the general results of a special
inquiry are thus described in the Weekly Return (Qctober 11th, 1854).

Ixviurnce of the Waters of Loxpon on the Morracrry of CuoLera.

The present epidemic of cholera in London presents a favourable opportunity for
determining the influence of waters of various degrees of impurity on the mortality
of cholera:

In the Report on the cpidemic of 1819 the following gencral results were
obtained:

“ In the six districts which are supplicd with watcr taken from the Thames at Kew
by the Grand Junction, and at Hammersmith by the West Middlesex, 15 in 10,000
inhahitants died from cholera, aud the mortality ranged from 8 to 33.”

“Inthe twenty districts supplied by the New River, the Kast London, and the Kent
Companies with water from springs from the Lea and the Ravensbourne, 48 in 10,000
inhabitants died of cholera, and the mortality ranged from 19 to 96.”

“Tn the twelve districts which are supplied with water taken by the Lambeth, the
Chelsea, aud the Southwark Companies from the Thames between Battersea and
Waterloo Bridge, 123 in 10,000 inhabitants died of cholera, and the mortality ranged
from 28 to 205.”

“In the second group of districts cholera was three times as fatal; in the third,
eight times as fatal as it was in the first; one, three, and cight express the relative
virulence of the epidemic in the three conditions. The density of the population was
greatest in the central group, and nearly the same in the first and third groups.”
Reg. Gen. Cholera Report, p. 1xi.

iV part of the excessive mortality is referable to the depression of the ground in
the twelve districts.

The Lambeth Company, which in 1849 took up its supply from the Thames at the
part where the water is most impure, has since January 1852 drawn its water from
the Thames bove the tidal flow, and has thus afforded an opportunity for ascertaining
the effects of this great improvement.

It was observed in the first eruption (1853) of the present epidemic that the
mortality was diminished in districts which were partially supplied by that Company.
(Supplement to Weekly Return November 19th 1853.)

On October 13th, 1853, a circular had been sent to the London Water Companies,
and the replies of all, except the Lambeth Company, showed that their new works
and improvements had not then been carried out, as they were only bound under
the Act of Parliament to complete them in 1855, 1856, or 1857.*

The Southwark Company, which now supplies the most impure water, stated,
however, that though the Act “allowed three ycars from August 1852 for the
execution of the new works, the contracts for the whole having been made imme-
diately after the passing of the Act, and being now [October] in a rapid course of
Sulfilment, the works will be completed and in operation one year within the time it
prescribes,” that is ia September 1854.

The hopes of the Company, notwithstanding their efforts, on the approach of
cholera, were defeated, the officers informed Lord Palmerston, by a concurrence of
various causes, and the impure water of the ‘Thames is still supplied by this Company.

Bermondsey, one of the south districts of London, is exclusively supplied with the
impure water, and the deaths by cholera are already more numerous than they were
in 1849, while in the parish of Lambeth, which is supplied partly by the Southwark
Company, aud partly by the Lambeth Company, the mortality is much lower than it
was in 1849.

 

* The Secretary of the East London Water Company in August 1854 wrote thus to Viscount
Palmerston :—“ In reply to your Lordship’s inquiry, what steps have been taken by the East
London Waterworks Compeny to effect a remedy in regard to the watar supplied by them, I am
instructed to state that the Company has already expended 150,0002. in effecting improvements ;
the supply has, for two months past, been taken through a newly constructed aqueduct, from a
point in the valley of the Lee, nearly three miles higher up than formerly; the sewage of the
valley, so far as it can effect the purity of this Company’s supply, has been diverted by an
intercepting drain, and the whole of the water delivered is filtered. Further works are also
in progress.”
DEATHS. | 361

Drarus from CHOLERA.

 

 

Districts. In the year 1849. In the 14 weeks ending 14th Oct. 1854.
Bermondsey 734 829
Lambeth 1,618 - 904

But the pipes of the two Companies which were once in active competition often run
down the same strects, and through the same sub-districts, so that alternate streets
or houses in the same sub-districts are supplied with the pure and the impure waters.

Dr. Snow, who has devoted much time to the investigation, having procured from
this office the addresses of the persons who died of cholera in Kennington and some
other sub-districts, states, as the result of an inquiry from house to house where the
pipes of the Lambeth Water Company are intimately mixed with those of the South-
wark Company, that, in the 7 weeks ending August 26th, of 600 deaths from cholera,
475 have happened in houses supplied by the Southwark Company ; 89 in houses
supplied by the Lambeth Company; 13 in houses supplied by pumps, wells, and
springs ; 8 in houses which derived their water directly from the Thames and from
ditches.

The Registrars on the south side of London were instructed to inquire, in all cases
of death by cholera, whether the house in which the patient was attacked was
supplied by the Southwark, the Lambeth, or the Kent Companies, or with water from
pumps, wells, ditches, or other sources. The inquiry was attended with considerable
difficulty, as the information could not be obtained from hospitals or workhouses, and
the informants and the householders themselves were often igeorant of the source of
supply, as the water rate in the worst districts is paid by the landlord. The informa-
tion was thus not obtained in 766 out of 3,805 instances; but it was stated that in
3,039 instances 2,284 deaths occurred in houses supplied with the impure Thames
water, 294 in the houses supplied by the Lambeth Company with the purer filtered
Thames water. The disparity was observed week after week in the progress of the
epidemic.

The total number of houses supplied by the Southwark Company is stated to be
40,046 ; by the Lambeth Company to be 26,107 ; consequently there were in 6 weeks
57 deaths in every 1,000 houses supplied with impure water, and 11 in every 1,000
supplied with the less impure or comparatively pure water.

It is deemed right at onee to state these facts now the epidemic is declining; but
the important inquiry can only be made complete in all its parts by the Board of
Health, who have requested the respective companies to furnish street lists in every
sub-district of the houses that they supply, with which the facts in the Registers of
Deaths may be compared. The effects of elevation and other causes may be thus
eliminated, and the fatal effects of impure water be precisely determined.

Invturnce of the Wirer Suppiy on the Mortratiry from CHOLERA in
the Sourm Districts of Lonpon during the Six Weeks from
August 28th to October 7th, 1854,

 

 

Estimated | Deaths | Mortalit; .
Houses | Population |registered] to cere oe
Water Company.| Source of Supply. : of the by Cho. 100,000 Cay
supplied.| Houses lera in Inhabi- Ho 0
supplied. | Houscs. tants. Cuses:
Southwark Com-| The Thames at! 40,045 266,516 2,28 857 57
puny. Battersea.
Lambeth Com- | The Thames at | 26,107 173 748 204 169 1
pany. Thames Ditton. .
Kent Company | The Ravensbourne, 14,594 O77 188 194 18

 

 

 

 

 

Note.—The source of water supply was not ascertained in 766 instances. The water was said
ta be derived from pumps, wells, rivers, and other sources in 273 instances.

At the close of the epidemic the results of the observations on the
water were finally summed up in the Weekly Return, December 9th,
1854.

It has been calculated that more than four million gallons of water evaporate
daily from the Thames in its course through London ; and besides the supply from

wells, pumps, and sireams, nine Water Companies in their returns state that they
pumped on an average 60,614,420 gallons of water into 302,428 houses and a certain
362 [PART IV.

number of manufactorics daily, during the year 1853. The water that tlows through
the houses and streets daily is probably double the weight of the population. It is
pumped at intervals into reservoirs until it is withdrawn for cooking, for cleansing,
for washing linen, for ablution, and in some cases for drink by the people. Jt thus
comes into contact with the body in many ways and it gives off incessantly at its
temperature, ranging from the freezing point to summer heat, vapours and effluvia
into the atmosphere that is breathed in every room; while the residue is discharged
to carry the dirt of the houses and the town guano of the waterclosets into the
sewers and the Thames.

A certain portion of the water of London is drawn by the New River Company
from distant springs and wells in the basin of the Lea river, which is a tributary of
the Thames ; but a large quantity of the water of this company, as well as the whole
of the water of the Hast London Company, is drawn from the Lea lower down its
channel. The Lambeth Company draws its water from the Thames at Ditton
above the tidal range, but the Grand Junction at Kew, the West Middlesex at
Hammersmith, and still lower down, at Battersea, the Chelsca and the Southwark
Companies draw up their water from a part where the Thames is now evidently
contaminated by the sewers which discharge the drainage of the population into the
river. The temperature of the water of the Thames ranged from 60° to 70° during
the cholera epidemics, and the chemical composition and changes of the matters in
its waters undoubtedly varied to a great extent; but the microscope and chemical
analysis have confirmed the evidence of the senses, in showing that the water which
the Chelsea and the Southwark Companies draw at Battersea contains the greatest
quantity of organic matter; that it is the most impure; and that fragments of the
muscular fibre of food exist in the Southwark water. The other waters are of a
better quality.

The mortality from cholera in the sub-districts of London is shown under two
aspects thus, the mean mortality of the districts wholly or partially supplied by the
New River Company in the two epidemics was at the rate of 15, 28, 28, 46, and 70,
in every 10,000 living on the successive terraces of elevation; and the mortality in
the sub-districts that are supplied by other companies at corresponding elevations is
found to differ from this scale, some in excess, others in defect.

In the supply by all the companies extensive improvements are projected, and in
some cases have been partially carried out. The New River Company states in
reply to an inquiry, that “works have been since June in operation to prevent
“ sewage from Waltham, Ponder’s-end, and Tottenham running into the River Lea,
“* which before affected the pumping station at Tottenham.” On the terrace of 60
to 80 feet elevation, containing Berwick-street, the cholera was more fatal (30) in
1854 than it was in 1849 when it was 25 ; but on the other elevations the mortality
from cholera was less than it was before, in the proportion of 18, 42, 72, and 73, in
1849; and 11, 14, 19, and 67 in 1854, to every 10,000 inhabitants, at the respective
elevations, supplied with water by the New River. A similar decrease is observed in
the mortality of the sub districts supplied by the East London Company, which has
latterly drawn its water three miles higher up the River Lea, than it did in 1849.

The sub-districts that were supplied by the Grand Junction and by the West
Middlesex Companies suffered much less from cholera in 1849 than the sub-districts
of the New River and the East London; but in 1854 the mortality increased in the
districts of the two former companies, and in all the districts that derive their water
from the Thames, which from Kew down to Battersea and Chelsea has every year
for the last five years received an increased quantity of town sewage.

The Lambeth Corupany has in the interval between the two epidemics changed the
source of its supply from Hungerford Bridge to Thames Ditton, where the river is
unpolluted by the London sewage ; but the pipes of this company run into the same
districts as those of the Southwark Company, against which it was at one time in
active competition, so that a special method of inquiry must be here resorted to.
The Tables 1 and 2 only show that the sub-districts that were supplied wholly or
partially with the impurest Thames water experienced a high and extraordinary
mortality from cholera in 1849, and again in 1854.

The region of London south of the Thames is divided into 11 large districts,
comprising 42 sub-districts, which extend from Putney in the west to Woolwich in
the east,-—from the large tract of low ground along the Thames to the heights of
Norwood and Sydenham. Many houses in every district derive their water supply
from -wells, pumps, and tidal ditches; in addition to these sources Bermondsey,
St. Olave, and Wandsworth, are supplied almost exclusively by the Southwark
Company; the Greenwich and the Lewisham districts chiefly by the Kent Company ;
in the streets of the other districts the pipes of the Lambeth and the Southwark
Company—the one supplying water comparatively pure, the other impure—are so
intermingled that neither the informants nor the Registrars knew in 823 cases out of
4,059 whether the house in which the death from cholera occurred obtained its water
DEATHS. | 363

from the Lambeth, Southwark, or the Kent Company. The officers of the latter
company themselves have stated that they experience almost insuperable difficulties
in distinguishing the houses which they supply in every street. It is therefore
evident, that in the general character of the houses, the means of the householders,
the density of the population, and the elevation of their dwellings, the difference is
not considerable. The water supply is the chief element in which there is an evident
difference; one class of houses is now supplied by water from Ditton, the other by
water which the Southwark Company draws from Battersea, where the Thames is
contaminated by the London sewage. And what is the result ?

In the 26,107 houses that derived the water from Ditton 313 deaths from cholera
occurred in ten weeks; in the 40,046 houses that received the impure water from
Battersea 2,443 persons it was ascertained died from cholera in the same time. The
deaths in the latter districts exceeded by nearly 2,000 the deaths that would have
occurred if cholera had only been as fatal as it was in the houses that derived their
water from Ditton. The Registrars were probably in some cases misinformed, but
there is reason to believe that no undue proportion of the deaths is referred to houses
that the Southwark Company supplies.

The deaths are given as they were returned by the Registrars in the eleven
districts ; and it will be observed, that the balance of mortality is heaviest in every
district against the impure water, to an extent that leaves little room for doubt on the
mind,

Thus in St. Saviour Southwark, 280 of the deaths by cholera were in houses
supplied by the Battersea water, 59 in houses supplied with the Ditton water. In
the week ending September 2nd the proportions were 58 to 11; in the week ending
October 14th they were 9 to 1. In St. Olave, containing the hospitals, and in
Bermondsey, an undue proportion is perhaps referred to Southwark, as the Registrars
notice no cases in houses that derived water from wells and ditches. In St. George
Southwark 254 persons died of cholera in houses that were supplied with water from
Battersea, 79 in houses that were supplied with water from Ditton; the proportions
were 303 te 47 in Newington, 349 to 95 in Lambeth, 206 to 6 in Wandsworth and
Clapham, 167 to 24 in Camberwell, and so the proportions ran week after week.
And it will be observed that in Bermondsey, which is not entered by the Lambeth
Company, 734 persons died by cholera in 1849, and 846 in 17 weeks of 1854; while
in Lambeth, which is wholly supplied with impure water, in 1849, the deaths in that
year by cholera were 1618, while in 17 weeks of 1854, when it was partially supplied
with a comparatively purer water, the deaths by cholera were only 935; of which
about four-fifths were in houses that received impure water.

Works are now in progress for procuring better water for Southwark and for the
rest of London; and the salutary effects of the changes that have been already
wrought justify us in anticipating that when London is well drained, and when the
Water Companies supply London with the cool, pure, refreshing water of the streams
from the high grounds of Middlesex, Hertford, and Surrey on the system of constant
supply, the health of the metropolis will be improved, and under wise medical
arrangements the devastations of cholera, if they recur, will be no longer terrible.

(17th Annual Report, pp. 90-7.)

Four Cholera Epidemics in England.—Asiatic cholera has visited
England four times. It first appeared in October 1831, and in that and
in the following year was fatal in many parts of the kingdom. Many
thousands of the people were attacked, and many thousands perished of
this new disease. The numbers are unknown, as no registration of the
causes of death then existed. In the United Kingdom the deaths of
52,547 persons were reported through various channels to the Board
of Health. The disease created consternation; and although it was
observed closely, and combated by the most active remedies, little
progress was made in the discovery of causes.

Its causes were indeed supposed to be enveloped in inscrutable
mystery, and to be above human control. No comet was at hand to
account for the phenomena, and there was only a whisper of telluric
and meteoric influences on the Continent. “ The cholera,” said the
Annual Register for 1832, “left medical men as it had found them,—
“ confirmed in most opposite opinions, or in total ignorance as to its
“ nature, its cure, and the causes of its origin, if endemic,—or the
“ mode of transmission, if it were infectious.” ‘Thus English history
is written.
364 [PART Iv.

Now the disease was well described by the Board of Health; its
pathology was studied, and the effect of a varicty of remedies was tu
some extent tested. Great care was bestowed upon the sufferers, for
whom hospitals and provisions of various kinds were made. The facts
were published as far as they were known. Andaithough it was a time of
great political excitement, and a year of election riots, the people
nowhere in England entertained the dreadful suspicions of occult
poisoning which excited the populace to madness and to murder, not
only in Hungary, but in Paris.*

And furthermore, an important discovery was made in 1832. It was
found that the cholera in its worst forms was preceded by diarvhiea;
and that this diarrhoea was in some cases a mild form, in others a first stage
of the disease. Now, to arrest this diarrhoea is to prevent cholera, as
to extinguish a spark is to prevent a conflagration. It is true that
perhaps ninety cases out of a hundred of epidemic diarrhea left to
themselves go no further, but it is equally true that the ten residual
cases turn into cholera if they are not treated in the first stage; and the
fact that one of the ten, even with treatment, turns into cholera, does
not invalidate the practice,

By the year 1866, from the observations of the three great plagues,
we had learnt enough of the causation of cholera to justify us in
believing that in London it could be confined within narrow limits,—in the
first place, by preventing any extensive distribution of the cholera-stuff
through water, as the companies, in compliance with the Water Act of
1852, had, it was believed, since 1854 carried out all their purifying
filtering works; and in the second place, by the organization of Health
Officers, who could secure attention to the early treatment of premonitory
diarrhcea, and to the destruction by disinfectants of the cholera flux.
How the actual facts turned out is shown in the Weekly Returns of the
year, extracts from which are reprinted in the Appendix, pp. 295-302.
Since those publications appeared four public inquiries have been
instituted into the water supply of East London, and into other cireum-
stancys affecting the outbreak. The first inquiry was by the River
Commission, over which Mr. Rawlinson presided ; and here Mr. Greaves,
the Engineer of the Hast London Company, first admitted that the
water of the open reservoirs had been distributed over the area supplied
from Old Ford. At the instance of the inhabitants of East London,
the Board of Trade instituted an inquiry, which was ably conducted by
Captain Tyler, R.E., during a period extending from November 27th,
1866, to May 27th, 1867. And further evidence is supplied by
Captain Tyler respecting the water of the East London reservoirs at
Old Ford. The Last London Company, in a very proper spirit, met
the charge, and admitted their dangerous proximity to the Lea, by
applying to Parliament for extensive powers to improve and augment
their water by a large outlay of capital. And the Committee on the
bill, under their chairman, Mr. Ayrton, the zealous member for the
Tower Hamlets, also inquired into the operation of the Metropolis
Water Act of 1852, and in an interesting report made some important
practical recommendations.t All the London Water Companies were
represented before the Committee by eminent counsel; and the
cause of the Hast London Company was skilfully defended by
Dr. Letheby, in the character of a scientific witness. The Royal
Commission on Water Supply has taken evidence, but bas not yet
reported. The medical officer of the Privy Council has discussed the

 

* Annual Register 1832. History, page 306.
{ Report of Sclect Committee on Hast London Water Bills. Session of 1867.
DEATHS. | 365

subject ; and Mr. Radcliffe has conducted a careful independent inquiry
into the causation of the explosion in East London. I refer to lis
report for a great many interesting details, and for an explanation or a
confutation of some of the fallacies set afloat. This report, the report of
the Lancet Commission, and some articles in the Medical Times and
Gazette, should also be consulted.

Thus in the year that has followed the outbreak in East London the
subject has been amply discussed under all its aspects. The waters of
the Company, their reservoirs, their works, and their servants, have
been examined before several tribunals; and it has all been done at
leisure after the epidemic had subsided. But the Registrar-General had
to speak in the midst of the tempest, and on his words at the moment
the fate of the ship to some extent depended. “ On the recent outbreak
* of cholera in the east of London,” says the Parliamentary Committee,
“ it was ascribed by the Registrar-General to the bad quality of the
“ water supplied by the East London Waterworks Company to a part
“ of the east of London.” This was a serious charge ; andthe question
was enshrouded in difficulties ; but it will be evident that the elements
of a judgment existed in the accumulated experience of the previous
epidemics, in the known laws of the disease, and in the facts of the
case looked at comprehensively. Ina subsequent paper I have given
in a narrative form an account of the steps taken at this office to
unravel the mysteries of the catastrophe, in which four thousand five
hundred persons perished in East London. It will be seen there how
much valuable aid was given by Professor Frankland. I propose now,
when the storm is over, and with all the ascertained facts before
us, to deseribe briefly the epidemic in London, and to investigate the
causes of its irregular diffusion, The lesson to be learnt is of deep
interest to this country and to all nations. (Cholera Report, 1866,
pp. ix—xii.)

Cholera in London, 1866.—Asiatic cholera had hovered over Europe
in the year 1865. In the autumn a few victims of the disease dicd in
England. Epidemic cases then occurred both in Portsmouth and in
Southampton.* At Epping, in Essex, the Groombridge family, the
medical attendant, and a woman who Jaid out their servant, were killed
by cholera in the last days of September and the first days of October.
Nothing remarkable was observed in London until the year following,
on Wednesday, July 11th, when five deaths by cholera occurred ; on the
12th and on the two following days 11, 20, and 15 persons died. Life
was then fiercely assailed by the disease in its quick form: the deaths
ran up from 14 on Sunday to 105 on Saturday July 21st; on Tuesday
July 31st the deaths were 191, on Wednesday 188, or including the
deaths in West Ham and Stratford, 205 ; they then declined.

Proceeding in weeks from Sunday, July 1st, the deaths by cholera in
the five weeks that ended on August 4th were 11, 63, 481, 1,097, 1,178.
Then dividing London, including West Ham and Stratford, into two
portions: in that supplied by seven water companies (Grand Junction,
West Middlesex, Chelsea, Southwark, and Lambeth from the Thames,
Kent from chalk wells, New River from wells and Lea River,) the
deaths by cholera were 10, 25, 61, 142, 196, but in the sub-districts
supplied wholly or partially by the East London Water Company the
deaths in the contemporaneous five weeks were 1, 38, 420, 955, and 982.
Thus in the first week the East London field bad one death, the rest of
London had ¢en deaths ; in the fourth week the deaths were 142 in the
rest of London, and in the East London field 955 deaths from cholera

 

* See Annual Report of 1865, p, 163.
366 [PART Iv.

alone. Several of the earlier deaths by cholera in other districts
happened to persons who had come or been sent from the East London
field. Each death by cholera implied two attacks about two days
before death. And for every attack by cholera there were about four
attacks by diarrhcea, approaching more or less in character to cholera.
As the epidemic rose so it declined more rapidly in the East than in the
other regions of London.

The total deaths in London, with West Ham and Stratford, were
5,973 by cholera, 3197 by diarrhea (about 800 referable to the epidemic),
9,170 by the two maladies. It will be observed in the tables that,
although unquestionable cases of the disease occurred in every sub-
district of London, and in some the number of deaths was not incon-
siderable, the enormous disparity between the earlier ravages of the
epidemic in the eastern waterfield and the rest of London was never
effaced. (Cholera Report, 1866, pp. xii-xiii.)

Origin and Causes of Cholera.—It may be stated first, simply as
hypothesis, that the cholera is propagated epidemically by a material
substance, analogous in its nature to the substances which produce,
under given circumstances, small-pox, cow-pox, syphilis, erysipelas.
This matter may be called cholrine,* for the same reasons as certain
substances were designated sugar long before the chemical constitution
of any kind of sugar had been determined, or before that substance had
been obtained pure. Dr. Snow advanced the view in 1849 that the
evacuations containing this matter, distributed by contact or through
water, were the sole means of propagating the cholera, which, on the
cellular theory, he held was propagated by cholera-cells. Dr. Richardson
contends that the cholera-matter is an “ alkaloidal organic poison, which,
“ soluble in water, but admitting of deposit on desiccation, passes easily
“ from one person to another under the agency” of certain peculiar
physical states.f It is a fact well established in the practice of vaccina-
tion, that the specific matter of cow-pox after insertion is developed into
full activity day by day in the pustule, and then loses its qualities, so as
no longer to take effect even under the most favourable conditions. In
this respect the stuff is like an organism: it is produced by pre-existing
forms out of other matter prepared for its reception ; it is developed,
produces its like, and decays. Brittain, Swayne, and Budd, indeed, held
in 1849 that they had discovered the cause of cholera in a fungus :{
Dr. Buchanan and Mr. Simon, the medical officer of the Privy Council,§
have given an interesting account of recent researches in this direction
by Ifallier, pointing to the action of urocystis, and by Pacini to vibrional
molecules in the intestinal canal, as its specific exciter.

Pettenkofer, who first drew attention to the sanitary importance of the
subsoil water line (Grundwasser), which rises and falls more or less in
different years, showed that in Germany the localities which have their
water-line nearest to the surface had suftered most from cholera, and that
the epidemic coincided with the rise and subsidence of the water in the
soil.|| Cholera in Bavaria, he says, prevailed epidemically only in places

 

* Registrar-General’s 4th Annual Report, page 200; 1842. The matter of
dysentery is there called enter ine, of cholera, cholerine, which I now propose to write
cholrine, to avoid any ambiguity.

+ See Dr. Richardson on Theory of Propagation of Cholera.—Transastions of
Epidemiological Society, Vol. IL., V’art. II., page 432.

t Report to Registrar-General, Cholera Epidemic, p. lxxvi.

§ Ninth Report of Medical Officer of Privy Council.

|| A clear account of Pettenkofer’s doctrine is given by Dr. Weber in Transactions
of Epidemiological Society, Vol. Il, Part II., page 404. See also Letter from
Professor Pettenkofer in Appendix, p. 280,
DEATHS. | 367

having a porous soil, with water never more than from five to fifty feet
below the surface. It should be borne in mind than in many of these
Bavarian towns water is drawn from wells by pumps or otherwise. The
excretions of cholera patients give the germ, the soil develops it, says
Pettenkofer. This is founded partly upon the interesting experiments
of Thiersch, which have been repeated by Dr. Sanderson, who has
shown conclusively that paper saturated in cholera flux, and dried, when
eaten produces the disease in a transmissible form in mice. The fresh
flux the first day after exposure in the air is almost inert, on the second
day it grows more active, on the third it is at its maximum of activity, is
jess and less active on the fourth and fifth, inert on the sixth day of
transformation. Of 148 mice experimented on, 95 showed no symptoms,
53 were affected, 31 died. The successful experiments were made
between 9th September and 10th October, when the mean temperature
was 56° ; a second series between 3d and 13th November, when the
mean temperature was 49°, failed.*

This is thus far confirmatory of the hypothesis that the epidemic is
propagated by cholera matter, which it may be said is not very well
characterized by the stereotyped words ‘“rice-water evacuations.” In
its pure form, after agitation, the cholera flux has the appearance of thin
cream, from which flocculent matter subsides after the lapse of some
hours, leaving a supernatant milky liquid. Onze volume was mingled
for me by Professor Frankland with ¢en volumes of distilled water in a
long glass tube: the flocculi subsided much more readily, leaving an
opalescent liquid above. One volume to one hundred volumes of water
in along tube presented the same appearances, but in a less marked
degree. Mixed in 500 volumes of water the opalescence was retained
after the liquid had been passed through filter paper. Opalescence is a
characteristic feature of the cholrine, even as it exists in a liquor holding
less oxidizable organic matter than the filtered London waters ; and in
these minute quantities it cannot at present be detected by chemical
analysis. Ifthe matter is organized it is necessarily suspended in water
and cannot be in solution.T

Numerous facts prove that cholera is communicated to a certain
proportion of the women washing the clothes of cholera patients, and
1 showed that the parts of London near the warm infected Thames
suffered in an unusual degree during the epidemic of 1849;{ hence it is
not improbable that cholrine is to some extent carried up from warm
liquids by watery vapour.

The cholera matter is often yielded by children, and even by adults,
suffering from diarrhea, and not afflicted by the characteristic symptoms
of Asiatic cholera.§ This property it has in common with scarlatina,
syphilis, small-pox, and other zymotic diseases, where the mildest types
communicate to other bodies diseases in their most malignant forms.

The cholera flux is of low specific gravity (1,008), and thus poured
on the surface of water sinks very slowly,|| but in the end it gradually

 

* Ninth Report of Medical Officer of Privy Council, page 452.

+ See Professor Frankland’s interesting account of cholera flux. I procured this
matter for the sake of studying its comportment when mixed with water in glass
tubes. The liquids in the hot weather have undergone little change since the tubes
were sealed, 26th October 1866, except that the cholera liquid is browner, and that
the flocculent matter in the hot weather rose to the top of the water in the tube
containing one-tenth of cholrine. 11th September 1867.

{ Cholera Report, pp. lviii-lxi.

§ Virchow’s Handbuch der Speciellen Pathologie und Therapie, 2 Band, 2 Abth.
page 332. The article of Griesenger on Cholera gives all the German learning in a
well-digested form. :

|| Rice-water evacuations.—Cholera flux is of low specific gravity : taking pure
water as 1,000 it is given by Dr. Robert D, Thomson as 1,008; that of blood serum
368 [PART IV.

falls towards the bottom of the vessel, leaving slight traces in the upper
stratum, and containing increasing quantities as the bottom is approached.
It is important to bear this physical property in mind. For cholera flux
dropping on the surface of the Broad-street well would be pumped up in
proportions varying with their stage of descent, and on falling to the
bottom might leave the upper water clear, I mention this simply by
way of illustrating the effect of the purely physical properties of the
cholera flux on the doses of it in the same quantity of water at different
hours of the day, or of successive days. For the game reason the waters
of contaminated reservoirs vary in zymotic strength from hour to hour.

It may appear at first sight impossible that the cholcra flux of one or
more patients should produce any effects in the waters of a river like the
Thames. But living molecules endowed with the powers of endless
multiplication are inconceivably minute, and may be counted by millions
in a drop of water. Pacini, an excellent microscopic observer, has found
that the germs of vibrions (molecule vibrionalt) are less than usboo of
an inch in diameter*; and placed in immediate juxtaposition a cubic
inch would contain (25,000)3 = 15,625,000,000,000 germs. Allowing
for interspaces, it is evident that a cubic inch might hold millions of
cholera particles, and one cholera patient might disseminate in water
millions of millions of zymotic molecules. <A litre of blood contains,
according to the determinations of Vierordt, 5,069 millions of corpuscles.
The water of a city is less in bulk than its atmosphere, and diseuse-
molecules, if freely distributed through both elements, will be rarer in
air than in water, IPfwe judge from analogy, a certain quantity of the
cholera matter is necessary to render its effect at all probable, as germs
of disease are as profusely expended by nature as seeds of plants.

The infection-power of cholera liquid is essentially transitory: it
is developed in given circumstances in its intenser form, and in a

 

being 1,028 in the healthy, while in two cholera cases it was 1,042 and 1,058 re-
spectively. ‘The most abundant matters present are flocculent bodies, which impart
the characteristic aspect to the fluid. Dr. Hassall says this liquor, after being set
aside for some time, let fall a deposit varying from a fourth to a sixth of its bulk,
consisting, as seen under the microscope, of innumerable mucous corpuscles, globules
of oil, and myriads of vibrions in every drop of every sample of rice water examined.

Y

—Appendix to Report of the Committee for Scientific Inquiries on the Cholera
Epidemic of 1854, pp. 285-293.

* Appendix to 9th Report of Medical Officer of Privy Council, page 519; Pacini,
Sulla Causa Specifica del Col. Asiatic, 1865; and the work Della Natura del Col.
As,, 1866.

} Carpenter’s Physiology, 6th Edition, page 155.

“Newport adds the important fact, established by numerous experiments, that
when a very small number of spermatozoa are applied to the ova of Batrachians, they
are only partially impregnated and the embryo is never fully developed eer
With respect to plants nearly the same results were obtained by Kélreuter and
Girtner. This last careful observer found, after making successive trials on a malva
with more and more pollen-grains, that even thirty grains did not fertilize a single
seed, but when forty grains were applied to the stigma a few seeds of small size were
formed. The pollen grains of mirabilis are extraordinarily large, and the ovarium
contains only a single ovule; and these circumstances led Naudin to make the fol-
lowing interesting experiments : a flower was fertilized by three grains and suc-
ceeded perfectly ; twelve flowers were fertilized by two grains, and seventeen flowers
by a single grain, and of these one flower alone in cach lot perfected its seed ; and
it deserves especial notice that the plants produced by these two seeds never attained
cheir proper dimensions, and bore flowers of remarkably small size. From these facts
we clearly see that the quantity of the peculiar formative matter which is contained
within the spermiatczoa and pollen-grains is an all-important element in the act of
fertilization, not only in the full development of the seed, but in the vigour of
the plant produced from such seed.”

[The Variation of Animals and Plants under Domestication. By
Charles Darwin, M.A., F.R.S. Vol. IL, pp. 863-64.]
DEATHS. | 3869

community as well as in an individual,—in India as well as in England,—
it grows as well as declines by alaw of its own; it is epidemic only for a
time and by periods of years. It has its seed-time and its harvest in
each locality, and the air or the water which on one day is poisonous may
a few days afterwards be harmless. There is thus an essential difference
between zymotic venom and a metallic poison like arsenic.

In its weakest form cholrine produces diarrhea in a great number of
persons; but in every population a large number of people appear to
resist its influence. They are insusceptible. The cases of attacks of the
same person twice in this as in some other zymotic diseases are rare.
(Cholera Report, 1866, pp. xiii-xv.)

Localization of Cholera in East London, 1866.—We may now discuss
the question of the unequal diffusion of cholera over London in the last
epidemic. It may be assumed that the cholera in its Asiatic form was
brought into England in 1866, and the argument will not be affected if
the first cases originated on the banks of the Lea, and not on the shores
of the Ganges. It may be further taken as proved that it is propagated
by the cholera flux ; and let those who doubt this accept the principle
for the moment as hypothesis, which the subsequent crucial facts will at
once either establish or dispel.

Then the elements of the disease must either have been diffused (1) by
personal contact ; (2) by translation through the air; (3) or by dissemi-
nation in vapour of sewers; or (4) by the various waters.

Now the evidence that cholera can be communicated in these ways by
cholrine is conclusive. Instances of a cholera patient brought to a
distant house and communicating forthwith the disease to an inmate are
too numerous to be mere coincidences ; as the chances by the doctrines of
probabilities against such numerous coincidences are inconceivably great..
But it is evident that as the population of every district of London
is in free communication with every other district, and is constantly
interchanging its residents on both sides of the river, so by this mode of
communication cases would be, as indeed they were to a limited extent,
freely distributed all over London. The same might be said of the air:
any gas generated in any point of London is by the iaw of gaseous
diffusion speedily distributed through the atmosphere; and matters in.
suspension are distributed by the winds, which are thus described during,
the first four weeks, extending from July 8th to August 4th, which saw
the rise and decline of cholera: variable; N.E. and E.N.E.; variable ;
W. and W.N.W. The winds were not still, but blew in various direc-
tions over London at the rate of eight miles an hour during the first
three weeks, and then with double that velocitv. Ifthey carried cholera
on their wings they must necessarily have shed its poison over all
London; the action of the winds could not have been confined to the
small area of East London. In India the cholera matter is scattered by
the natives on the surface of the earth, and may be either washed into
the tanks or be dispersed in clouds of dust.* But in a town of water-
closets and privies the diffusion of dry cholera dust must be exceedingly
circumscribed.

In the watercloset system the cholera flux in vapour, if it is not some-
times generated, is sometimes distributed in sewers, and is driven into
the dwellings of the people. An instance of diffusion in sewer vapour at
Southampton is given by Professor Parkes in his masterly paper.{
Professor Parkes in the same paper shows that the foul water of the
Peninsular steamer “ Poonah” proved much more virulent than sewer

* See Fick’s letter on Ztirich outbreak.
t Appendix to Ninth Report of Medical Officer of Privy Council, pp. 244-233.

AA
370 [PART Iy-

vapour. And it is evident that the amount of zymotic matter evaporated
from cholera flux, and entering the system through air, must be incon-
siderable as compared with the amount that may enter through a water
supply contaminated with sewage.* All over London the sewage exhala-
tions went on during the summer of 1866, and produced certain effects.
It happened, too, that several districts in the group so heavily visited by
cholera lie in the particular region which then derived no advantage
from the contemplated low-level sewer. But too much importance must
not be attached to this circumstances. The whole of the region on the
Thames, from Chelsea to the city of London inclusive, is in the same
predicament, and there the mortality by cholera in the present epidemic
was low; in the Chelsea water-field, for example, the deaths by cholera
did not exceed 4 in 10,000, nor is the rate exceeded by the average
mortality of the whole region along the proposed low-level sewer except
in the East London water-field, where the mortality by cholera was at
the rate of 72 deaths in 10,000 living! Again, West Ham with Strat-
ford-le-Bow has an independent drainage system of its own; and over
this region, where the same water went, the same dreadful mortality
prevailed.

The cause of the mortality of cholera in London, whether on the north
or the south of the river, up to the rate of 5 in 10,000, it may be admitted
on all hands is explained by the diffusion of the cholera-stuff through
personal intercourse, sewers, and the slight contamination of the waters
either of wells or of the Thames and of the Lea after filtration by the
water companies. All those companies had before 1866 professedly
carried out extensive works for taking their waters from better sources,
for filtering it, for storing it, for distributing it, in conformity with the
provisions of the Metropolis Water Companies Act of 1852; and their
works had been pronouuced very good by three engineers appointed by
the President of the Board of Health. “The requirements,” said the
three engineers, “set forth in the Metropolis Water Act, 1852, have in
“all essential respects been fully and satisfactorily complied with by
“ the several companies.’ t

The East London Water Company’s works are described in the
Engineers’ report: in 1850 it had six open reservoirs, one at Lea
bridge, one at Stamford Hill, and four at old Ford; in 1855 the new
filter beds at Lea bridge were completed; the filtered water was brought,
in a four-feet iron pipe, to Old Ford, into two oval reservoirs, which,
used formerly as subsiding reservoirs, were now covered over with brick
arches and earth. ‘“ The other reservoirs of the company near Old
“ Ford and that at Stamford Hill are,” says the reporters, * now
“ thrown out of use. * * * The iarge depositing reservoirs upon
“ which they had to rely for clearness of the water have now been
© abandoned, and all communication between them and the mains has
“ been cut off.”{ In the reporters’ map the small covered reservoirs of
2k acres is engraved; the two open reservoirs of 9 acres, east of the
Lea, are suppressed in the map, on the ground probably above alleged,
that “ they were thrown out of use.” These open ponds do not figure
in the elaborate water map of R. W. Mylne, C.E., published in 1856.

rs

 

* Dr. Hassall remarks that the sporules of some fungi are aerial and repel water,
but vibrions are true aquatie productions : ke found no vbrions in the water distilled
from rice-water flux at a low temperature.—A ppendix to Board of Health Report of
Committee for Scientific Inquiries, page 305.

+ Report to Right Hon. W. Cowper, M.P., President of Board of Health, on
“Metropolis Water Supply,” 1856, by H. Austin, W. Ranger, and A. L. Dickens,
Superintending Inspectors, p. 101.

{ Ibid, pp. 65, 67.
DEATHS. | 371

‘The open reservoirs contain water admitted to be unfiltered; and
Mr. Greaves, the engineer, speaking for the company, in his letter to the
Times, dated August Ist, 1866, made this statement: “The facts are
“© * * that the canal having been since 1853 disused for all purposes
“ of supply, is only maintained as a drain from the filter to a lower
“ part of the river ; that not a drop of unfiltered water has for several
“years past been supplied by the company for any purpose.”*

This was perplexing, but the company, by taking the unfiltered water
from the open reservoirs, violated an Act of Parliament, and on the
ground, perhaps, that they were not bound to criminate themselves,
they, in the words of their engineer, besides pleading “not guilty,”
boldly proclaimed their innocence on August Ist. Shortly afterwards
Mr. Greaves, however, admitted candidly, that the open reservoirs of
unfiltered water could be drawn on; and by the report of Professor
Frankland (August 25th) goes a step further. ‘* Communication,”
Professor Frankland says, “can be established between these reservoirs
* and the pumping wells supplying the public, but Mr. Greaves assured
“ me that it was never done, except in cuse of emergency.”t In his
examination before the Pollution of Rivers Commission on December
10th, Mr. Greaves advances another step, and states, that “a small
“ quantity of water was taken out of one of the open reservoirs this
“ spring ;” “he had not the date,” “ probably June was the latest date,”
but he could not say definitely. Further revelations were made by the
workmen under examination by Captain Tyler; and the story is at
length thus told by officers of the company :—

The foreman of the company died quite suddenly of apoplexy early
in this year (1866). In appointing a new man, in giving him dis-
cretionary instruction as to how he was to manipulate the water, “I
“ described,” says Mr. Greaves, “this possibility [of drawing on the
“ open ponds] as something which he must keep in mind, rather than
“ suffer an accident, and so I suppose he may have acted in that sense.”
He, Mr. Greaves, kept these open ponds in reserve, as the question of
quantity was important, “to meet such necessities as might arise.”

The Lea, Mr. Beardmore asserts, was full of water in 1866; how then
could the supply be in any way deficient in July ? This is explained to
some extent by Mr. Maine, the manager of the works at Lea Bridge.
The rapidity of filtration is very variable; and in the month of July
every year§ a slimy matter is rapidly deposited on the sand, blocking
up its pores, and stopping this filtration altogether. In August this
slimy matter grows, and no sooner produces green confervoid fibres than
the power of the filters is restored; the water flows freely.

The foreman of the works, in his evidence, says that he considered
the water in the open reservoirs available as a reserve in the event of
the water getting low in the covered reservoir, to prevent the damage of
the engine with the higher suction. He kept no notes, but he
believed that he allowed the water to run from the open to the covered
reservoir not more than three times during the year 1866; at the latter
end of March, at the latter end of Sune, and some time in the early
part of July. The sluice was never open after cholera broke out; he is
certain of that. He had no fear of its doing harm.||

A carpenter, twenty-four years at Old Ford, appears to have been the
only man who worked the sluice between the open and the closed

 

* See Appendix, p. 92,

t+ See Appendix, p. 124.

ft See Extract from Mr. Greaves’s Evidence, pp. 100-101.
§ See Professor Frankland’s Report, Appendix, p. 123.

\| Appendix, p. 105.

AA 2
372 [PART lv.

reservoirs. He did other jobs, but that was his specialty. He opened
that sluice freguently in 1864, frequently in 1865, and three times (!) in
1866. He describes in three cases what he did. In March he was at
the engine-house : the engine began to draw air; and he was ordered by
the engineer of the company to open the sluice. He left it open two hours.
In June he was about the yard, when the engine driver called to him,
and “ordered him to let him have some water.” He complied by
command of the foreman. About two p.m. early in July, and this may
have been the first fatal day, he opened the sluice again, and left it open
for about the same period of the day. ‘ He considered the water in
“ the open reservoir to be very good, and had often drunk it.”*

When this statement is compared with that in Mr. Greaves’s letter,T
and when it is borne in mind that these dependent men were not giving
evidence on oath, that the opening of the sluice would be precisely one
of those acts of which no record was desired, we can scarcely expect a
more explicit statement. It is enough to have in evidence, that immedi-
ately before the outbreak in July the foul water of the reservoirs was
pumped over the parts of East London where cholera was epidemic.

Again, there was another channel for the entrance of the foul water of
the Lea directly into the covered reservoirs supplying the pumps.
Professor Frankland sagaciously remarked, that the bottom of these
reservoirs, within a few yards of the river, is 16 feet beneath the low
ground, which is here only just above the level of spring tides. When
the tide was high, and the water of the reservoir was low, the permeation
of the water through the gravelly bottom into the reservoir was on
hydraulic principles inevitable. Captain Tyler describes graphically
how he put this to the proof, and established the fact, by wading over
the bottom. The reservoir was on Sunday, February 24th, at his.
instance, pumped, in 36 hours, as low as possible, the bottom was found
foul, but the water at last came in faster than it could be pumped out by
the powerful engine. The patience of the waiting company was
exhausted; the water still came in.

Cholera flux, with the other excremental matters in the channel of the
Lea, thus must have found its way from the reservoirs to the pump
welis of the company at Old Ford.

Mr. Greaves himself could not perhaps describe precisely what took
place in July, but this is substantially what occurred :—The Lea at Old
Ford was much more polluted in the summer of 1866 than it was in
1854, for, besides the sewers emptying into it on the side of East
London, the whole sewage of Stratford and West Ham on the Essex
side has since 1561 been discharged into the Bow Creek arm of the
river at the iron bridge. This sewage is washed up and down the
stream by the ebb and flow of the tide twice daily between and in close
proximity to the open and the storage reservoirs of the company. The
storage reservoir, full, holds 6,000,000 gallons of water in the morning ;
in the day 8,000,000 gallons flow into it by the iron pipe from Lea
Bridge; and as the pumps distribute 11,000,000 gallons in the day,
8,000,000 gallons are left in the reservoir at the close of the day, to be
augmented to 6,000,000 in the night when the distributing pumps cease
working. But one day, early in July, probably on Monday or Tuesday
July 9th or 10th, at 2 o’clock in the afternoon, the storage reservoir was
at the lowest ebb, and the dregs of the water were drawn on, the well
was scantily filled, the pump gave unmisiakable signs of distress, the
engine-driver called out for water; und then the old carpenter opened
the sluice and let in the contents of the northern stagnant pond, with

 

* Appendix, p. 105. + Appendix, p. 92.
DEATHS. | 373

its bottom pervious alike to the waters of the Lea and to the waters of
its sister reservoir, which had been recently refilled by soakage from the
Lea, and was slightly turbid and milky on the 9th of August.* How
often this was repeated in July it is impossible to tell, as the engineer
did not even know that the pond water had been used at all in that
month, and the old carpenter’s memory, minute in some respects, repro-
duced facts too imperfectly to form a basis for a negative argument.
If the scanty supply of water was due to slimy obstructions of the Lea
Bridge filter bed, Mr. Maine tells us that the slime lasts till its germi-
nation in August. Again, if the supply from Lea Bridge in July was
dess than in May the East London Company must have drawn on its
-open reservoirs, for in their return they give the quantities supplied at
2,167,885 gallons a day more ‘in July than in May. They distributed
636,000,000 gallons of water in July, where did it all come from ?

The lowness of the water level in the storage reservoir would during
the same month let in impurities from the Lea every evening.

Several cases of cholera and choleraic diarrhoea had occurred over
London in May, and on 27th June, at 12, Priory Street, Bromley, one
poor Hedges, a labourer, and his wife, both of the age of 46 years, died
of “ cholera Asiatica,” the former after 15 hours, the latter after 12 hours
illness. Their cases are minutely described by Mr. Radcliffe, who traces
the discharge into the watercloset of 12, Priory Street, and thence
300 yards down the sewer to its opening into the Lea at Bow Bridge,
half a mile below the Old Ford reservoirs.f He attaches great impor-
tance to these first cases; and they undoubtedly sufficed to pour into
the sewers and waters millions of zymotic molecules, which day by day
grew more and more frequent in the Lea by every hour’s choleraic
discharges on both sides of the river. On Wednesday, 11th July, the
‘first four deaths of the explosion occurred, one in each of four distinct
sub-districts; and allowing for duration and incubation, it is not
improbable that the four persons took the poison early in the week.
Nine deaths occurred on the 12th in seven of the East London
sub-districts wide apart. On Wednesday the 18th, were 59 deaths,
singly, or sometimes in clusters of 8 or 9 deaths in 16 sub-districts of
the East London water-fields ; a few deaths dropped in here and there in
a sub-district of the other water-fields; but this mass of death in East
London was due evidently to some superadded agency. It operated
mainly in every district supplied by the Old Ford pumps, that is, in
Bow, Bromley, Poplar, Limehouse, Mile-End-Old-Town, St. George-in-
the-East, Whitechapel, parts of Bethnal Green and West Ham, which
Captain Tyler tells us would in the ordinary way be suppiied “on the
“¢ greater part of week days from Old Ford.’’f

The East London field is supplied by the company from pumps at
‘two different sources, three miles apart: (1) from the Lea Bridge pumps
‘drawing their water direct from filter beds, and beyond the range of
‘tidal sewage contamination, and (2) from the Old Ford pumps.

At Old Ford there are houses with five pumps and steam-engines of
640 horse-power, at Lea Bridge two engines of 300 horse-power. The
power in the gross is equal to the delivery of 38,000,000 gallons of
water daily. The actual supply during the year 1866 was 19,380,739
gallons daily.§ Of this, Captain Tyler says, 11,000,000 gallons are

 

* See Professor Frankland’s Report in Appendix, p. 125. Extract from Letter
of Mr, J. Hutchings, who passed by the East London ponds at Old Ford nearly
every day during the year 1866.

+ Appendix to Ninth Report of Medical Officer of Privy Council, p. 285.

+ Report on the Quantity and Quality of the East London Water Supply. Parlia-
mentary Paper, No. 339, Session of 1867, p. 16.

§ Appendix to Report of Select Committee on East London Water Bills, Session
of 1867, pp. 266, 269.
374 [Part Iv.

delivered daily from Old Ford, and the rest (8,380,739) from Lea
Bridge. With some variation, this is the order of the work :—the
engines at Gld Ford are started at 54 in the morning and stopped at
74 p.m.; and from 7} in the evening till 54 aa. of the next day the
water supply “is entirely produced from the Lea Bridge station.”*
“The Old Ford engines do not,” says Captain Tyler, “work at night
“ or on Sundays.” “The water from Lea Bridge at those times
* supplies the whole district [water-field] passing by Old Ford, and even
“* to the Essex part of the district.’{ Three hundred miles of street
are traversed by the company’s pipes: the pipes of six inches and
upwards, called by the engineer “mains,” are 147 miles long ; while
the smaller “ service pipes,” some constantly charged, the others turned
on once a day, are 828 miles long.t

The effect of all this is, that the Lea Bridge waters usually meet the
Old Ford waters at a fluctuating line running from Victoria Park,
through Bethnal Green, onwards to Spitalfields. Far south of this line
the Lea Bridge waters pass on Sunday, and even early in the morning,
but only in very rare instances could the Old Ford waters be carried
into Hackney north of that line.

It was precisely in the region of the Old Ford waterfield that cholera
raged. There, in three months, it killed little less than 4,000 men,
women, and children ; while in the Lea Bridge field, and in all the other
water-fields of London, the epidemic was kept within such narrow
limits of fatality as would be accounted for by diffusion through sewers,
direct contact with cholera matter in various ways, and the slightly
contaminated filtered river waters of the other companies.

It must be evident that the dose of cholera matter in a given quantity
of the water supplied from Old Ford would vary indefinitely in different
localities, for example, assume that the North Woolwich main was filled
by water pumped from the covered reservoir before 2 o'clock on the fatal
afternoon of July, when the old carpenter confesses that he let in the
open pond water, or that it was filled on Sunday with the water of
Lea Bridge, and in either case the water of the main would be compara-
tively pure. In fact as the composition of the water in the supply
reservoir would vary from day to day and from hour to hour as the level
of the water got lower, and as the tide of the river happened to be in or
out, it is evident that the composition of the water in the supply pipes
at any given moment would vary to an inconceivable extent.

But the cholera matter, after it leaves the body, undergoes changes of
which some may render it more, others less and less, active from day to
day ; and, moreover, this flux holds in suspension active matter heavier
than water ; hence it is probable that in an aggregate of several districts
thrown together, to get rid of accidental disturbances, the effect of the
cholera flux will be least in elevated and in remote districts supplied by
sains constantly filled. The cholera flux in a six-inch iron pipe, rising
for a mile to an elevation of a hundred feet, would comport itself very
much as we see it in a glass-tube; thus, if the flux was equally distri-
buted from the reser voir over the field of a company varying in elevation,
the quantity of cholrine in a given quantity of water, like the quantity
of cholera in a given population consuming that water, would vary with
the elevation. The cholrine might also vary with the distance of the
point of discharge, as the velocity of water and the quantity of matter it
carries in suspension change under most complicated hydraulic laws, to

 

* Evidence of Mr. Greaves before Rivers Commission, Q. 384, page 11.
} Captain Tyler’s Report (Parliamentary Paper, p. 16).
{ Appendix to Report of Select Committee on East London Water Bills, p. 267.
DEATHS. | 375

say nothing of the laws of the changes affecting cholrine itself—( Cholera
Report, 1866, pp. xv-xx.)

Cholera in the several Water fields of London, 1866.—I now proceed
to call attention to the mortality from cholera in the various water-fields
of London.* As their areas correspond with none of the other
recognised divisions of London, the 185 sub-districts have been distri-
buted into 15 groups, under the various heads corresponding as nearly
as possible with the water-fields. It will be seen that while there is a
certain mortality from cholera in every condition, the excess above this
standard is constantly in proportion to the impurities of the water
during the epidemic period.

London is now supplied with water by eight companies. South of the
Thames it is supplied by three companies; the Lambeth and the South-
wark companies taking their waters from the Thames; the Kent drawing
its waters, the officers say, from wells, and not as formerly from the
Ravensbourne. London, north of the Thames, is supplied by jzve com-
panies, the Chelsea, the Grand Junction, and the West Middlesex taking
their waters from the Thames, the East London from the Lea, the New
River from the Lea mainly, and from wells. The area which each
company respectively supplies I call its water-field, and London is con-
sequently divided into eight such fields. In some cases the water-fields
of two or three companies are intermingled at their edges, and do not
coincide precisely with the registration districts. Pumps exist to some
extent, and draw water from shallow wells. By taking the sub-districts
included in each water-field we get, however, eight areas, each of which
is supplied almost exclusively by one of the eight companies, and where
the mortality by cholera in three epidemics can he determined with
sufficient exactness. ‘Then we have a group of the sub-districts supplied
conjointly by the New River and the East London companies, some
streets of cach sub-district getting water from one company, other streets
getting water from the other company ; and so it is in the case of other
companies. Thus 15 groups of sub-districts have keen formed; each of
8 supplied by a single company, and each of 7 by two companies.

The proportion of deaths by cholera to 10,000 inhabitants in 1866
will show the relative fatality of the disease. Thus the deaths by cholera
in the field of the Chelsea company were in the proportion of
4; in that of the West Middlesex 4; in that of the Grand Junction 8 ;
nor do the proportions differ from those above given to any extent in the
sub-districts supplied conjointly by any two of the companies, as is
shown in the Table. The rate of mortality in the group supplied by the
West Middlesex Company and the New River is necessarily corrected,
for of the 48 deaths there by cholera 36 took place in University College
Hospital, among patients brought from all the sub-districts in its
vicinity. After a correction for these imported cases, the proportion
is reduced to the average. The deaths in the water-fields of the three
companies, including all the three sub-districts which they supplied
jointly with the New River, amounted to 266 by cholera, 687 by diarrhea,
among a population of about 739,279, giving 4 in 10,000 as the death-
toll by cholera, and 9 as the death-toll by diarrheea, which included
a certain proportion of choleraic cases.

The fatal cause, and the means employed to hedge it in, produced a
very uniform result over the first seven groups of the T'able* ; and upon
taking the 27 western sub-districts of which they consist, covering an
area of 15,020 acres, and extending from Fulham on the Thames to.

 

~ Cholera Report, 1866, Table 83 (Appendix, p. $3),
376 [PART Iv.

Charing Cross and Hampstead, the differences of cholera death in the
sub-districts are not of any significance.

The water-field of the New River is extensive ; it covers the large part
of London lying along the Thames from Hungerford Bridge over the
city of London down to Si. Catherine’s Dock, and extends northwards
to Stoke Newington and Highgate. This company supplies exclusively
39 sub-districts on an area of 8,755 acres, inhabited by about 834,617
people. The deaths in this region were 661 by cholera, 846 by diarrhea.
The deaths by cholera were in the proportion of 8 to 10,000 inhabitants,
by diarrhoea 10. ‘The mortality by cholera was more than double that
of the western water-fields; but by diarrhea there was only a slight
excess; indeed, the deaths were proportionally less than in the West
Middlesex water-field.

The water-field of the East London Company covers all the area of
London on the river Lea, and extends to Stratford and West Ham,
which are not yet in London. The deaths in the 22 sub-districts
supplied by this company were 3,947 by cholera, 813 by diarrhea; the
deaths by cholera were thus 72, by diarrhcea 15, in every 10,000 in-
habitants. This dreadful mortality by cholera was nine times as great
as in the New River sub-districts, and ¢wenéy times as great as in the
north-western sub-districts. In seven populous sub-districts supplied
jointly by the East London Company and the New River the deaths were
in the proportion of 34 by chelera, 11 by diarrheea.

And it will be remarked that the mortality by cholera was excessive
in every one of the 29 sub-districts supplied by this company wholly or
partially from the Old Ford reservoir, except Stamford Hill, which is
said by the officers to have got its water from Old Ford.*

Crossing over the Thames, the whole of South London lies before us.
There the three high sub-districts of Sydenham, Norwood, and Streatham
lost out of every 10,000 inhabitants 3 by cholera; they were supplied by
the Lambeth and Southwark Companies. The deaths in the exclusive
field of the Southwark Company were 7, and in that of the Kent Company
15; the cholera deaths in the 17 sub-districts supplied conjointly by the
Southwark and the Lambeth Company were 6 in 10,000 inhabitants ;
and 6 in Peckham, which is supplied by these companies in conjunction
with the Kent Company.

In the whole of South London the cholera deaths were 8 in 10,900
inhabitants, which stands in strong contrast to the 72 deaths to an equal
population in East London.

It is then evident that in the year 1866 the epidemic cholera matter
(cholrine} found its way into every district of London; that its quantity
varied, and was limited in every district within narrow limits, except in
the water-field of the East London Company, where the cholera deaths
_also varied from place to place, but were in nearly every locality so
excessive as to leave no doubt that an excess of cholrine was distributed
over that field.

That neither less poverty, depression of soil, nor density of population
suffice to account for the diminished prevalence of the epidemic in South
London is evident on comparing the cholera deaths of the same
sub-districts in the year 1849 and in 185+.

 

* Mr. Greaves, in his evidence before the Rivers Commissioners, says: ‘The
“ Stamford Ilill district Iam able to supply either from Lea Bridge or from Old
“ Ford. . . The Lea Bridge water-whee] is now (Dec. 10, 1866) working to
“ Stamford Hill, but for some years past I was entirely supplying Stamford Hill
« from Old Ford.” (Rivers Ccmmission, 2nd Report, Vol. IL, Evidence, p. 11.)
DEATHS. | 377

Confining our attention to South London, there is no reason to believe
that the poverty of the districts was greater in 1849 and in 1854 than it
was in 1866 ; the density of population was less, the depression of the
soil was the same, and yet in 1849 the cholera deaths to 10,000 in-
habitants were 121; in 1854 the cholera deaths were 94; and, as we
have seen, in 1866 they fell to 8. The cholera deaths to 10,000 fell at
once in the four sub-districts supplied exclusively by the Lambeth Com-
pany from 93 in the year 1849 to 17 in the year 1854; in the sub-districts
supplied jointly by the Lambeth and the Southwark Companies from 138
to 95 ; in the sub-districts supplied by the Southwark alone the proportions
rose from 135 to 154, Some deterioration in 1854 is noteworthy in the
Chelsea water-field, but there is a noteable amelioration in the water-fields
of the New River and the East London. In the water-rield of the Grand
Junctien Company, the fatality of cholera greatly increased in 1854 ; and
that not only in the Golden-square sub-district in the vicinity of Broad-
strect pump, but in Kensington town, and St. John, Paddington. The
mortality by cholera in the Chelsea and the West Middlesex water-fields
was higher in 1854 than in 1849 ; and the waters of the upper Thames
had grown impurer.

The companies were appealed to (see Appendix, pp. 297-301), and
several of them improved their waters materially before the Act of 1852
came into operation ; butin the beginning of the year 1853 the Lambeth
Company, quitting its source of supply at Hungerford Bridge, where the
Thames was foully polluted with London sewage, drew its water from
Thames Ditton, above Teddington Lock aud beyond the reach of London
sewage, but even then apparently exposed to the pollution of the drainage
of Thames Ditton.* Still the whole character of the Lambeth water
was changed; it could no longer be contaminated by the cholera flux of
London, and the result was astonishing. As the Southwark water then
remained the same, while the Lambeth water was changed, the operation
of other causes remaining the same in the two intermingled fields, the
phenomena were analyzed, and the vast differences in the mortality of
the people living in the two fields were evidently due to the differences
of the water.

The reasoning may be put in this form: the excess of the mortality (x)
by cholera in the Southwark and the Lambeth water-fields in 1849 and
1854 was produced by one or other of the possible causes all existing in
1849, represented by a, b, c, d, e, 2; in the second pericd, as well as the
first, all the possible causes remained unchanged, except the possible
cause z, which varied, and with it varied 2 so as to diminish as z
diminished; therefore z was the cause of x If the enumeration of
possible causes is complete, and the assumption that the forces of «bede
are substantially unchanged, it is difficult to resist the conclusion that
zwas the cause cfa. ‘The obvious possible causes are exposure to
infection (a), bad drains (6), crowding (c), poverty (e), imperfect medical
relief (f), impure water z: none of these, as far as it is known, differed,
as far as Lambeth is concerned, in 1849 and in 1854, except the water
(z), which was very impure in 1849, much purer in 1854. Again, all
these causes, except z, were substantially the same in the Southwark
and the Lambeth water-fields in the year 1854; but then the water in
the Southwark water-field became worse, and there 2 increased, while
in the adjacent Lambeth field the reverse happened.

In the interval between the year 1854 and the year 1866 the water
of all the eight companies was taken from points higher up the rivers,

 

* This may be inferred from a passage of the Mngineers’ Report to the Right
Hon. W. Cowper, p. 50.
378 [PART Iv.

and filtered, and following this, in 1866, cholera in every water-field
was fatal to comparatively few when it visited London under nearly the
same epidemic circumstances, and, as far as could be judged from
continental experience, with undiminished viruleuce, except in the
water-field of Hast London.

The East London Company itself had succeeded by filtration* and
other means in reducing the cholera mortality, which was 59 in 1849,
to 84 in 1854; and the deaths by diarrhwa remained nearly stationary
In the years after 1854 the waters of the Lea grew every year fouler
by the discharges of the sewers on its west bank, and by the drainage
of West Ham into its eastern margin; a work designed by an eminent
engineer, that has gradually extended since it was first opened in the
autumn of 1861,f and now (1867) pours the contents of the water-
closets of 10,000 houses into this tidal tributary of the Thames,{ above
its loop at the iron bridge, only a mile and a half below the water
reservoirs of the Last London Company. <A large part of the sewage
is discharged by gravitation, but about 4,600,000 gallons were pumped
daily into the river in the year 1866. “The effect of the sewer
“ outlets,” says Mr. Beardmore, the able engineer of the Lea Trust,
“ is no doubt to keep the tidal water in a foul state, especially during
“ the summer and autumn months, when there is not an excess of water
“ in the Lea.”’§ The river is as foul, in the opinion of Mr. Marshall,
as the West Ham sewage. ‘It looks as foul, and certainly no sensible
“ impression is produced on the river Lea that I could ever detect, even
“ when we are pumping into it at all times of the tide. A large area
“ of bank is exposed every tide; it is covered with a slimy deposit of
** mud of a most offensive appearance, and certainly with no agreeable
“ smell.” ‘In hot weather, what kind of sensation have you when
“ walking near that mud ?—I always have the sensation that I should
“ like to be somewhere else.”{ “ We found it expedient, during the
“ last summer (1866), to wash out the sewers. I believe that we should
“ not have had occasion to do so except to please the people on account
“ of the cholera.”

West Ham is out of London, so, although the great metropolitan
sewer passes over lis main sewer at Abbey Mills pumping station, the
Lea, instead of deriving any advantage from that circumstance, thus
grew liable to further pollution by the discharge into its waters of the
overflow of the metropolitan great sewer in times of storm.

The East London Company had apparently no defence against the
tidal waters encompassing its reservoirs round about and growing fouler
and fouler every year after 1861 ; thus at Old Ford it lost in 1866 the
advantages it gained by filtration at Lea Bridge, besides being exposed
to the temptation of resorting to the vast stagnant infected ponds in
close proximity to the Lea. The cholera deaths from 34 in 10,000
in 1854 rose to 72 in 1866, while the cholera and diarrhcea deaths in
the same epidemics rose from 51 to 87.—(Cholera Report, 1866,
pp- XX-xxiv.)

 

* Before 1852 the East London Company employed no means of filtration, but
relied upon its large depositing reservoirs to which reference has been made. By
June 1854, that is, before the height of the London epidemic of that ycar, half
of their filtering beds were in operation. See Engineers’ Report to the Right
Hon. W. Cowper, p. 67. :

} First contract let in 1858. J. Meeson.

tJ. G. B. Marshall, C.E., Engineer to Board of Health, West Ham. Evidence
before Rivers Commission, River Lea, 2d Report, Vol. II., Evidence, pp. 126-8.

§ Letter dated November 1, 1867.
DEATHS. | 3879

Scientific Elements of Cholera ; Epidemic of 1866.—ELEvatIon.—
Cholera was very unequally distributed over England. 14,3878 people
were slain by the disease in 641 districts; and of that number
10,889 fell in 87 districts of London, and in 24 other town districts ;
3,489 in 342 districts; while in 238 districts no death from cholera was
recorded.

All the districts, with the exceptions of Wigan and Merthyr Tydfil,
were seaport towns, or districts in their immediate neighbourhood ;
the populations were dense, and were nearly all dwelling on the lower
alluvial soils of the kingdom. These correlations have been observed
in all the epidemics. The exceptions are accounted for by such peculiar
circumstances as the mortality around the Broad-street pump, Lendon,
in 1854, and in St. Giles’s London, in 1849, where either the people were
excessively dirty and crowded, or took in water large doses of cholera
matter in a very active state.

To get aclear idea of the operation of elevation it is necessary to
exclude the notion that the mere fact that people live a few feet above
the sea level has in itself any direct influence on health. It is the
indirect influence of elevation on the air and water of a place that
produces the surprising effects observed.

The zymotic matter being organized lives irregularly distributed in
air or in water. It is in suspension either in the atmosphere or in the
waters; and as it is necessarily under the influence of gravitation, it is
as a general rule in larger quantities in the lower than it is in the
higher strata. Pasteur has proved this by experiment as far as the
atmosphere is concerned. He deposited at the Academy of Sciences
73 flasks, each holding a quarter of a litre; they were carefully pre-
pared so as to exclude air and were one third part full of limpid
yeast water, susceptible in the highest degree of the influence of
ferments. Twenty flasks were opened in the open country at the foot
of the Jura; 20 were opened on the Jura at the height of 850 metres,
and 20 were opened at Montanvert, near the Mer de glace, at an elevation
of 2,000 metres. Of the 20 opened on Montanvert, only 1 sustained
any alteration from the air admitted; of the 20 receiving air on the top
of the Jura, 5 were affected; and of the 20 opened on the plain, 8 were
thrown into fermentation. The greatest precautions were taken and are
required in-these experiments.* He only closed the other 13 flasks,
opened on the heights, after having left them in the air of the bedroom
of the little inn at Montanvert for the night; in 10 of the 13 infusoria
were found. Thus the atmosphere is in some parts pure; in other
parts it is pervaded by mists of living matter; and the density of these
mists increases near the earth, as would be indeed the case in the
unorganized water globules of clouds, if they were not in the lower
strata volatilized by the leat of the earth into transparent vapour.

The law regulating the distribution of cholera matter in water is very
easily shown by mixing the cholera flux with 10 times, 100 times,
500 times its bulk of distilled water in glass tubes a metre long; after
agitation the liquid is opalescent, and grows denser and more opaque
as the bottom is approached, where there is a flocculent deposit if the
proportion of cholrine is considerable.

Now the waters of London form a continuous communicating sheet
resting on the London clay under gravel and other ground, and as the
houses and the water sheet rise from the river brink up to Hampstead

* Pasteur, Annales des Sciences Naturelles, 4° série, Zoologic, tome xvi.,
pp. 76-8. — : i

{ For displaying the distribution of suspended matter in tubes, sewage water or
Thames water at the oid intakes of the water companies may be used.
380 [PART Iv.

and Norwood, all round the London basin, it is pretty certain that
sewage matters finding their way into that water exist in greater propor-
tions in the underground water of the low than in the underground
water of the high districts. The wells of the undrained low level of
South London were excessively impure in 1849 and in 1884;
since those dates the soil has been drained, and that is equivalent to
elevating it.

The mains and pipes of the waterworks form a subsoil network all
over the London area; each company has its centre of supply, but in
1849 and even in 1854 their sub-divisions may be treated as parts of one
great homogeneous system for the present purpose. Then round the
Thames at the bottom of the basin, to get definite ideas, take an area
under 20 feet of elevation; a second area of 20 and under 40 feet of
elevation; a third of 40 and under 60 feet; a fourth of 60 and
under &0 feet; a fifth of 80 feet and upwards, all permeated by
water mains and pipes filled by steam power, with the waters of the
Thames and of the Lea containing various sewage ferments, and among
others the cholera ferment in suspension; then it is plain that if
the proportions of the cholera ferment in water as in air vary in the
various belts it will be densest in the lowest belts, and the mortality
it occasions will increase in descending on every successive terrace of
the metropolis. This was observed both in the epidemic of 1849 and
in that of 1854.

The greater the quantity of cholrine in a given quantity of water, the
greater is the inequality in its distribution; thus with one part of
cholera flux in ten of a water solution a considerable quantity of the
matter falls to the bottom; with the strength of 1 in 100 or a portion of
1 in 1,000 nearly the whole matter remains after shaking pretty evenly
in suspension as far as the eye can judge.

There was a direct relation between the elevation of the ground and
the mortality of cholera when the waters were saturated largely with
sewage, and in 1854 a similar relation obtained in the fields of the
several water companies so far as they could be distinguished.

In 1866 it becomes necessary to separate the supplies of the several
companies, and it is seen that when this is done the same general law
prevails. The mortality in the East London sub-districts was at the
rate of 103 in 10,000 living at elevations below 20 feet; it was 71 at
the elevation 20-40 feet ; 20 at 40-60 feet, and 4 at 60-80 feet above
Trinity high-water mark.

In measuring elevation the height should be taken above the level
from which the water is lifted, but in 1849 I took the elevations from
the ground. The mortality was inversely as the elevation; thus let e
be any elevation and e’ any higher elevation of the house ground,
ce’ being the mortality by cholera at the higher, and ¢ the mortality
by cholera at the lower elevation, then e + a:e + a::c¢’:e

eta
“eta
cholera and elevation above the Thames. a is a constant quality, and
was in 1849 taken as 13. Thus at e' = 90 feet we had c’ = 22

‘ce’ expresses the general relation between the mortality by

 

fen Ey og 22 Sas -
ande = Gy q3 * = 6 ~ 13 Bere the series of mortalities for

the elevations 70, 50, 30, 10, 0 feet; at 27, 34, 53, 99, and 174 deaths
from cholera in 10,000, which agreed very closely with the observed
mortality at those elevations, namely, 27, 34, 65, 102, and 177.* The
same law prevailed in the epidemic of 1854.

 

* See Cholera Report for year 1849, pp. lxi-lxviii; extracts therefrom are given
on pp. 343-7. (Editor.)
DEATHS. | 381

The general results are subjoined, as an opportunity will, we may
hope, never recur of measuring the effects of cholrine diluted in water
on two or three millions of people living at such regulated elevations
above a tidal river.

Deartus from CuoLera in the Year 1866 to 10,000 Persons living, at
different Elevations in the Fields of the Water Compantgs.

 

Compantns furnishing the ELfVATION IN FEET ABOVE TRINITY HIGH-WATER Mark.
g

greater part of the

‘WATER SUPPLY.

 

Under 3 Feet. 3-10. 10-20. Under 20.

 

 

Thames Companies :—

Grad junetion, West) Ge eres | GF Pena | ares | aes

Southwark and Lambeth} (16) 6°78 (s) 5°76 (2) 5°30 (26) 6°40

From River Lea :—

New River - - - G) 56°68 GC) 56°68
East London - -| G) 141°80 | (2) 95°08 | (8) 10164 | (8) 103°06
From the Ravensbourne
and Wells :—
Kent - - - oe (2) 88°86 (3) 12°26 | (5) 19°33

 

 

 

 

ELEVATION IN FEET ABOVE TRINITY HiGH-waTER Mark.

CoMPANIES furnishing the
greater part of the
‘WATER SUPPLY.

 

cf j oe 80 and
ee 20-60: 60-80. upwards. Elevations.

 

Thames Companies :—

Grand Junction, West}! a) 2°25. | 2) 3°08} @) 2°98] 3:48| (7) 3-60

Scuthwark and Lambeth} @) 1°71 | (1) 2°57] (2) 2°44] (2) 3°10] (32) 5°89
From River Lea:—

New River - >| (8) 10°72 } (16) 11°56 | (13) 7°87] (4) 3°98] (42) 8°72

East London : - | (a3) 71°30 | (4) 20°34] G) 3°65 — (24) 70°50
From the Ravensbourne

and Wells :—

Kent - * = G) 1°49] (3) 18°84] @) — (0) 15°30

 

 

 

 

 

 

 

 

 

 

1 Ege nate fem Wish fhe el pe cuuated apy, In Table (tn Apron
grouped according to its water supply. ;

* The small figures of this Table represent the number of sub-districts at each elevation

supplied by the respective companies.

In the New River sub-districts the mortality ran down from 57 to
11, to 12, and to 8 on the four successive twenty feet vertical terraces,
and as low as 4 at the elevations over 80 feet.

In the Grand Junction, West Middlesex, and Chelsea fields the
mortality was at the rate of 5 in 10,000 at levels below 20 feet, and
it was uniformly 2 or 3 in 10,000 at all the higher levels, that is, it was
uniformly low as might be expected where there was very little effect
from the waters.

In the field of the Southwark and Lambeth companies supplying
South London the mortality was 6 in 10,000 at elevations under
20 feet, and 2 or 3 at the higher elevations.

The field of the Kent company presented some suspicious circum-
stances during the epidemic; and it now appears that their reservoirs
are in “ dangerous proximity” to the foul waters of the Ravensbourne,
and being below its level are in such hydraulic conditions as to render
occasional contamination not only possible but probable. This will
382 [PART Iv,

account to a certain extent for the high rates of mortality observed
there in the advanced state of the epidemic in Woolwich and Deptford.
In this field the influence of elevation was also felt. The mortality was
at the rate of 19 in 10,000 below 20 feet, while above it was 13 in
3 sub-districts.

If we conceive that the water in one vertical column A contains
ten times as much of the chlorine as the water of another column B,
it is evident that the lower sections of B may only contain as much of
the stuff as the higher sections of A; so the mortality at different
elevations would be the same under such circumstances.

In the epidentic of 1849, when the waters were generally contaminated,
the mortality was regulated by elevation; the same law was observed
in 1854; and in 1866, after throwing the sub-districts into water-fields,
as there was a striking difference in the quality of the waters, the law
is still found to prevail.

Dewnsiry.—It may be stated generally that the cholera is most fatal
in densely peopled districts, and where it finds its way into a school,
a prison, a workhouse, or a barrack under bad sanitary conditions, it is
generally fatal in proportion as the inmates are crowded.

But the water-supply and the elevation together have hitherto masked
the effects of density in London, and if 9 of the densest districts con-
taining from 197 to 258 persons on an acre are placed by the side of
9 of the sparsest districts containing from 5 to 34 inhabitants to an acre
it will be observed that the mortality was highest in the thinly peopled
districts both in 1849 and in 1854, the scale being accidentally turned
in 1866 by St. George-in-the-East. This is explained by the other
columns of the subjoined Table ; six of the last nine districts got the
worst water of the Thames, the Lee, and the Ravensbourne, or, as in
Rotherhithe, drew water from the tidal ditches and foul wells. The
ground was often undrained, whereas there was a partial drainage of
the higher dense districts.

When cholera matter is distributed by water, as it was in St. James’s
in the year 185-t, among a dense population, the consequences are rendered
the more appalling.

 

 

  

 

 

 

 

 

 

 

 

i z DEATIUS BY CHOLERA.
Initial of & | 1866. to 10,000
Water = DisrRicts. —, pe a
Companies. | 5 Persons
» to an acre. | 1349, | 1854. | 1866.
| 1
- DENSEST DISTRICTS :—
NE st! St. Luke 258 34 wo! 5
N.R.. E. 40) Basi London | 2465 45 23°, 4
aol, 50 | Strand - : 238 35 oo 6
N.R. \ 53 Totborn 217 35 6 7
NLR. | 68 | St, Giles 213 53 22 10
N.R., E 48 | Shoreditch - - 212 76 23 11
G.., N.RB | . . Jrmes, Westminster 208 16 14a 5
S.L. | y Southwark 204 164 11 al
B, | 17 42 36 97
= 221 56 45 | 18
aera SS
aoe 43 | Mean 21 71 59 7
| Lyast DENSE DIsTRICTS :—
8. Poplar - 34 71 42, 89
O- Rotherhithe - 33 205 165 9
40 Ikensington 31 24 38 4
27 Greenwich s 27 5 49 20
53 Hackney - 25 25 15 11
44 Camberwell - 19) 97 99 6
350 Hampstead - 11 8 12 1
2h | Wandsworth - 7 100 85 5
87! Lewisham - - Bi 30 2 6
1

 

 

 

 

 

 

 

 

 
DEATHS. | 383

Seweracs.—A system of sewerage is the necessary complement of
a water supply. Jt carries off the water charged with the various
impurities of houses, shops, manufactories, and streets. These impurities
are however of subordinate importance. The watercloset throws into
the sewer the evacuations of the sick, and carries them in the sewage
sometimes directly into a river, and sometimes over land. The matters
undergo various transformations, and sewage is sometimes innoxious and
inoffensive; at other times, where there is stagnation or languid circu-
lation, fermentations arise, and, as at Southampton, the germs of disease
ascend into streets and into dwellings.

There is, however, good reason to believe that where the circulation
is sustained and rapid the danger from this source as far as cholera is
concerned amounts to little, and is certainly insignificant when compared
with the evils resulting from the accumulation of the cholera flux in
streets and cesspools, whence it often finds its way into the wells and
canals and streams close to inhabited places.

Almost coincidently with the first appearance of epidemic cholera,
and with the striking increase of diarrhoea in England, was the intro-
duction into general use of the water-closet system, which had the
advantage of carrying night-soil out of the house, but the incidental and
not necessary disadvantage of discharging it into the rivers from which
the supply was drawn.

The water-closet was invented by Bramah, apparently at the close of
the last century ; the dates of its general introduction are thus described
by Mr. W. Haywood, the able engineer to the corporation of the city of
London :—* Water-closets were invented about 45 years ago (1813),
“ and became general in houses of the better class about 30 or 35 years
“ since (1833 or 1828), and the entire discharge of the dejecta from the
houses in which the water-closets were fixed in many cases took place.
Nevertheless even their introduction did not directly in all cases lead
“ to this, inasmuch as the interdiction of the Commissioners of Sewers
“ prevented it; and the custom obtained, to a large extent, of building
“ cesspools having overflow drains just beneath their doming, by which
“ means the solid matters were deposited, and the supernatant liquid
“ only ran off; but gradually the existing mode of construction crept in
“and the entire refuse of the better class of new houses flowed by the
‘“ drains into the public sewers.

“Tn the year 1849 what may be said almost to_be an organic change
“in the system took place. In 1848 the City Commission of Sewers
“* obtained its Act for sanitary purposes, which became operative upon
“ the Ist of January of the following year (1849); for the first time
“ indeed then was this discharge into the sewers legalized. Previously
“a penalty might have been enforced for such an usage of them, but
“ henceforth, within the City of London, those incurred a penalty who
“* failed, upon notice, to construct the drainage of promises in such a
“ manner as not to discharge all waste waters and fecal matters
“ directly into the public sewers” (i.e, directly into the sources of water
supply], “of which the full utility was therefore for the first time
“ recognized by statute; this Act was speedily followed by others for
“ the remaining area of the Metropolis and for the entire country, the
“ clauses of the City of London Sewers Act being the basis upon which
“ they were framed.”

The deaths from cholera and diarrhcea increased in London in 1842 ;

increased still more in 1846, when the potatoe crop was blighted, and
in 1849 culminated in the epidemic cholera,

a

+

‘
384 [PART IV.

The experience of South London might be specially cited to show the
great utility of sewerage in conjunction with a liberal supply of such
water as is obtained from the Thames above Teddington Lock; and to
prove that cholera matter is not distributed to any considerable extent
by such sewers as those of South London. Good sewers lower the
level of the wells, and ensure the filtration of the surface waters through
a greater thickness of earth.

WeaLtH and Poverty.—Wealth gives the command of the neces-
sarics of life in food, clothing, dwelling; it implies personal purity, and
algo secures prompt and skilful medical treatment. Poverty presents
the sad reverse. Hence the poor as a general rule suffer more than the
rich in cholera.

But that is by no means always the case, particularly where the
water is impure. Thus in East London many of the victims were in
good circumstances. The poorest man in St. George, Southwark, was
less likely to be attacked by cholera than the richest man in Stepney.
The pauper of Hampstead escaped in 1849, while the opulent perished
in Beleravia. And the same rule obtained all over the kingdom where
there were equivalent differences in the qualities of the waters.

The reiative economical condition of the various districts of Londou
is shown by the assessed annual value of the houses, but with the value
of the dwelling houses is unfortunately mixed up the value of the shops,
manufactories, and other structures so as to give an undue degree of
relative value to the city and to some other districts. Still the division
of the assessed annual value of the property in each district by its
population supplies a good index of its condition. On comparing the
four luwest and poorest Surrey districts of South London with the
wealthiest districts of Middlesex the subordination of this cause to others
is evident.

With the density the parks produce some disturbing effect, and the
Broad-street explosion of 1854 throws a heavy charge on St. James’s,
Westminster, in 1854. But it will be observed that in spite of depressed
soil, density, and poverty, the mortality by cholera of the four south
districts in 1866 was very little above the mortality of the favoured
districts of West London. Bethnal Green is by our standard the poorest
district in London, and the deaths by cholera in 1866 were in the
proportion of 63 in 10,000, but even this high rate isnot so high as
the proportion in the other and wealthier districts supplied from Old
Ford with water. There in the five districts paying nearly double the
mean rent of Bethnal Green the deaths were 64, 76, 89, 97, and 11€
in 10,000.

 

 

 

 

 

 

 

 

DEATHS by CHOLERA
a8 ‘i House ye
a Tipale oe Be Den- | Rent of to 10,000 living.
Companies. | tion. sity. se
erson.! 1849, | 1853-4. | 1866,
£s |
Bermondsey - - 8. 0 94; 2 7 161 179 6
St. George Southwark - 8.L. 0 204 211 164 1 1
Newington - - 8.L. -1 149 212 144 112 3
Rotherhithe - - 8.L. 0 33 218 205 165 9
All London — 30 39 50 62 46 18
Kensington - -| GJ., W.M.,C. | 40 31 6 6 24 38 4
St. George Hanover-square GF., C. Bd 81 |11 8 18 33 2
St. Martin-in-the-Fields - N.R., C. 38 7 |12 8 37 20 5
St. James Westminster - G.J., N.R. 5S 208 | 18 10 16 142 5

 

 

 

 

 

 

 

 

 

 
DEATHS. | 385

Sex and Acre.—The fatality of an epidemic depends not only on
external conditions but also on the internal organization. It is found
by experience that the two sexes at different ages are not affected to the
same extent by all diseases, either because by the habits of life they are
not exposed to the same extent to the causes of disease, or because
the power of resisting the operation of those causes varies.

The three epidemics of cholera supply data for determining the
mortality of cholera at different ages in the two sexes, for the deaths
were 102,186, inclusive of about 14,418 deaths by the epidemic, which
were registered under the head of diarrhcea. It is important to include
these outside deaths in estimating the effect of age, inasmuch as the
occult form of the disease is not met with in equal proportions at
all ages; and it is evident that we have the means of framing an
estimate by comparing the deaths registered from diarrhoea in the
epidemic years (1349, 1854, and 1866) with the deaths under the
same head in ordinary years, such as the three years 1848, 1853,
and 1864.

The characteristic symptoms, it will be seen at a glance, are not so
well marked in early infancy or in the second infancy of old age; and
the reason of this is that the muscular and nervous systems being then
less active, and giving rise to less convulsive and violent symptoms, the
medical attendants return the cases as diarrhea.

At all ages above 5 and under 55 the number of such cases of occult
choleraic diarrhoea is not considerable; while under the age of five
years, according to this estimate, four cases of diarrhoea must be added
to every six deaths registered from cholera to get the actual deaths
by the epidemic. At the age of 75 and upwards also there is a large
addition of these occult cases.

After correction we find that the mean of the mortality in the three
epidemics was, of males 18°0, females 17°8 to 10,000 living at all
ages.

The addition for occult cases was nearly the same, or 2°6 to the male
and 2°5 to the female mortality.

The mean mortality from all causes in the three cholera years was,
for males, 19°3 in excess, for females, 17°9 in excess of the average
mortality to 10,000 living; so females suffered less than males.

The mortality is higher in boys than in girls at all the agcs under
15; at the ages of reproduction, 25-45, the mortality of women, many
of them pregnant, exceeds the mortality of men; but at the ages after
65 the mortality of men exceeds the mortality of women.

There is evidently a law of mortality involved in the age, inde-
pendently of sex: thus in the three first lustres of life the deaths of
boys to 10,000 living were 31:8, 13-2, and 7°6; of girls 28-4, 12°6,
6°4; and the mean mortalities of the two sexes at the same agcs were
30:1, 12-9, and 7:0, which differ little from the series 380°1, 14°5, and
7°0, where the numbers are obtained by assuming that the mortality is
inversely as the age, and decreases about 14 per cent. for every year of
age, or is less than half at 5-10, and less than a fourth at 10-15, what
it was in the first five years of life.

After the age of puberty, or from the age of 15-25, the mortality
also increases very little; it is 81 for males and 7°8 for females; and
at the six decennial ages extending from 25 to 85, the mortality increases
from 15-4 to 43°6, at a very constant rate, as is scen on comparing the
calculated series with that observed in both sexes.

BB
386 [PART Ly.

 

 

 

Observed in 3 Epidemics, the Deaths by
ses Cholera to 10,000 living at each Age. Catena
Bees Series.
Men, Women. Mean.
25-35 - M2 15°6 15°4 15°4
35-45 19°5 20°2 19°8 19°0
45-55 23°5 23°1 23°3 23°4
55-65 28°4 31°4 29°9 28°9
65-75 - 35°9 85:4 35°7 35°7
75-85 42°2 44°9 43°6 44°0
85-95 46°0 41-4 43°7 54:0
95 and upwards - 82-4 32°8 57°6 67°0

 

 

 

 

 

 

 

Norr.—Let m, = mortality by cholera at age x, then r" m, = mz +4, = mortality
at age « +. In the series given the logarithm of + is taken at 1:93665. This
applies only to the ages under 15. At the ages from 25 to 85, and even upwards,
the logarithm of r is 0:00911.

L af
35°65\ iy (2 ing : “
pies Gea) = an = 1°0212, And logarithm r = 0-00911.

Thus to 10,000 men living of the age 25 and under 35 the deaths by
cholera and choleraic diarrhcea, as above defined, were 15:2; to 10,000
women the deaths were 15°6; and the mean mortality of the two sexes
in equal numbers is expressed by 15°4. The mean deaths by cholera
at the next age (35-45) were 19°8 to the 10,000 living, and so on. The
calculated series approximates very closely to the observed facts: it is
a series in geometrical progression, and may be conceived as representing
this principle, that human life loses the power of resisting the zymotic
life of the cholera epidemic year by year after the age of puberty, or
what is equivalent, that the lethal power of the epidemic on the organism
increases at the rate of 2°12 per cent. Thus, for instance, 1,000,000
persons of the age 30 are exposed to cholera, and 1,540 of them die;
then of the same number of the age 31 exposed to the same epidemic
under precisely the same circumstances, 1,573 will die; and to 1,000,000
persons of one year of age older, or age 32, the deaths will be 1,606.
So some force is taken away from the organism every year of life,
every second we may conceive, by which its constituents become less.
able to resist the action of the cholera leaven. And the diminution of
resisting force obeys a law which is of this nature: the loss is an
accumulating quantity, and in the end becomes so great. as to leave the
life at the mercy of other forms of life, or of other forces.

Thus the mortality at one age being given, the mortality at any other
age within certain limits can be calculated.*

Small-pox, scarlatina, diphtheria, measles, and whooping-cough obey
special laws of their own, yet all of them agree in this: the mortality by
them declines as age advances; but the fevers and the other zymotic
diseases taken in the aggregate are more closely allied to cholera, for the
deaths by them are most numerous at advanced ages.

 

* meg = 7mgo = 15°40 79 = 15°40 x (1'0212)3 = 28°89. By logarithms
A 15°40 + 80Ar = Amp = A28'89.

t See Supplement to Registrar-General’s 25th Annual Report, Tables on pp. viii
and ix.
DEATHS. | 387

ATTACKS oF CHormrs.—The resistance which the body offers at
different ages may be of two kinds; it may resist an invasion and, as in
unsuccessful vaccination and in unsuccessful inoculation, not take a
disease, as it is called; or it may take the disease and live through it,
or succumb to it, in variable proportions.

All the cases of cholera have never been registered in any epidemic,
and it is impossible to determine directly what relative numbers are
attacked at each age.

The deaths out of 3,635 cases of cholera at different ages were
investigated by the Scientific Committee of the Board of Health, and the
result showed that, yiven 100 men attacked at the age 25-35 about 36
died, while of 100 attacked at the age 35-45 about 44 died; and
generally the mortality of persons actually attacked increases as age
advances, according to a determinable law. So in the ages before
puberty the mortality of cases declines until it reaches the minimum.
Here observation grows more difficult, as the mortality of cases of
choleraic diarrhea has not been determined, and it cannot be derived
from the mortality of cases of diarrhoea selected indiscriminately for
medical observation at hospitals or dispensaries.

To avoid fallacies of observation the cases of cholera, and the deaths
at the ages 25-55, when the symptoms are well marked, may be taken;
and having the number of deaths by cholera given at three ages to a
fixed number living, we can calculate the corresponding number of
attacks at those ages from the Scientific Committee’s returns. Thus the
mean mortality by cholera at the age 25-35 is by the three epidemics
15 to 10,000 living; then by the Committee’s returns 107 deaths occur
in 800 attacks : therefore in this proportion the 15 deaths imply 42:1
attacks. Applying the same method, the attacks at other ages have
been calculated.

 

 

 

Mery. Women.
Ages. Population.
Attacks. Deaths. Deaths. Attacks,
25-35 10,000 41°3 14:7 15-1 42°83
35-45 10,000 42°8 18°9 : 19:4 45:2
45-55 10,000 43°8 22°4 21°9 44°7

 

 

 

 

 

 

Thus it may be inferred that at these ages the proportion of men
attacked differs little from 43, and of women little from 44 in 10,000;
men and women in the prime of life, in the reproductive ages, are nearly
equally liable to attack, but the influence of advancing age is manifest
in the advancing mortality.

The proportions attacked appear to be greater after than before
the age of 55, but this disparity may be compensated by the cases of
choleraic diarrheea; all that is certain is that old women are more liable
to attacks of cholera than old men,

The facts are displayed in the annexed Table, deduced partly from
the observations of the Scientific Committee of the Board of Health on
the epidemic of 1854.

The morbility differs less than the mortality.
383 [PART Iv,

 

 

 

 

 

 

| Estimated Proportion to 10,000 Living.
Death to One
Attack. |
Ages. : Males, Females.
Males. Females. | Attacks. | Deaths. || Attacks. | Deaths.
|
All Ages “486 “480 31°6 15-4 31°9 15°3
0-5 °611 *632 31°75 19.3 27°0 17-0
5-10 *542 "424 22;°'9) 12°4 27°7 1i:7
10-15 °437 “500 16°5 7°2 12°5 6'2
15-25 “328 *389 23°9 8 19°2 775
25-35 *356 “354 41°3 14:7 42 8 lol
35-45 441 +429 42°8 18°9 45°2 19-4
45-55 “513 *491 43°8 22-4 44°7 2130
55-65 “B62 *519 46°5 26°1 55°0 28°35
65-75 *589, °578 o2° 1 30°7 51°8 29°9
75-85 ‘741 +695 40+1 29°7 49°4 84°3
85-95 *858 *667 31°7 27°2 44°3 29°6
95 & upwds. _ “500 -- 20°6 59 29°8

 

 

 

 

 

 

 

 

 

Duration or FataL Cases.—The greater the dose of any poison
the more fatal it is, and the more rapidly it is fatal. By parity of
reasoning it may be presumed that the more destructive an epidemic
is the more rapid are the cases in their course.

The mortality by cholera in the epidemic of 1849 was at the rate of
30 in 10,000, and the mean duration of the fatal cases was 50 hours.
As the mortality by cholera in 1866 was only at the rate of 7 in 10,000,
we may expect to find the fatal cases of longer duration, if the duration
is in an undetermined degree inversely as the mortality. The duration of
fatal cases in 1866 was in fact 61 hours ; and we have this exponential
equation from which the value of w can be found (2°) = (5-3)

6°8 49°9/°
That upon trial is found to be w= 7'2. Put m for mortality of cholera
in the epidemic when the duration of cases was shortest (4), and w’ for

! z
amortality for time (¢’) when the cases were longest; then = = (=) .
mM as

m\-b t’ 6 LEN m\1
(=): = 7 7 aS mM () and ¢/ = (“)°. t. The value of 2 is 7-3
or 7°O according as it is deduced from the facts of 1849 and 1854, or
1854 and 1866; so that 7°2, or nearly 7, may be taken as the mean
value.

The duration therefore of fatal cases of cholera in two epidemics
varies inversely as the 7th (or more closely 7:2) root of the mortality.

To give an illustration, let us apply this formula, deduced from the
observations of 1849 and 1866, to determine, from the duration of fatal
cases, the mortality of the epidemic in 1854. Then (ay x 80°3=
11°06 mortality by cholera in 1854. The observed mortality was 10:9,

Thus the calculated series is 30°3, 11-1, 6°8, while the observed series
is 80°3, 10°9, 6°S.
DEATHS. | 389

The numbers and the logarithms (a) are subjoined.

 

 

Mortality Mean
Epidemic by Cholera. Duration of xt re
Year. Deaths to Fatal Cases
10,000 in hours
(m) @®
1849 30°3 49°9 1-4814 1°6981
1854 10°S 57°4 1°9374 1°7589
1866 6'°8 61:4 0°8325 1°7882

 

 

It is probable that the mortality, as well as the duration of cases of
cholera, follows some such law in different epidemics and localities.

And it may be laid down as a general law of each particular zymotic
disease that the quicker the fatal disease is in its course in any given
epidemic the more fatal the epidemic is to the affected population.

MORTALITY ON DIFFERENT Days or THE WEEK.—In spite of the
popular belief in ill-omened Friday, it is evident that the days of the
week can in themselves have no more influence than the deities after
which they are named on the fatality of cholera. It happens that in all
England the fewest deaths in the epidemic occurred on Saturday, and
next to it on Sunday. On Wednesday the greatest number of deaths
occurred, and next to it stands Tuesday. In the epidemic of 1849, the
deaths on Tuesday and Saturday stood highest, on Thursday and Friday
lowest. In London the deaths were highest on gay Monday and
Tuesday, lowest on dull Friday. If the temperate or intemperate habits
of any of the working classes of London had any effect on this series of
facts, they therefore raised the deaths on Monday, lowered the deaths on
Friday.

Deatus from CHOLERA on EHaAca Day of the WEEK in the 23 Weeks
ending 3rd November 1866.

 

 

 

 

 

a
: 3 | 8 S
Total in a P| 2 $13 a) 8
23 Weeks. sg 23 |3 § Z S =
eg 5 g 3 5 = 2
n = |e =e a = B
In England and Wales” - 13,553 | 1,897 | 1,903 | 1,987 | 2,039 | 1,940 | 1,900 | 1,887
ee 4,284 s77| 685 | 632] 680] 6ce| 549) 595
In England and Wales,
exclusive of East Lon: 9,269 1,820 | 1,818 | 1,365 | 1,859 | 1,274 | 1,351 | 1,292
don and West Ham -
Average
Proportion on each day 1,000 943 } 956 | 1,033 | 1,111 | 1,088 897 | 972
to 1,000 deaths on_the } |Defect or Excess
average day in East over average i —57 | —44 | +383 ] +111 | +88 | —103 | —28
London and West Bam daily deaths -
Proportion on each day 1,000 997 | 995 |1,024 } 1,026 | 962 | 1,020] 976
to 1,000 deaths on the } |Defect or Excess
average day in the rest over average ; -3| -5 | +24] +26] -—388] +20) —24
of England - - daily deaths -

 

 

 

 

 

 

 

 

 

 

 

The order of deaths in 1866 was quite different in East London,
There the deaths were high on Tuesday, Wednesday, and Thursday ;
low on Sunday, Monday, Friday, and Saturday. The excess was
greatest on Wednesday, and the defect was greatest on Friday. The
outbreak there began on a Wednesday, end attained its maximum on a
390 [PART lv.

Tuesday and Wednesday. It will be recollected that the pumping from
Old Ford ceased every Saturday at 7} p.m., and was only resumed on
Monday morning at 54 a.m., the whole water-field being supplied
on Sunday from the purer Lea Bridge reservoirs.—(Cholera Report,
1866, pp. lii—Lxiy.)

Fever Mortality at different Ages——The annexed Table shows the
mortality of all forms of fever in the London Fever Hospital at different
ages ; in which it will be seen that the mortality is at the rate of 9°67
deaths to 100 cases of persons of the age of 15-25, and 15°41 deaths
to 100 cases of persons of the age 25-35. But in all England 3,189

 

Apmisstons, Dnarus, and Rate or Morrariry per CENT. at
different Periods of Life of all Cases of “ ContinuED FrveErs”
admitted to the Lonpon Fever Hospirat during the Ten Years
1848-57.

(The facts of this Table were supplied by Dr. Murchison.)

 

 

 

|
| Morrvatity
AGES. ADMISSIONS. DEATHS. een Guna:

At AGES 6,628 1,059 15°98
Under 5 Years 83 a 9°09
5~ 401 29 7°23
10- 809 51 6°30
15 2,481 240 9°67
25- 1,207 186 15°41
35- 816 201 24°63
45- 445 170 38°20
55- 231 110 47°62
66- = 77 46 59°74
75 and upwards 10 7 70°00
Age not stated 118 16 13°56

 

 

 

 

 

 

Note.—Under “Continued Fevers” are included Typhus, Enteric Fevers,
Relapsing Fever, and Febricula; but all cases of “Fever” dependent on local
disease are excluded. Dr. Murchison shows the mortality of cach of the three
forms.

 

deaths by fever were returned of the first age, and 1,898 of the second
age; consequently if the mortality of cases of fever in the country at
large is truly represented by that of the London Fever Hospital, the
3,189 died out of 32,952 attacked, of ages 15-25, and 1,898 died out
of 12,317 persons attacked by fever of the ages 25-385. The same
calculation is applicable to the deaths at other ages, and hence it may be
inferred that at least 152,653 persons were attacked every year, and
17,491 died of these fevers. In this great annual battle 17,491
Englishmen were killed, and 135,162 were severely wounded, but
ultimately recovered.

The mortality of the severe fever hospital cases is probably twice as
great as the mortality of cases out of hospital, so it is possible that as
many as 150,000 slighter cases might be left out of this reckoning ;
which will more than counterbalance the cases of fever dependent on
local disease, improperly returned as fevers, and classed under that
head in our tables.
DEATHS. | 391

The fever itself subsides earlier; but the sickness which follows its
complications protracts the duration of cases, which, on an average of
the 152,653 cases, imply about a month’s sickness in each ; so the
average fever population during these years was 12,721. They would fill
127 hospitals, each containing a hundred beds, and require more than
4,643,000 days’ subsistence.

About 56,784 cases and 8,901 deaths occurred among men and women
of the age of 15 and under 65; and in their illness 1,703,520 days of
suffering were experienced, and 1,460,160 working days were lost.

Children and aged people are not often treated in fever hospitals, so
that Dr. Murchison supplies no facts respecting infants, and few facts
respecting children of 5-15, or old people of the age of 65 and
upwards ; but it is evident that the mortality is lowest at the age of
10-15, and rapidly increases as age advances; observing a very
regular law of increase, from which the mortality at one age, between
15 and 55, being given, the mortality at any other age within that limit
can be calculated.*

It appears to be established that patients are not liable to a second
attack, either of typhus or of typhia, but that relapsing fever (typhinia)
often recurs; and typhus follows typhia, as typhia follows typhus ; both
being as independent of each other as small-pox and measles. This
‘being so, it is evident that as age advances the proportion of people
susceptible declines, and we find that the calculated average liability of
people living to attack decreases, until at the age 45-55 the minimum
liability is attained; and then only 20 in 10,000 or 2 in 1,000; one
annually in 500 experiences attack. At the age 35-45 the propor-
tional number of attacks among 10,000 persons is 26°93, at 25-865 it
is 43°30, at 15-25 it is 93:20. The facts do not justify us in
proceeding further towards infancy, but they seem to imply that in
childhood the liability to invasion, from greater susceptibility rather
than from greater exposure to it, causes a maximum proportion of
attacks,

We have then greater liability to attack in early manhood, conjoined
with greater power of resisting the disease; so that the final result is an
equal rate of mortality among the population at the ages extending
from 25 to 45; for 6°67 died out of 10,000 living of the age 25-35 ;
and 6°63 died out of the same number living in the next age,
35-45.

The higher rate of mortality, 9:02, at the ages 15-25, is probably
connected in some way with the migration from the country to the
towns, where the new comers are exposed to stronger forms of the
zymotic exciter. “As far as the figures [of Louis, Chomel, and
Murchison] go,” says Dr. Murchison, ‘they show that recent residence
“ in an infected locality increases the fatality of pythogenic fever.” {

 

*The calculated and observed rates of mortality in fever cases are shown
below :—

 

Age. Observed. Calculated.
15—25 - 9°67 9°77
25—35 15°41 - 15°44
35 —45 24°63 24°40
45—55 - 38°20 38°57

The mean annual increase of the death-rate is 4:7 per cent. for each year of age
°S Mtn = Mz 1” = M, (1°047)".

t Murchison on Ccntinued Fevers, p. 533.
392 [PART Iv.

The expressive name, derived from rv@ouc, putresco, and yevyde,
Dr. Murchison gives to typhia in his classical treatise ; thus pointing
to the constant fountain of impurity from which this bitter water
springs to poison the kingdom. This is the form of fever which is so
common in France; and which was characterized by Bretonnean of
Tours ia 1820 under the name of dothinenterite, and was analytically
studied by Louis in Paris, and described by him in his great philosophical
work, Sur la Févre Typhoide in 1829.* ‘The putrid state of the air of
the cabinets in all the hotels and houses of Paris at that time is am
argument in favour of Dr. Murchison’s doctrine,—that the fever is
“often generated spontaneously by fecal fermentation,’ and is occa-
sionally communicated by the sick to the healthy directly through this
medium, or through the air of cesspools and drains. The impurities
and the seeds of the disease can only be eventually got rid of by a
vigilant sanitary police; and by the effectual destruction of typhine, its
exciting leaven.

Typhus and famine fever (typhinia), like the pythogenic fever (typhia),
are lit up by a specific zymotic matter which is generated whenever
human beings are badly fed, and are crowded together dirty in an
inadequate supply of fresh air. These two forms of fever fluctuate in
intensity as the operation of their causes does, and give rise to the
great spreading epidemics, which follow war and famine, and afflict the
world.— (25th Annual Report, pp. 176-181.)

r
7, CLASS AND OccuPATIONAL Mortatiry.f

Class Mortality ; Kings and Peers —The average reigns of kings
should correspond with the expectation of life at the period of accession.
This varies in elective and hereditary princes. The mean age at
accession is higher, and the reigns shorter, in the former than in the
latter case. The popes represent the electoral system ; 156 successors
of St. Peter occupied the papal chair 1,023 years (8O0—1823). Each
continued pope at an average 64 years. In England, from William the
Conqueror to William 1V., 34 sovereigns reigned 763 years; the mean
age at accession was 80 years, and the mean length of the reigns
223 years. The hereditary kings were younger men on their accession
than the popes: the kings who gained the throne by violence, or were
chosen by the peeple, have been above 380 years of age in England.
William the Conqueror was 42 years of age ; Cromwell, 52; William IIT.,
39; George I., 55; at the time they ascended the throne. When, as
in the case of George LV. and William 1V., the crown devolves upon a
brother the age at accession is advanced, and the reign shortened. ‘The
ancients reckoned three generations to a century; and the estimate is
very near the truth, where the line is uninterruptedly kept up from
father to son. In the English peerage 313 years intervene, at an
average ,between the birth of father and son, in the line of ancestors of
any peer. Newton, in his Chronology, found, upon taking 11 monarchies,
that 189 kings reigned 8,597 years; and that the mean of all the reigns
was 19 years.

Of the 34 English sovereigns, 10 died violent deaths; 2 died in
battle; 3 by accidents ; 1 was publicly executed; 4 were assassinated

 

* English and American students, and I among the number, had then an
opportunity of studying this disease clinically under Louis at La Pitié, and thus
carried away clear ideas of a disease which could no longer be confounded with
typhus.

J For class mortality of children aged under five years, see Extract on p. 202.
ee

DEATUS. | 393

by other sovereigns. Suspicion of poisoning was popularly entertained
in other instances. The mean expectation of life, of the 384 sovereigns
at the time of their accession was 33 years, according to the English
Table: they should, therefore, have died aged 68 ; but died actually at
the age of 524; their life was 11 years shorter than it should have
been, according to the rate of mortality prevalent among the people
generally in the present century. If the Manchester Life Table,
(7th Report of Registrar-General, 8vo. p. 338,) which represents a
lower mortality, be referred to, the mean duration of the reigns should
have been 27 years instead of 224 years.

These facts point out the dangers which have surrounded the throne;
they evince no less distinctly the progress of civilisation, in the
increased security of life enjoyed by the heads of the government.
Of the 17 first sovereigns, 7 diel violent deaths; of the 17 last,
(including Charles I.), only three died violent deaths. Sharon Turner
gives lists of the reigns in the kingdoms of Kent, Wessex, Bernicia
(Northumbria), and Mercia, frem which it appears that the mean
duration of 83 reigns, betwen A.D. 449—836, was 14 years: from
Egbert to Harold II. (800—1065), 20 kings reigned, each upon an
average 13 years. This proves incontestably that the life of sovereigns
is infinitely safer in popular than iu despotic—in civilised than in
barbarous states. The same truth is exhibited by the following
observations. In Germany (1056—1792), the reigns of 388 eroperors
lasted at an average 19 years; in Sweden (1066—1818), 41 kings
reigned 752 years, 18 years each; in Russia (1073—1825), 50 czars
reigned 750 years, or upon an average 15 years, when the English
kings reigned 22} years! The lives of the nobles partook of the
insecurity of those of the sovereigns, in the early ages; and they were
equally interested in the progress of civilisation, which mitigated
violence, and suppressed many other causes of premature death.*

Themortality of English peers has been investigated by Mr. Edmonds. f
The inquiry extended to 707 peers. The author reduced the number
to 675 peers by excluding 32 whose deaths were violent or acciental:
a proceeding by which he probably proposed to render the results more
applicable to the peerage of the present day; as it would otherwise have
been unjustifiable to exclude deaths which are, in certain states of
society, of constant occurrence, and only accidental in the same sense as
a fever or a pleurisy. The number of lines of succession was 109;
the number of peers observed, 675; the aggregate of ages at accession,
20,390; the aggregate of years of rule, 17,931; the average age at
accession, 80°21 years; the average period of rule, 26°56 years.{ The
expectation, or mean duration of life, after accession, when the peec
acceded between the ages 10-19 was 38°29 years; 20-29, 27°03 years ;
30-39, 23°87 years; 40-59, 15°99 years. In other terms, the mean
future duration of the life of the peers who acceded at the mean age 34}
was 23°87, nearly 24 years.

 

 

* Article by William Farr, Esq., the writer of this article, in the British Annals
of Medicine, July 14, 1837.”

t Lancet, Feb. 1838.

t 262 years is the average duration of the reigns of the 24 sovereigns who died
in the ordinary course of nature, from William I. to George IV.—Edmonds. The
first peers are excluded from the calculation: for the reasons explained in speaking
of sovereigns they are older at the period of accession, and their period of rule is
shorter than that of their lineal descendants.
894 [PART Iv.

Peers who acceded to Tirtr, and who died in each DecEennIAL
IntErvAL of Aan; also the AnnuaL Dearus out of 100 living at
each DecENNIAL InTERVAL of AGE.

 

 

 

 

 

 

PEERS.
Age. . » | 0-9 10-19120-29 30-39]40-49]50-59/60-69|70-79)80-89)90-99

Entering - 62} 128] 157] 147 90 55 27 8 1
Dying te - s| 29] 67| 106} 142] 142] 130] 40

ortality per Cent. per z ‘ a0 3 . , ‘ a

aa 2 a 1a] 7} 12] 19] 27] 4°38} 6-4] 13°8 | 18°9 | 37-5
East. India Company’s . ‘i : ‘ a is ae.

Capac eet xe | a | s| 15] 24) 43) 92 | 10-7

 

 

 

 

 

 

 

 

 

We have subjoined the rate of mortality which prevailed among the
Hast India Company’s labourers; and it will be observed that, after the
influence of selection has ceased in the latter, at the age of 50 and
upwards, there is a near approximation in the rates of mortality. And
it must be recollected that 32 violent deaths have been excluded from
the peers. Are we to infer that the mortality among peers is now
higher than among labourers, crowded within the metropolis? Should
we not rather infer, that as the investigation extends far back into the
centuries of bloodshed and pestilence, that the lives of peers were then
shorter, and are now longer, than the lives of labourers? The plague,
which was born in huts, and nursed by famine, rioted in luxurious halls,
and smote the highborn.

Dr. Guy and Mr. Neison have recently* determined the duration of
life in the males of the families of the peerage and baronetage; it is
35 years at the age 25, 27 years at 35, 18 years at 50.—(McCulloch’s
Account of the British Empire; Art. Vital Statistics, pp. 552-4.)

—_——s

/ Mortality of Males engaged in different Occupations, 1851.—The
| previous investigations of the various rates of mortality in the districts of
\the kingdom have shown how much the health and lite of the population
\are affected by fixed local influences. The professions and occupations
of men open a new field of inquiry, on which we are now prepared to
enter, not unconscious, however, of the peculiar difficulties that beset
all inquiries into the mortality of limited, fluctuating, and sometimes
ill-defined sections of the population.

Laudable attempts have been made by ingenious men to determine
the effects of professions on health, by general observation, unaided by
exact recorded facts. Ramazzini and Thackrah in this way deduced
some useful practical results and rules for the improvement of the
health of artizans. More recently the mean age at death has been
relied on to show the healthiness or insalubrity of certain occupations.
And this method, as well as that of the annual rate of mortality without
distinction of age, is applicable in certain definite conditions where only
approximations are required.

But the mean age at death evidently depends upon many circum-
stances besides health, and among others, upon the ages of the living,
which vary in proportions in almost every profession, according as it is
a profession that people enter early or later in life, and according as the
numbers that enter it annually increase or decrease.

The mortality is at the rate of 20 in 1,000 among men of the age of
20 and upwards in England; but this gross rate is compounded of all

 

* See Journal of the Statistical Society, 1845, p. 76.
DEATHS. | 395

the varying rates, from the age of 20 to the age of 100. For while the
annual rate of mortality among men of the age of 25 and under 35 is 9
in 1,000, the rate among men of the age of 45-55 is nearly 1%, and the
rate among men of the age of 65-75 is 64: so, as the age of the living
in different professions may vary almost indefinitely, the gross rate of
mortality affords only an imperfect indication of the influence of occupa-
tion on health and on the duration of life. The rate of mortality among
farmers of the age of 20 and upwards is 28 in 1,000, among tailors
20 in 1,000; yet it will be shortly shown that when the rates of
mortality among men of corresponding ages are compared, the farmers
are much the healthier of the two classes.

To obtain results upon which reliance can be placed for the purposes
of sanitary inquiry and of life insurance, several extended series of
observations are required, and have now been obtained in England.
The Census Report exhibits the number of persons in each occupation
at each decennial age in 1851, and the present Report shows the
numbers in those professions dying at corresponding ages,

Upon examining the results of these two series of observations,
it is evident that the unsettied nomenclature of the professions throws
in the way of the inquiry another formidable difficulty, which can only
be gradually removed. ‘Thus it is impossible at present to determine
the relative mortality of the classes that are respectively engaged in the
silk, cotton, linen, and woollen manufactures, as great numbers of men
are registered as weavers simply, without any further distinction ; so all
the persons that are engaged in the textile manufactures are thrown
together. Miners in iron, lead, copper, coal, and the manufactures of
the metals, have for the same reason been thrown into one group.
Again, as the large class of agricultural labourers has in the registers
often been confounded, under the indefinite term “labourer,” with
labourers on roads, on railways, in quarries, labourers have been dealt
with in the aggregate.

By selecting a few of the well-defined occupations in which large
numbers of men are employed, and by grouping together in one line
classes easily confounded in the returns, certain striking and interesting
results have been obtained, which are embodied in the Tables. In
some instances these results confirm preconceived opinions; in others
they bring to light important facts of which we had before no idea,

Farmers.—Of the twelve cla: in the Tables, the farmers are
he oldest and the longest he aaa of 225,747 there are 31,720

the age 25 and under 35; 48,378 of the age 85-45; and 53,608 of
the age 45-55. Their numbers then decline, and there are 45,585
of the age 55-65 ; 28,660 of the age 65-75 ; 11,363 of the age 75-85;
and 1,711 of the age 85 and upwards. Their numbers, depending on
the number of farms, have been probably stationary for some years
in England, and it is evident that men enter the class at all the ages
up to 45-55, when the number living is greater than the number at
any other period of life. Few become farmers after that age. The
total deaths in the year were 6,426; and the deaths to 1,000 living
at each of the decennial ages commencing at 35-45 were nearly 9, 12,
25, 55, 148, 324.

The deaths to 1,000 labourers at each of the corresponding ages were
13, 17, 29, 68, 174, and 418. The advantages in respect to health of
the farmer over the labourer are considerable at every age after the
age of 35; but singularly enough, the mortality of the young farmers

of the age 25-35 is rather higher (10°15) than the mortality (9°79) of
the young labourers of the same age.
7
396 [Part ly.

The labourers of all classes that are brought into the calculation were
1,192,909, of whom 25,801 died in the year. They constitute nearly
one fourth part of the male population of England ; and their mortality
is at nearly the same rate as that of the whole population, except in the
very advanced ages, when the Poor Law apparently affords inadequate
relief to the worn-out workman,

The four classes which on the whole experience the heaviest rates of
mortality are miners, bakers, butchers, and inn and beershop keepers.
Thus at the age of 45-55 out of every 1,000 farmers 12 died; of 1,000
ishoemakers 15 died; of 1,000 weavers and others employed in the
‘manufacture of cotton, silk, and wool, 15 died; out of an equal number
‘of grocers 16 died; of blacksmiths 17 died; of carpenters 17 died; of
tailors 17 died; of labourers 17 died; of miners 20 died; of bakers
2i died; of butchers 23 died; of inn and beershop keepers 28 died ;—
the mortality at that age among the whole population of England being
at the rate of 18 in 1,000.

At every period of life the mortality of the inn and beershop keepers
is in excess of the mortality of all the other classes except the butchers
at the age of 55-65 who died at the rate of 41 in 1,000; while the rate
among the inn and beershop keepers of the same age was 39 in 1,000;
the rate among the whole population being 30.

Among the important class of men, 55,315 in number, variously
designated hotel keepers, inn keepers, licensed victuallers, and beershop
keepers, distributed all over the kingdom, but concentrated especially in
towns, the causes of this unusually heavy rate of mortality deserve
careful and extensive investigation. Many highly respectable men of
‘the class lead regular lives, and are of steady habits; but others,
exposed by their business to unusual temptations, live intemperately,
and enjoy less quiet at night than the rest of the community. They are
also exposed to zymotic diseases, by intercourse with large numbers
of people.

But in a matter ef so much importance these remarks mst only be
viewed as indications of the direction that the inquiry should pursue in
the hands of competent persons,

BurcuErs.—This useful body of men amounted to 49,403, and they
experienced a much heavier vate of mortality than any other class except
that preceding—at the ages under 65. Thus at the age 35-45 the rate
of mortality per 1,000 among farmers was 9, carpenters and joiners 10,
shoemakers 11, blacksmiths 12, tailors 14, bakers 15, butchers 17. At
the next decennial age (45-55) the mortality of butchers was 23;
at 55-65 it was 41, or higher than the mortality that any other class
suffered. The mortality of the old butchers of the age of 65 and
upwards is near the average.

While much has been written about the diseases of shoemakers, weavers,
tailors, miners, and bakers, the extraordinary mortality of butchers
appears to have escaped observation. Calculation alone has taught us
that the red, injected face of the butcher is an indication of a frail
habit of body.

--~ Here is an important problem for solution. On what does the great

mortality of the butcher depend? On his diet, into which too much
animal food and too little fruit and vegetables enter ?—on his drinking
to excess ?>—on his exposure to heat and cold ?—or, which is probably
the most powerful cause, on the elements of decaying matter by which
he is surrounded in his slaughter-house and its vicinity ?

 

Baxers and Conrectionens.—The habits of bakers in town and
country differ considerably ; but the mortality among the 42.717 was at the
DEATUS. | 397

ages from 35 to 65 much above the average. The young bakers of the
age (25-35) experienced a low rate of mortality (7°59 in 1,000).

Miners die in undue proportion, particularly at the advanced ages,
when their strength begins to decline. In this particular they resemble
labourers.

Taitors die in considerable numbers at the younger ages (25-44) ;
but their mortality after the latter age, though higher than that of the
former, is below the average of the people in general.

Carrenters, Grocers, WEAVERS, and SHOEMAKERS in early manhood,
25-45, do not experience a high rate of mortality ; and subsequently
the range of the rate below or above the average of all classes is not
considerable,

Brackswitus, 75,998 in number, are distributed all over the kingdom
in shops, where they work under peculiar conditions. Their mortality
differs little from that of labourers, but it is excessive after the age
of 55, and from the age of 55 to 75 it exceeds the mortality of
labourers.

In the annexed Table the several classes are arranged in the order of
the mortality at the age (45-55). The facts deserve to be carefully
studied.

Morrautry per 1,000 living at Stx AcE-PrEriops.

 

 

 

 

 

 

AGES.

25- | 35- | OccuPATION. | 45- | 55- | 65- | 75-
10°15 8°64 Farmer - - 11°09 24°90 55°30 143°02
9°12 10°59 Shoemaker - 15°03 28°69 65°05 164° 46
797 10°56 Weaver - 15°37 32°99 74°59 173°08
7°63 10°46 Grocer - - 15°79 22°65 49°72 124°57
8°12 12°40 Blacksmith - 16°51 87°24 74°43 167°10
9°45 10°32 Carpenter - - 16°67 29°66 65°86 142°86
11°63, 14°15 Tailor - 16°74 28°18 76°47 155°28
9°79 12°52 Labourer - - 17°30 29°20 67°90 173° 94
8740 11°35 Miner - - 20°15 34°50 80°51 178° 67
7°59 Li 75 Baker - 21°21 83°01 66°78 150°66 -
11°30 16°53 Butcher - - 23°10 41°49 66°47 15 4°49
13°83 20°45 Innkeeper - 23°34 38°97 81°51 18°84
9°48 12°36 All England - 17°87 30°31 63°96 140°55

 

 

 

 

 

 

Nes acs eneruation has its peculiar dangers, which in their results
sometimes counterbalance each other. Thus, the tailor is not exposed
to the explosions which are fatal to the miner; and the labourer has
exercise which is denied to the tailor. It is hence probable that the
diseases of classes that experience the same rate of mortality differ; so,
necessarily, do the measures by which those diseases may be obviated.
Insurance offices and friendly societies will prebably find the facts
in these tables of use to them in their transactions. For it is evident
that the lives of farmers, for example, may be safely insured at much
lower rates than the lives of licensed victuallers. Life Tables may be
constructed from these death-rates, showing the probabilities of life or
the mean life-time of several classes on a wider basis of facts than those
which were employed by the eminent actuary, Mr. Milne, in constructing
the Carlisle table. But before the tables are constructed the inquiry
must be extended over other years; and must embrace the diseases, and
several other circumstances on which it is desirable to obtain satisfactory
information before constructing new tables on which large pecuniary
investments may be made to depend. .
The result of the inquiries which the facts that have been already
analysed suggest, will, I trust, lead to great reductions in the rate of
398 [PART IV.

mortality from which all the unhealthy professions now sufter.—(14th
Annual Report, pp. xv—xxiil.)

Mortality of Males in various Occupations, 1861-2 and 1871.—
Small principalities and republics have alike contributed their quota
to art, science, and literature ; and among them Modena under the house
of Este deserves mention. There, on the northern slope of the
Appenines, Fallopius first saw the light; and Bernard Ramazzini, born
in 1633 at Carpi, has made Modena for ever memorable by his De
Morbis Artificum Diutriba. In the University he was the Professor of
the theory of medicine from the year 1678, the date of its foundation
by the Duke Francis II., and in Modena during his practice to the end
of the century, when he was called away to take a chair in Padua, he
collected the observations on the diseases of men engaged in the arts
and professions. And that city may be well held in the same regard as
the cities that the “ starry Galileo” made so famous by his observations,
for though the observations were made in workshops and not in celestial
space, their immediate result was the relief of the incidental sufferings
of the men to whom the world owes much of its progress and many of
its enjoyments.

Ramazzini created a new art, the art of preserving the health of the
men who are engaged in the arts of life. In his work he refers the
abundant and varied crop of diseases from which artisans suffer to two
distinct heads: the noxious materials in which they work, and to the
violent disorderly movements of the body, as well as its incongruous
attitudes, acting on the structure of the vital machine.

He commences with the miner and passes in review all the workers in
metals; describes the diseases arising from working in mines, from
quicksilver, antimony, lead, copper, tin, arsenic, iron; all those maladies
that afflict the vir metallicus, to use the characteristic designation of
Hippocrates. He then takes the workers in materials of vegetable
origin, and devotes a special chapter to the agriculturist. His chapters
on wet nurses and midwives are highly curious. He surveys nearly the
whole field of kuman activity in an Italian city.

In his chapter on soldiers (silites) he treats of the diseases of armies
in the field, not, as he says, from personal experience, but from report.
But he had in some Brunswick physicians excellent informants who had
been engaged in the last Hungarian war, and he sets the causes of camp
fevers, dysenteries, and other maladies in the clearest light. Sir John
Pringle i in his classical work developed and established the true doctrines
of military hygiene, so that our subsequent losses due to its disregard
were quite inexcusable.

The chapters on the health of the learned and the scientific professions
are elaborated with great care. And leaving the homes of workmen,
Ramazzini wrote a special treatise on the health of vestal virgins, a name
by which he designates nuns, who, he says, excelled the vestal vir gins of
old, whose vows were for thirty years. A second treatise De Principum
valetudine tuenda is full of instruction, and deserves to be read, not
only by all princes, but by all persons of wealth and rank. He pleads
with them the cause of their own as eloquently as if he were pleading
for his own life.

Ramazzini was in possession of all the ancient learning, and he every-
where refers with reverence to Hippocrates as the Divine Preceptor.
He is equally well versed in the most recent discoveries of that age.
No one has expounded more clearly the immense importance in ‘all
medical reasoning of Harvey’s immortal discovery of the circulation of
the blood.
DEATHS. | 399

What is most defective is due to the imperfection of the chemistry
of his day, and to the absence of exact observations on the mortality of
men in the different professions.

Thackrah wrote an excellent work on the effects of various occu-
pations on health. It is the result of conscientious study, and if not
marked by the learning and eloquence of Ramazzini is characterised by
sound professional sense. French and German writers have contributed
much informaticn on this subject; but nearly all of the previous writers
employed methods which could render no precise results, except in cases
where the influences they dealt with were very powerful. The effects
of compensating circumstances in a trade could not be weighed, and
they were more impressed by the sickness than the mortality of the
workmen in any particular business.

The mean age at death of people in different businesses often furnishes
very erroneous indications, as it is affected as much by the ages at which
people enter and leave, and by the increase or decrease of employment,
as by the salubrity or insalubrity of any particular profession. The
only way in which the mortality, and the duration of life, of miners,
tailors, farmers, Jabourers, or any other class of men can be accurately
determined is to determine the ratio of deaths at each age to the living
during a certain time—in fact to apply the same method to each class as
is applied to determine the mortality and the mean life-time of all classes
in a town, in a district, or in the whole kingdom.

The materials for such an inquiry extending over all the recognised
trades of the men in England were in part supplied ten years ago in the
Supplement to the Registrar-General’s 25th Annual Report; and it has
now been deemed right to publish as a sequel the deaths in 1871 in the
same classes at ten different ages in England and Wales, in each of its
divisions and in eighty town districts.

This series will serve as « good basis to the inquiry into a subject
next to none in importance in an industrial country. The inquiry must
embrace at least the various questions of which an outline is given in
the Census Report of 1861 (pp. 29-30). It well deserves the attention
of the Health Officers. Every help may be expected from the intelligent
artisans of the country, who have, in the Reports of the Odd Fellows
Society, shown their appreciation of it by giving the rates of sickness
and mortality in different trades. The late Mr. Neison and his son
have ably discussed the materials derived from the various friendly
societies, and with their observations those here published may be
usefully compared. ‘They throw light on each other.

As an illustration of the uses to be made of the facts relating to
occupations two sets of tables have been calculated, the one of sixteen
groups constituted so as to embrace well-defined occupations or groups
of allied and easily confounded occupations. The results are sufficiently
remarkable.

The high mortality of those two important classes the publicans and
butchers is unfortunately still maintained. It may be well if the many
persons of intelligence and influence amongst them would inquire into
its causes.

In the Appendix to the Report of the Commission on Mines, over
which Lord Kinnaird presided, I have given life tables for miners, and
tables showing the deaths of miners from different causes, which may
assist those who are engaged in investigating other occupations, as the
same methods are applicable to all.*

 

* See Extracts from this Report on pp. 404-11.
400 [PART IY.

The results deducible from the returns for the learned and other
professions are given in Tables, which are instructive, but have to be
read with care, as the numbers are not large and are only for one year.

By adding these results of 1871 to those for the two years 1860 and
1861, a large basis of facts is obtained ; and sufficient to enable us to
determine the relative mortality of men of various ages in all the leading,
numerous, and well-defined professions. The clerical work in the
reduction of these Census and registration tables is very great, and
nothing analogous to it has yet been undertaken in any other country.
The results fully justify the expenditure in the collection and analysis
of the facts, which are now submitted to the hygienic student. They
will repay his careful study of the mortality in its relations to the
circumstances of every occupation.

The degree of confidence to be attached to the rates depeuds to some
extent on the numbers of deaths which on that account are given in the
same table.*

I can only call attention here to some of the more remarkable results.

The pudlicans and butchers it will be recollected according to the
previous returns experienced high rates of mortality. As they still main-
tain a high position it has been thought expedient to commence the
analysis by dividing them into groups; the first group following their
occupation in London, the second group the corresponding occupation in
the rest of the country.

In the annexed table the mortality of butchers and publicans is
shown in comparison with the mortality of males of all classes.

Awntat Mortavity per Cent. among Burcuers and Pusricans in the
Years 1860, 1861, and 1871, at different Periods of Acr, in LonpoNn
and in England exclusive of London; also among Marrs of ALL
CLassEs at the same periods of Lire during the Ten Years
1861-70.

 

London. England exclusive of London.

 

 

All Males, Butchers, | Publicans,} All Males, Butchers, Publicans,
1861-70. |1860,61,71.(1860, 61,714 1861-70. |1860,61,71.1860, 61,71.

 

15-25 *703 +492 “686 (727 “383 1°003
25-35 - 1°086 1°050 1642 "972 “996 1°407
35-45 1-714 2°060 2°324 1°281 1°669 1-981
45-55 - 2°568 2°764 3°766 1°812 2°157 2°797
55-65 4°385 4°582 5°487 3°154 3°624 4°228
65-75 - 8° 283 9°052 10°383 6489 8°121 7-088
75 and up- | 18°451 24°424 32°692 16° 288 19°731 21-034

wards.

 

 

 

 

 

|

 

The mortality of butchers’ boys and potboys is lower in London than
the mortality at the same ages (15-25) of all classes.

The mortality of London butchers exceeds that of country butchers,
and would no doubt be still lower if their cattle were slaughtered at
public abattoirs and not in private slaughter-houses.

Young publicans (15-25) die at a faster rate in the country than in
town ; at all ages after 25 the mortality of London butchers is excessive ;

I

 

* See Tables in Supplement to 35th Annual Report, pp. elxxii-iv.
DEATHS. | 401

it is beyond not only the mortality of all other classes in London, but
beyond the mortality of the butchers of the rest of the country.

Fishmongers experience full as high a mortality as butchers.

The numerous body of men who supply the community with drinks,
food, and entertainment in inns, are shown to suffer more from fatal
diseases than the members of almost any other known class. They might
themselves institute a strict inquiry into its causes. But there can be
little duubt that the deaths will be found to be due to delirium tremens
‘and the many diseases induced or aggravated by excessive drinking. It
seems to be well established that drinking small doses of alcholic
liquors, not only spirits, the most fatal of all the poisons, but wine and
beer at frequent intervals without food, is invariably prejudicial.
Wien this is carried on from morning till late hours in the night few
stomachs—few brains can stand it. The habit of indulgence is a slow
suicide. The many deaths of publicans appear to prove this. Other
trades indulge in the publicans’ practice to some extent, and to that
extent share the same fate. The dangerous trades are made doubly
dangerous hy excesses,

The clergy of the Established Church, Protestant ministers, Catholic
priests, and barristers, all experience low rates of mortality from ages
25 to 45. The clergy lead a comfortable, temperate, domestic, moral
life, in healthy parsonages, and their lives are good in the insurance
sense. The young curate compared with the young doctor has less
cares.

[The mortality of Catholic priests _after the age of 55 is high ; perhaps
the effects of celibacy are then felt

Solicitors experience the full average mortality after the age of 35;
the legal work is hard.

Physicians and surgeons from youth up to the age of 45 experience a
mortality much ubove the average; after that age they do not approvch
the priesthood in health, but differ little from the average. Many
young practitioners have hard struggles to encounter. They are in
contact with the sick; are exposed to zymotic disease, and their rest is
disturbed. In states of depression deadly poisons are at hand. There
is an excess of practitioners in cities. Country practitioners have to
visit their patients in all weathers, at all hours. The causes from which
the medical men suffer demand careful study.

Chemists and druggists are younger than medical men, because
pharmacy is a separate business, and is of more recent growth. Their
mortality, like that of medical men, is high, and above the average,
especially in the younger ages. Manufacturers of chemicals, dyes, and
colours also experience a mortality above the average.

Commercial clerks experience an exceptionally high rate of mor-
tality. The rooms in which they work are generally close and ill-
ventilated. They often stoop at their desks. They require Sir John
Lubbock’s holidays.

The railway service taken collectively experience a high rate of
mortality, somewhat higher than medical men at advanced ages.

Coachmen (not domestic servants) and cabmen experience nearly the
same high mortality as the railway service from the age of 20 to 35;
after 35 the mortality is in still greater excess; the causes are probably
drink, exposure to the weather, and violent deaths. The mortality of
horse-keepers and grooms is, without hard exercise, pearly as high at
the ages of 25 and upwards as the mortality of coachmen.

Veterinary surgeons and farriers of the age of 25 and upwards
experience a very high rate of mortality; higher than physicians and
surgeons.

co
402 [PART Ly.

Gamekeepers offer an example of the healthiness of out-door life ;
their mortality is very low. The exercise of genuine sport is no doubt
as salutary to the amateur sportsman as it is to the professional
descendant of the hunters of old.

Publishers and booksellers fare well in health and life; they are
generally masters in better circumstances than their confederates,
bookbinders and printers, including masters and men, who often work
in badly ventilated rooms, and die at a rate of mortality exceeding the
average,

Tool, file, and sawmakers have among them the grinders who suffer so
much from sharp particles of stone and steel inhaled into the lungs;
their mortality is still high, and at the ages 45 to 65 excessive. The
mortality of needle manufacturers at 35-45 is excessively high.

Coachmakers of all branches working in wood, iron, binding, and
paint, up to the age of 45, experience a low rate of mortality ; afterwards
the mortality exceeds the average. They live in towus.

Wheelwrights working chiefly in wood, and scattered all over the
kingdom are healthy ; their mortality is low at all ages.

‘Lo carpenters, joiners, sawyers, and workers in wood generally the
same observation may be extended; their mortality is low; their
occupation is healthy.

The mortality of the blacksmiths, also scattered over the country,
and working in heat and iron, is higher than that of the wheelwright and
carpenter.

The carver and gilder suffers less than he did. But both he and the
plumber and glazier require further protection against the metallic
poisons. The mortality is high among them from age 35; but at the
age of 45-55 it approaches 50 per cent. higher; at 55-65 it is near
the ordinary mortality of men. 7

The wool, silk, cotton manufacturing population no longer experience
an exceptionally high mortality. Lord Shaftesbury and his enlightened
colleagues must be gratified, if not entirely satisfied, with the success
that has crowned their life-long labours. And it is creditable to the
mill-owners to find the men and boys in their employ suffering less than
many other people in towns.

The people working in wool are the healthiest ; at all the young ages
their mortality is the lowest; at 45 and upwards the cotton workers
suffer much more than the workers in wool and silk.

The mercers and drapers are not so healthy a class as could be
desired; their mortality is above the average, especially is this the case
from 25 to 45. Perhaps much of their in-door work is better suited to
women than to young men.

The hairdressers, barbers, and wig-makers, living chiefly in cities,
experience, according to these returns, high rates of mortality at all
ages ; and so do hatters.

Shoemakers at all ages, except 20-25, and at advanced ages,
experience a rate of mortality below the average.

Tailors on the contrary die at rates much above the average. For
their health aud for shoemakers, both classes counting more than
300,000 men, much remains to be done.

Bakers experience a mortality very little above the average, and that
is chiefly at advancing ages.

Grocers at all ages after 35 experience a low rate of mortality.

The tobacconists, snuff, and tobacco manufacturers suffer very much
at all the younger ages; indicating clearly how prejudicial smoking
is to young men.

They present a strong contrast at the corresponding ages to tanners
and eurriers who are healthy up to 45, and then show signs of suffering.
DEATHS. | 403

The eaithenware manufacture is one of the unhealthiest trades in the
country. At the age of joining it is low ; but the mortality after the
age of 85 approaches double tke average; it is excessively high; it
exceeds the mortality of publicans. What can be done to save the men
dying so fast in the potteries and engaged in one of our most useful
manufactures ?

Among the glass manufacturers the mortality is higher at 25-35
than among the earthenware manufacturers; but much lower
afterwards.

The men engaged in copper manufactures from 20 and upwards
experience a mortality somewhat above the average; at 55-75 their
death-rate is heavy—much heavier than it is among the workers in
brass and in iron.

The men in the iron manufactures do not die at the average rates
under 45 ; after that age the average is exceeded.

Working in wood on the whole is comparatively cool compared
witb working in iron; the loss by perspiration is excessive among such
men as puddlers, and they require a great deal of drink, which should
contain little or no alcohol.

Taken in the aggregate the metal worker—the metallic man in all
England does not experience the average rate of mortality under 436,
after that age the table turns against him and his losses grow heavier
and heavier every year.

Miners in the aggregate experience a heavier rate of mortality, largely
from violent death, than metal workers; and the mortality of both classes
greatly exceeds that of the agricultural labourer.

Independently of the influence of the material and of the work itself
on health, the place in which men work exercises so great an influence
that it has to be taken into account in judging of the salubrity of their
occupations.

Man is naturally an open air animal ; he is made to work, and the sky
is his native covering. So after taking everything into account, the
hunter, the sportsman, and the husbandman in a cultivated land are at
present the healthiest of all workmen. All would no doubt be the
better if the higher parts of the brain had their due share of activity ;
and this, though not often the case now, we may hope will come.

The farmers and agricultural labourers are at present among the
healthiest classes of the population classified according to occupation.
The young farmer for some reason or other suffers a bigher mortality
than the labourer; but at 35 and upwards the British farmer enjoys
comforts which are beyond the reach of the labourer. It is probable
that in no country is the agricultural population healthier than in
England. Ramazzini thus writes of the agriculturist in Italy :

O fortunatos nimium, sua si bona noruit agricolas.

So it might perhaps have been, he says, with that pristine race of
mortals who cultivated the paternal acres with their own oxen, but it is
not so in this age with our husbandmen, who struggle on another man’s
land (alieno fundo) with perpetual toils and extreme poverty. Then he
enumerates their diseases,* pleurisies, peripneumonias, ardent fevers,

 

* De morbis artificum, cap, Xxxviii.

Q
©:
bo
404 [Part Ivy.

fluxes, and other maladies to which they are particularly liable ‘at
“ least,” he adds, “in Italy,’ and especially in the region of the Po.
Carelessness is one cause of their ill-health ; for before the cowhouses,
pigsties, and dwellings, which may indeed be called augean stables, they
they heap up ordure to dung the fields, and keep it there “for a
“ nosegay all summer* ;” whence it cannot but be that fetid exhalations
arise continually and pollute the air. Tn no men does the blood undergo
greater changes in a short time from exposure to the weather and
work. Galen denounces the air of gardens for a similar reason ob
stercorationem ct arborum parvos helitus, Ramazzini notes that the
country people do not bear bleeding even in pleurisies. The reapers in
the Ager Romanus every year fill the hospitals, and it is uncertain
whether the scythe of death or the lancet of the surgeon is the more
fatal.

The English farmer is in a very different plight; his blood is not poor
and he is not ill fed. The weather it is true troubles his mind, but
against its severities he is well sheltered. His capital not being sunk in
the purchase of land he has more to expend on stock, implements,
labour, and fertilizing materials. His profits are greater. No doubt
the dirt which feeds zymotie disease germs, cattle and human alike,
still pollutes the farmyards, and the farm ponds; but foot-and-mouth
disease, peripneumonias, and cattle-plague will in the end teach the
intelligent farmer that in his management of all live stock cleanliness is
next to godliness.

The mortality of the English farmer is not now high; but it may by
care be reduced to a lower figure. To what is the high mortality of the
young farmer of 15-25 due? Farmers’ sons appear to be healthy. The
labourer experiences a higher rate of mortality than the farmer at all
ages after 35.—(Supplement to 35th Annual Report, pp. lii-lviii.)

Mortality of Miners, 1848-53 and 1860-2,¢ Cornwall—From the
evidence given before us by Dr. Farr, F.R.S., Chief of the Statistical
Department of the General Register Office, and from a Return
prepared for us by the Registrar General and printed in the Appendix,
we are enabled to show the rates of mortality prevailing among the
miners of Cornwall at different periods of life, as compared with those
prevailing among the non-mining population of the same districts, for
the five years 1849-53 inclusive, and also for the more recent triennial
period 1860-62 inclusive.

The districts selected for the purposes of this comparison were those
of Liskeard, St. Austell, Truro, Helston, Redruth, and Penzance. The
death-rates were computed from the aggregate numbers of males, and
of deaths of males of the two classes respectively in the whole six
districts taken together. The subjoined table shows the rates of
mortality from all causes during the earlier period 1849-53, among the
two sections of the population, for the several successive decennial
periods of life, from the age of 15 up to that of 75 years.

 

* Such is Dr. James’s translation of “ per totam estatem pro delitiis.” He is not
often so happy, when not literal.

+ This extract is a summary of Dr. Farr’s evidence given before the Royal
Commission on the Condition of Mines in 1864, of which Lord Kinnaird was
Chairmaa, and is reprinted from the Commissioners’ Report, together with some of
the Tables furnished by Dr. Farr, the remainder of which will be found in the
Appendix to that Report.
DEATHS. | 405

Average Anyust Numper of Duatus per 1,000 Miners, and per
1,000 Males exclusive of Miners, in Cornwall, from all Causes,
during the five years 1849-53 inclusive.

 

 

Males,
Ages. oe exclusive
* | of Miners.
Between 15 and 25 years 8:90 7°12
BB e385 8-96 8°84
» 85 5 45 45 - 14°30 9-99
3 «4D gg BD gy 33°51 14°76
BB yg BB. gs 2 63°17 24°12
» 65 4, 75 4, 111°23 58°61

 

 

From the figures in the above table it appears that the rates of
mortality among the miners are not materially different from those
prevailing among the non-mining males of the same districts until after
the age of 35 years, after which there is a large and progressive excess
of mortality among the mining section of the male population. If we
assume the rate of mortality among the non-mining males at each
decennial period of life to be represented by 100, then that among the
miners would be represented by 125 between the ages of 15 and
25 years, by 101 between 25 and 35, by 143 between 35 and 44, by
227 between 45 and 55, by 263 between 55 and 65, and by 189 between
65 and 75 years. That the large and progressive excess of mortality
among the miners between the ages of 85 and 65 years must be due to
unwholesome conditions incident to their occupation may be inferred
from the fact that it does not commence until they have had full time to
operate. The somewhat higher rate of mortality among miners between
the ages of 15 and 25 years probably arises from the circumstance that
many of the boys are put to work in the mines at too early an age.

That the excessive mortality among the miners in Cornwall is not
caused by the mere working underground in dark galleries, a necessary
condition of the miner’s occupation, and must therefore be mainly due
to other causes, is clearly proved by some statistics relative to the coal
miners of Durham and Northumberland, also given in cvidence by
Dr. Farr. The annexed Table shows the rates of mortality among the
coal miners of Durham and Northumberland during the five years
1849-53 inclusive, for each decennial period of life, from the age of 15
up to that of 75 years, compared with the rates among the Cornish
miners already quoted.

Averace AnnuaL Numper of Deatus per 1,000 Cornish MErar
Miners, and per 1,000 Nortaern Coat Miners, from all Causes,
during the five years 1849-53 inclusive,

 

Cornish | Northern

Ages. Metal Coal

Miners, Miners.

Between 15 and 25 years 8-90 8°50
53. 25 5 BD 8-96 8°49

e BS yy 45s, 14°30 10°13

o 45 3s BS ay 33°51 16°81

or ae ae 63°17 24°43

53 GOO es - | 171-23 65°16

i

 

 
406 [Pant Iv.

Assuming, on the authority of the previous table, the rate of
mortality among the coal miners at each period of life to be represented
by 100, then that among the Cornish miners would be represented by
105 between the ages 15 and 25 years, by 106 between 25 and 35, by
141 between 35 and 45, by 199 between 45 and 55, by 258 between 55
and 65, and by 171 between 65 and 75 years. The rates of mortality
among the Cornish miners from the age of 35 years upwards are thus
shown to have been almost as much in excess of the rates which prevail
among the coal miners in the selected districts of Durham and North-
umberland, as they were above the rates prevailing among the non-
mining male population of Cornwall.

The evidence regarding the more recent period 1860-62 shows that
the great excess of mortality among the Cornish miners still continues,
although the proportions are slightly different. The subjoined table
shows the rates of mortality among the two sections of the male popula-
tion respectively, from all causes, during the three years 1860-62, for
the same periods of life as the former table.

AveraGe AnnuaL Numper of Dearus per 1,000 Miners, and per
1,000 Mavzs exclusive of Miners, in Cornwall, from all Causes,
during the three years 1860-62 inclusive.

 

 

Metal Males,
Ages. ; exclusive
SanTensy of Miners.
ae '
Between 15 and 25 years | 9-44 7°50
fn OE yee BO cs / 9°57 8°32
a BB yy ED gy eee 10°08
sie HD aps DE - yy | 99-74 12°50
ABBR sp BB ss 63°21 19°96
a 6B 5 7B 110°51 53°31

 

Aguin, assuming the rate of mortality at each period of life among the
non-mining males to be represented by 100, then the rate among
the miners would be represented by 126 between the ages of 15 and 25,
by 115 between 25 and 35, by 150 between 35 and 45, by 238 between
45 and 55, by 317 between 55 and 65, and by 207 between 65 and
75 years.

From Dr. Farr’s evidence, supplemented by the Registrar General’s
Return, it further appears that the excessive rate of mortality among the
Cornish miners is mainly caused by the large number of deaths from
pulmonary consumption and other diseases of the lungs. As, however,
deaths which are registered in some districts as due to consumption are
registered in other districts under different names, such as asthma and
bronchitis, it is best for statistical purposes to throw all the diseases of
the lungs into one class under the general name of Pulmonary Diseases,
an arrangement which enables the rates of mortality from diseases of
the lungs in different districts to be more accurately compared with
each other than it the several diseases of these organs were nominally
kept separate. The class of pulmonary diseases thus formed comprises,
phthisis, laryngitis, bronchitis, pleurisy, pneumonia, asthma, and all
cases returned as “ diseases of the lungs.”

The annexed table shows the average annual rate of mortality per
1,000 persons from pulmonary diseases among miners, and also among
males exclusive of miners, during the three years 1860-62 inclusive,
for each decennial period of life between the ages of 15 and 75 years.
DEATHS. | 407

Averace AnnuaL Number of Deratus per 1,000 Miners, and per
1,000 Males exclusive of Miners, in Cornwall, from Pulmonary
Diseases, during the three years 1860-62 inclusive.

 

 

Ages. oo jee
*- | of Miners.
Between 15 and 25 years 3°77 3°30
” 25, 85, 4°15 3°83
» 385 ,, 45 4, 7°89 4:24
» 45 ,, 55 5, 19°75 4°34
» 5d 4 65 4, 43-29 5-19
» 65 4 75 45 45°04 10°48

 

 

 

Assuming as before, that the rate of mortality among the males
exclusive of miners is represented at each period of life by 100, then
that among the miners would be represented, by 114 between the ages
of 15 and 25 years, by 108 between 25 and 35, by 186 between 35 and
45, by 455 between 45 and 55, by 834 between 55 and 65, and by 430
between 65 and 75 years. It is therefore evident that pulmonary
diseases are the chief cause of the excess of mortality among the
Cornish miners; and that these diseases are due to the conditions
incident to the miners’ labour may also be confidently inferred, as in
the case of the death-rates from all causes, from the fact that the excess
of mortality arising from them does not reach its acme until after the
middle of life, when these conditions have had full time to produce their
effect on the health of the miners. A much greater discrepancy will be
observed between the rates of mortality from pulmonary diseases among
the miners and non-miners than has been shown to exist between the
rates of mortality from all causes among the two sections of the
population respectively. This is undoubtedly due to the fact that
exposure to the peculiar evils incident to the occupation causes many
miners to die of pulmonary diseases who in different circumstances
would have died of other complaints.

The subjoined table contrasts the rates of mortality among miners at
the two periods 1849-53 and 1860-62, both from all causes and from
pulmonary diseases.

AVERAGE ANNUAL Numper of Dearus per 1,000 Mryers in Cornwall
from All Causes and from Pulmonary Diseases in 1849-53 and

 

 

 

 

 

 

 

 

1860-62.
All Causes. Pulmonary Diseases.
Ages. During During During During
the'five | the three | the five | the three
years years years years
1849-53. 1860-62. | 1849-53. | 1860-69,
Between 15 and 25 years 8:90. | 9°44 3°05 3°77
» 23 4 85° ,, 8°96 9°57 4°42 4°15
iy BBE BS” 14:30 15°12 8°47 7°89
» 45 4 35 33°51 29°74 24°31 19°75
» 3d 4 65 ,, 63°17 63°21 44°46 43°29
we 6B FB as -| 111°23 | 110°51 55°87 45-04

 

 
408 [PART 1V«

It will be scen in the above table that the only material difference in
favour of the rore recent period is that existing between the 45 and
55 years. A comparison of the rates of mortality from all causes
among the non-mining section of the male population also shows @
similar improvement in favour of the more recent period.

YorksairE anp Nortuern Counties.—From a return prepared
at our request by the Registrar General, and printed in the Appendix,
it appears that, as has been shown to be the case in Cornwall, so
also in these northern districts the rates of mortality are much higher
among the mining than among the non-mining section of the male.
population.

The districts comprised in the return are the lead-mining districts of
Northumberland, Durham, Cumberland, Westmorland, Yorkshire, and
Lancashite. But inasmuch as the numbers of miners, and of course
the numbers of deaths of miners, in some of these counties were
too small, taken separately, to justify any deductions with regard to
the comparative health of the mining and non-mining sections of the
population, we shall only quote from the return of the death-rates as
computed from the aggregate numbers of males, and of deaths of males
of the two classes respectively, in all the lead-mining districts of the
six counties taken together. In order to show the comparative health
of the two sections of the population at the present time, the rates of
mortality comprised in the return have been calculated for the three
years 1860-62 inclusive; these years have been selected because the
last Census was taken in 1861, the middle year of the term which
renders the calculations as nearly accurate as possible. The subjoined
table shows the average annual rates of mortality per 1,000 miners, and
per 1,000 males exclusive of miners, from all causes, for the several
successive decennial periods of life from the age of 15 up to that of
75 years.

Averace AnNuAL Numpser of Dzarus per 1,000 Leap Miners, and
per 1,000 Males exclusive of Miners, from All Causes, during the
three years 1860-62 inclusive.

 

 

|
Males,
Ages. ae | exclusive
iners. :
| of Miners.
|
Between 15 and 25 years 9°53 7°57
Pay aetna 12°38 $19
4, BB ig 17°64 10°13
se CEB: yD 35 33°11 16°18
BB gy BB sy 78°34 29-38
» 63 5 73 55 127°52 66°10

 

The figures in the above table show that at all ages from 15 years
upwards the miners die in larger proportions than the men of the same
districts not employed in mining, and also that this excess of mortality
among the miners increases largely and progressively with increasing
age, up to that period of life after which few miners continue to work
underground. Thus if it be assumed that the rate of mortality among
the non-mining section of the male population at cach successive period
of life quoted in the table is equal to 100, then the ratc among miners
between the ages of 15 and 26 years would be 126 ; between 25 and
DEATHS. | 409

35 years, 185; between 35 and 45 years, 174 ; between 45 and 55 years,
205; and between 65 and 75 years, 193.

From the return prepared by the Registrar General it al-o appears
that this excess of mortality smong miners is mainly due to the greater
prevalence and fatality of pulmonary diseases among them, as compared
with that among the non-mining section of the male population. The
subjoined table shows the average annual rates of mortality per 1,000
miners, and per 1,000 males exclusive of miners, from pulmonary
diseases, for the several successive periods of life from the age ef 15 up
to that of 75 years.

Averace Annuat Number of Deratus per 1,000 Leap Miners, and
per 1,000 Males exclusive of Miners, from Pulmonary Diseases,
during the three years 1860-62 inclusive.

 

 

Males,

Ages. Si oe exclusive

* | of Miners.

Between 15 and 25 years 3°40 3°97
2B a, BR gy 6°40 5°15

3 BB we 40 os 11°76 3°52
AD gs DDL as 23°18 5°21
«© BD ogg BB Cy, 4147 7°22

a OD ay TR as 53°69 17°44

 

 

With regard to the above table, if it be again assumed that the rate
of mortality from pulmonary diseases among the non-mining section of
the male population at each successive decennial period of life is equal
to 100, then the rate among miners between the ages of 15 and 25
years would be 88; between 25 and 35 years, 124; between 35 and
45 years, 3384; between 45 and 55 years, 445; between 55 and 65
years, 574; and between 65 and 75 years, 308.

Thus it appears not only that the rate of mortality from pulmonary
diseases among the lead miners in these counties is higher than that
among the male inhabitants of the same districts who do not work in
the mines, but also that this excess of mortality does not begin until
after the age of 25 years, when the unwholesome conditions contingent
on working in the mines have had sufficient time to exercise a sensible
influence on the health of the miners. The smaller rate of mortality
from pulmonary diseases which will be observed to exist among miners
between the ages of 15 and 25 years, as compared with that among the
non-mining section of the male population at the same ages, may be
presumed to arise from the very probable fact that youths with known
tendency to diseases of the lungs are not usually.put to labour in the
mines. On the other hand, the much larger discrepancy between the
rates of mortality among miners and among other males from pulmonary
diseases, as compared with that between the respective rates of mortality
froin all causes, is undoubtedly due to the fact that exposure to the
peculiar conditions attendant on their occupation causes many miners
to die of pulmonary diseases who in different circumstances would have
died of other complaints, and therefore the great excess of deaths from
pulmonary diseases does not in the same proportion raise the general
rate of mortality, although, as has been scen, it.does so to a very large
extent.
410 [PART Iv.

Nortu Waxres.—The returns of mortality relating to North Wales,
prepared for us by the Registrar-General, have reference only to the
district of Holywell. The subjoined table shows a very considerable
excess in the rates of mortality from all’causes among the lead miners,
as compared with the other section of the male population, during the
three years 1860-62 inclusive.

AVERAGE Annuat Numer of Dearas per 1,000 Leap MINERS, and
per 1,000 Mares exclusive of Lead Miners, from all Causes, in the
District of Holywell during the three years 1860-62 inclusive.

 

 

Males,
Lead exclusive
Ages. Miners. of Lead
Miners.
Between 15 and 25 years 6°04 7°46
3 25D » BS 4 15°72 10°52
» B54 45! gy 18-05 12°57
a. (4S oe G8 Sy 25°74 15°19
» «=D gy 65 yy 55°19 28°11
gp 6D ge AID <5 86°96 75°78

 

 

 

Assuming, asin the previous sections, that the rates of mortality among
the males, exclusive of lead-miners, are represented at each period of
life by 100, that among the lead miners will be represented by 81
between the ages of 15 and 25, by 149 between 25 and 35, by 144
between 35 and 45, by 169 between 45 and 56, by 196 between 55 and
65, and by 115 between 65 and 75 years.

As in the other metal-mining districts referred to in this report, so
also in this district, the excess of mortality among the metal miners,
over that which prevails among the other section of the male popu-
lation, is mainly due to the excess of deaths from pulmonary diseases.
The subjoined table shows the mortality from these diseases, among the
two sections of the population respectively, for each decennial period of
life from the age of 15 up to 75 years.

AVERAGE AnNUAL Number of Deatus per 1,000 Leap Miners, and
per 1,000 Males exclusive of Lead Miners, from Pulmonary Diseases,
in the Districts of Holywell during the three years 1860-62

 

 

inclusive :—
|

Males,
Lead exclusive

| Ages Miners. of Lead
Miners.

Between 15 and 25 years 3°02 3:39

» 25 4 35, 4°19 5°79

yc BB gy ADs 10°62 5:41

AB yy BB. 14-71 7-06

wy BD gs BB as 35°32 12°21

65 4 75 ,, 48°31 16°96

 
DEATHS. | 411

Again, assuming the rates of mortality among the male population -
not engaged in lead mining to be represented at each age by 100, then
that among the lead miners would be represented by 89 between the
ages of 15 and 25, by 72 between 25 and 35, by 196 between 35 and 45,
by 208 between 45 and 55, by 289 between 55 and 65, and by 285
between 65 and 75 years.

The excess of mortality among the lead miners of the Holywell
district over that which prevails among the other section of the male
population is thus evidently much less striking than has been shown to
be the case in the Cornish and Northern metal-mining districts, both as
regards the deaths from pulmonary diseases and those from all causes,
Nevertheless, the above statistics clearly indicate that the Holywell lead
miners suffer from some causes of disease and premature death from
which the rest of the male population are exempt. Reasoning from
analogy, it is therefore but fair to presume that in this as in the other
metal mining districts, the excess of mortality among the miners arises
in some way from conditions incident to their occupation. (Report of
Royal Commission on Condition of Miners, 1865; pp. x-xxxvi.)

Mortality in the Royal Navy and in the Mercantile Marine.—The
Registrar-General of Shipping and Seamen returns the strength of
the Merchant Service in 1871 at 199,738 men and boys, exclusive of
Masters, and the deaths occurring in the year out of that strength at
4,338, the rate of mortality being equivalent to 21:7 deaths per 1,000 of
strength. The death-rate shows a further decline from the very high
rates in several preceding years, and was in fact lower than in any year
since 1864. But that it is and has been for some years excessive, will
be evident from a comparison of the two decenniums 1852-61 and 1862-
71; the mean annual mortality was 19°2 in the former as compared
with 23:1 in the latter period. As the condition of the Mercantile
Marine is just now engaging a good deal of public attention it may be
worth while to see how that Service compares in point of mortality with
the Naval Service and the general home population at corresponding
ages. The mean age of the men afloat in the Merchant Service is
about 28 years, while that of the men in Her Majesty’s Navy is about
26 years, so that there is really little difference between the two in
respect of age. Now the mortality among the English male population
at the age 28 is by the English Life Table 9-7 per 1,000; in the Navy
the average annual rate of mortality in the years 1856-72 was 14 per
1,000; in the Merchant Service from 1852-71 it was 21 per 1,000.
(84th Annual Report, pp. xxiv-v.)

8.—METEOROLOGY AND Morvrariry.

Influence of Climate—-In the diseases registered in twenty-five divi-
sions of the kingdom, the influence of cities, occupations, and perhaps
climate, may be traced. The tables may be advantageously compared
with the corresponding tables of ages, and with the births; for where
the number of births is greatest in proportion to the population, the
number of deaths at early ages, and the diseases of children, will be
found to preponderate.

It appeared important to compare the fatal diseases with the popula-
tion, and to endeavour to ascertain the influence of climate, of the north
and south, the east and west, the maritime and inland parts of the
island. With this view a separate calculation for each county might
412 [PART Iv-

have been entered into, but three objections presented themselves against
that course. The population increases rapidly and irregularly in
different counties, the districts of the respective counties are not in-
variably coincident with the boundaries in the population returns, and
the population of some of the counties is too small to neutralise accidental
fluctuations. By taking groups of counties, comprising a mean popu-
lation of about 1,400,000, the basis of calculation, these objections were
obviated. The population of the metropolis and the ten classes of
counties in England and Wales, in 1838, was calculated from the rate of
increase in the ten years, 1821-31 ; 4 per cent. was added to the metro-
polis, and 0°4 per cent. to the ten other classes, for the numbers not
enumerated. The increase was placed exclusively to the account of the
males, when the sexes were distinguished.

In investigating the effects of climate, the influences of density, of the
ages of the living, of occupation, and of differences of food, must be
eliminated. The climate of the channel is the same as it was at the end
of the last century, but the mortality of the crews of vessels in the
channel is probably not now a third of the mortality at that period.
The army reports, drawn up with so much ability by Major Tulloch and
Mr. Marshall, exhibit the influence of barracks, us decisively as they do
the effects of climate on English soldiers.

Sic James Clark, in his ‘Influence of Climate,” observes that
although the power of different climates to produce as well as to
wlleviate and cure diseases is well estublished as a matter of fact,
‘ yet, perhaps, there is nothing in general science more unsatisfactory
than the manner in which we are able to explain this influence;
and certainly, there is nothing in physic more difficult than to direct
successively its application.” Climate should always be considered
separately, in reference to the indigenous inhabitants, and to strangers,
the natives either of a similar or of a different climate.

The diseases of the 324 classified districts will throw light upon this
anda variety of collateral subjects. Town districts, watering places,
and districts in any way remarkable, have been distinguished ; the
diseases of similar and contiguous districts have been thrown together in
one column. The extent of epidemics, and their order of succession,
will be shewn by this annual series of tables.

a

n

‘

a

rs

a

The separation of Wales—or the districts chiefly inhabited by the
Celtic race—from the districts of England, will show at some future
time if there is any difference in the diseases of the two races. But the
ordinary laws of mortality are at present disturbed in Wales by the
confluence of workmen within the mining districts. The population
suddenly collected by mining operations, is exposed to all the evils of
dense districts, with few of the alleviations which spring up in towns of
slow growth, having well-organized intelligent municipal councils. (2nd
Annual Report, pp. 86-88.)

Influence of Seasons ——In order to determine the exact influence
of the changes of the seasons, the general condition of the people should
remain uniformly the same through the year; or corrections should be
made for accidental privations, abundance, and the perturbations caused
by epidemics. The metropolis presents a series of facts which enable
us to dispense, to a certain extent, with these diflicult corrections. It
would, perhaps, be vain to expect less fluctuation in the condition of any
DEATHS. ] 413

large mass of people than has been experienced by the population of the
metropolis within the 34 years ending in June 1841: hence, for the
present purpose, the mortality from the pressure of privation may
be fairly considered to have been nearly invariable within that period,
and to have exhibited fluctuations, directly or indirectly, dependent on
the seasons, if we except the results of improvements going on in the
sewerage, and the decline of the epidemics of small-pox and typhus.

A table shows the deaths from different causes in each quarter of the
3k years—1838 to June 1841. The quarters of the years 1840-1 have
been obtained by adding together the deaths returned in the Metro-
politan ‘lables of Mortality for periods of 13 weeks; and, alihuugh the
facts were abstracted from the unchecked Weekly Returns, and do not
precisely correspond with the dates of the other years, the summary in
the table is sufficiently accurate for all the purposes of this inquiry.

The mean temperature of the seasons is given from the observatious
made at the apartments of the Royal Society.

It is found that the degree down to which the mean monthly tempera-
ture falls in December, January, or February, determines, to a great
extent, the mortality of winter.

The January of 1838 was the coldest month of the 3} years: the mean
temperature of the two cold months—January and February—was
nearly the same in 1839-40, and the winter of 1841 was anticipated by
the cold December of 1840, when the mean temperature attained the
minimum, and rose slowly through January and February.

The deaths registered in the seasons of the three years are compared
with the temperature expressed in degrees of the Fahrenheit and Centi-
grade thermometers. The number of deaths has been corrected, on the
assumption that each period embraced 275 days.

The causes of death which proved the most fatal in the cold months
belong principally to the pulmonary class and the cerebral diseases of
the aged ; those which prove most fatal in summer belong to the diseases
of the bowels ; but in almost every class there were one or two diseases
over the fatality of which temperature exercised a marked influence.

Of the diseases in the epidemic class, influenza and wheoping-cough
followed the same law as the pulmonary—cholera, dysentery, diarrhea,
and thrush, as the abdominal affections.

Persons affected by the following diseeses died in greatest numbers
when the temperature was low. It has been already rendered probable
that many cases, arranged under apoplexy and sudden death, are the
effects of congestions in the lungs—a sort of spontaneous asphyxia,
the development of which appears to be favoured by a temperature
beiow the freezing point of water.

The range of temperature in this climate appears to have little effect
upon some of the fatal diseases of infants and adults.

As the corresponding seasons of different years present fluctuations in
the temperature, this will supply another test of its influence.

The autumn of 1840 was much colder than the autumns of the two
preceding years; the mortality of the diseases under the influence of
temperature was raised in an equal degree.

The fluctuations in the temperature of the three summers were less
marked; their influence was scarcely sensible in any of the diseases
most fatal in warm weather.

At what degree of cold does the mortality begin to rise? And how
soon after the cold weather has set in is its effect experienced? The
414 [PART IVe

Weekly Tables of Mortality furnish replies to these questions. It will
be recollected that the tables of the week comprise the registered deaths,
about half of which must have occurred when the rate of mortality was
uniform, in the week preceding.

Meteorologists have observed that the mean temperature of October
represents very nearly the mean temperature of the year and the place ;
and the facts in the table show that the mortality rises progressively, as
the mean temperature falls below the mean temperature of London
(50°°5); the deaths in the week rising to 1,000 and upwards when the
temperature of night falls below the freezing point of water, and to
1,200 when the mean temperature of day and night descends a degree or
two lower than 32°.

The rise in the mortality is immediate, but the effects of the low tem-
perature go on accumulating, and continue to be felt 30 or 40 days after
the extremities of the cold have passed away. The cold destroys a
certain number of persons rapidly, and in others occasions diseases which
prove fatal in a month or six weeks. The relation of the temperature
and mortality may be distinctly shown; where accidental irregularities
may be diminished by extending the number and the period of the
observations. The practical lesson taught by these facts is obvious. A.
great number of the aged, and those afflicted with difficulty of breathing,
whether it arises from emphysema, chronic bronchitis, diseased heart, or
impairment of the function of respiration, cannot resist cold sunk so low
as 32°. The temperature of the atmosphere in which they sleep can
never safely descend lower than 40°; for, if the cold that freezes water
in their chamber do not freeze their blood, it impedes respiration, and
life ceases when the blood-heat has sunk a few degrees below the
standard.

So far as statistical investigation has hitherto gone, temperature
appears to have no influence on the fatality of consumption (tubercular
phthisis) ; while it exercises a well-defined influence in emphysema and
in the inflammatory diseases of the chest. (8rd Annual Report,
pp. 102-9.)

Weather and Mortality ; Summer Quarter of 1860.—The weather
of this quarter may be looked at as an experiment on the health of the
people. Employment has been easily obtained by workmen, but the
prices of provisions have been high. And this general survey seems to
establish the fact, that the salubrity of the season is chiefly due to two
circumstances ; the reduced temperature of summer, and the abundant
supply of water by rain. The low temperature retarded the putre-
faction of the town impurities ; and the water washed them away ;
so both the forces acting in the same direction gave a great result.
A careful study of the circumstances of each locality by which the
result was produced, cannot fail to be instructive; and to confirm the
faith of the authorities in the simple sanitary elements with which nature
works.

If Wolverhampton is, as the Registrar conjectures, extraordinarily
healthy, ‘ because the frequent rains have swilled away the impurities
“ from which in hot summer weather noxious effluvia arise, thereby
“ preventing the sickness, and diarrhoea more especially, caused by
“ such vapours in the air, and impurities in the water supply,” why
should Wolverhampton ever be again as unhealthy and as dangerous
to its inbabitants as it was before? It is true the town has no
command over the rain; but it has unquestionably the power to wash
DEATHS. | 415

awey tLe impuiities frcm its cecspcols and its sewers. Its engineers
can supply tbe town with sweet waters in abundauce for the use of the
inhabitants. If the Birmingham and Aston district too lose only
1,243 inhabitants by death when the town is well washed, why should
they ever die again at the rate of last summer when 1,815 of the people
perished ?

The remedy is too simple to obtain immediately all the attention it
deserves from the municipal authorities. But they cannot do better than
imitate the great oriental dignitary suffering from leprosy, as our towns
are now suffering from other diseases, who, although he was wroth when
told to “ wash and be clean,” yet finally obeyed the injunction, and was
healed.— (28rd Annual Report, pp. xxv-vi.)

Meteorology and HealthAny investigation of the laws of health
and sickness, life and death, in connexion with meteorological phenomena,
which is confined in its scope to mean temperatures, must be imperfect,
and can bardly be expected to be crowned with any important results.
The facts observed were entities; they had an actual existence, and
they produced actual effects ; but the mean forces derived from them
exist only in the tables of the meteorologist. Two periods of equal
length might be compared as regards the mean force of the wind, and
two amounts might be obtained exactly equal. One of those periods,
though generally marked by tranquillity of the air, might in one or two
short intervals have given birth to hurricanes, and in this latter mood
the noblest trees may have been uprooted, the ocean strewed with
wrecks, buildings overthrown, and their inhabitants buried under them.
Throughout the second period the movement of the air, undisturbed by
convulsions, may have sufficed only to maintain a healthy and agreeable
freshness. The character of the two periods, estimated, by total work
done in each, by the anemometer, would be the same; the facts
on which it was based, and the effects produced by these on the face of
nature, would be entirely different. The temperature, weight, humidity
of the atmosphere, and other physical forces should not be masked under
mean values, but laboriously traced throughout their course from day
to day, and if it were possible, from morning to night and from night to
morning, and observed in connexion with the contemporaneous facts
that relate to human life, as these also are successively recorded, if the
sway which they exercise is to be appreciated in its full significance,—
(28th Annual Report, pp. xvili-xix.)

Low Winter Temperature, and the Public Health; London 1855
and 1874.—Men, as well as other animals with warm blood, have the
power of producing heat so as to maintain their temperature very
constant ; but this power varies under different circumstances. And
the demands on it vary still more; for the loss of heat by the surface of
the body, and especially by the lungs which lose heat by evaporation,
and by contact with the cold air inspired at an inconceivably more
rapid rate in cold weather than in warm. The heat has to be supplied
by the food consumed, and the conversion into heat is accelerated
by exercise. If food is the fuel, exercise is the blast that makes it
burn.

Tt was well established by the researches of Villermé and Edwards
that young children die in considerable proportions by exposure to cold,
and it was known in a general way that the winter is more fatal to old
people than to young.
416 [PART IV.

The Weekly Tables carry us much further, and show that the mortality
after 20 increases with age rapidly, and that after a determined law.
Thus, if we divide life into vicennial stages, then beginning at 20, 40,
60, 80, the result in London in the six weeks of very cold weather
ending 24th February 1855 was found to be that the mortality due to
cold at the four ages was 2°0, 7°5, 44°9, 181°8; so rapidly did the
power of resistance decline with age. Taking the increase of mortality
by cold between 20-40 as one, then the mortality became 2, 4, 8, and so
on, “ doubling every 9 years.”

The effects of the cold of the five weeks that ended on 19th of December
(1874) have been tested in the same way by comparing the deaths at
each age with the deaths in the five previous average weeks. The
deaths were raised from 6,967 to 9,871; so the excess due to cold was
2,904 in the five weeks, and on an average 581 weekly. The mortality,
higher than before, increased with age at the same rate; it was in every
1,000 living at the four ages, 2°2 at 20-40; 9:4 at 40°60; 46°9 at
60-80; and 218°3 at 80 and upwards.

The mortality from cold increased 8 per cent. for every year of
age; or it doubled every 9 years from the age of 20, as it did in
1855. There is thus a law of mortality from excess of cold. But
it must not, therefore, be assumed that the mortality is beyond
control.

The air we inhale at 28° or lower is raised not to blood heat but to
something approaching 98° when it is exhaled; and as about a gallon
of air is thus heated every minute, and as the evaporated vapour in the
breath also carries off a considerable quantity of heat, the loss by the
lungs is large, however warm the clothing may be.

The cold is most effectively combated by exercise which excites
the heating energy of the system, and warmth is sustained by
nutritious food; by artificial heat; by warm woollen or fur clothing;
and by the respirator, which retains the heat exhaled by respiration.

Taste of the Mortatiry due to Coxv in 1855 and 1874.

 

 

 

 

 

EsTIMATED WEEKLY Excess of
POPULATION DEATHS by Comp in ao NUAL Rate a
divided by Number fa RCH cE ean
a Weeks aa aaa y Excess of Coup in
AGES. eur. 6 Weeks . ce s
—— |] enaing 24tn | oping 20th
Feb. 1855 | over Deaths || 6 Weeks of | 5 Weeks of
1855. | 1874, || overthe | iy Sreceding || 1855. | 1874,
RERASEs 5 Weeks.
f |
ALL AGES 48,826 65,176 323 581 | 67 8:9
t
0- 20,351 | 27,830 70 192! 34 6°9
20- 16,811 21,747 33 47 2°70 22
40- - | 8673 | 11,548 65 109 75 9°4
60-  - - | 2,804 3,799 126 178 44°9 46°9
80 & upwards 187 252 34 55 181'°8 218°3

 

 

 

 

 

 

 

 

 

 

Note.—The increase of mortality by cold due to age increased from the age of 20-40 at such a
rate as to double every 9°21 years in 1855; i 1874 the time of doubling was 8°77 ; the geometrical
mean of the two was 9°01 years.

(Weekly Return, No. 51, 1874.)
DEATHS. | 417

9.—Mortatity IN Posric Institutions.

Mortality in Metropolitan Workhouses, 1837.—The following Tables
exhibit the mortality in workhouses. They are from the Appendix to
a Report by the Select Committee on the Poor Law Amendment Act
(1838).—Mediecal Evidence :—

 

Average Number’ | 4 verago Number constantly

 

 

 

 

 

 

 

 

5 constantly Resident.
Year 1837. rasa oa
Males. | Females.| Sick. Infirm. | Healthy.
Ten Metropolitan Workhouses 1,252 1,926 462 1,591 1,125 1,318
One Hundred Workhouses in
various Counties, taken in- 4,650 4,485 945 2,864 5,334 2,717
diseriminately - z
: Total discharged, 7
Total Admitted. including Deaths. Total Deaths.
Year 1837.
Males. | Females.| Males. | Females.| Males. | Females.
Ten Metropolitan Workhouses 2,316 2,942 2,174 2,719 402 5OL
One Hundred Workhouses in
various Counties, taken ine} 10,764 9,172 8,935 7,341 970 676
discriminately = 5

 

 

 

 

 

 

Some of the results deducible from the above facts are contained in
the annexed Table.

 

 

 

 

 

 

 

Average Proportion in 100 Annual Deaths to 100
Number of Paupers. constantly Resident.
Year 1837. Paupers
in each
Workhouse.| Sick. | Infirm.| Healthy.| Males. | Females. | Mean.
\
The Metrovontan Works?) gieso || aes | ord | aga | aoa | aoa | wa

honses in various
Counties, taken indis-
criminately - -

One Hundred Work-
91°85 | 10-3 | 31°3 | 583 | goo | 151 | 18-0

 

 

 

 

It will be observed that the mortality was highest in the metro-
politan workhouses, and among males. This immense mortality is
not confined to workhouses under the New Poor Law Regulations :
it is, eeteris paribus, equally high in all workhouses; and is an
insuperable objection to the extension of the workhouse test (so called)
or its substitution for a labour test. The ages of the inmates may be
conjectured from the following enumeration made at the same time as
the returns :—

 

 

 

 

 

 

 

 

ment 0-10. | 10-20. | 20-40. | 40-60. | 60-79. | 70, &e. | Total.
Sick - : - 43 34 61 76 52 53 819
Infirm - 7 12 59 220 862 369 1,029
Healthy - - 300 215 148 174 61 13 911
Total - 350 261 268 470 475 425 2,259

 

 

 

 

 

 
418 [PART Iv.

Twenty-five in 100 were sick when admitted into the metropolitan
workhouses; 14 in 100 when admitted in the workhouses in other
unions. ‘his will account for part of the excessive mortality ;
infirmity for another part; age for a third part; leaving a large residual
mortality to be accounted for in the same manner as the mortality of
prisons. The mortality of paupers out of doors has not been ascer-
tained; the mortality is probably raised 50 per cent. by confinement
in the workhouses. In a depression of trade, or in a densely inhabited
district, it must be considered a hazardous experiment to bring crowds
of the sickly and depressed classes within the walls of one building.
Nothing is more likely to generate an epidemic. The system of
administering relief in workhouses should, on this ground alone, be
reduced within the narrowest possible limits—(McCulloch’s Account of
the British Empire, Art. Vital Statistics, Vol. 2, pp. 569-70.)

Prison Mortality.—Considerable misapprehension prevails respecting
the mortality in prisons. ‘The deaths have been divided |:y the com-
mittals, instead of the average population, and the quotient has been
compared with the annual mortality out of doors. In this way the
result appears so much in favour of the prisoners, at first sight, that a
French minister declared the gaols the healthiest places in the world ;
and in a recent report, one of the English inspectors “ confidently
“ aflirmed that in very few situations of life is an adult less likely to die
“ than in a well-conducted English prison.”* Only 1 in 500 prisoners
dies; so, according to this view, if a man desires to live to the age
of Methusaleh, he should go to Newgate.

As serious intentions appear to be entertained of substituting the
Penitentiary system for transportation ; and in the greater number of
cases for hanging, we have endeavoured to ascertain the actual etfect
of imprisoument upon mortality. In the elaborate gaol returns under
4 Geo. IV. c. 64, and 5 Geo. IV. ec. 12, the average population of
the respective gaols is not given; but a sufficiently near approxima-
tion to this may be obtained from the numbers “remaining” at the
Michaelmas term of every year, when the returns are made. We took
the first 93 gaols (omitting only 5 or 6 which were incomplete) for
the 5 years Michaelmas 1826-31; and found that the mean constant
population, from 6 enumerations, amounted to 9,409; while the deaths
in the 5 years were 769. The mean annual mortality was 16°3 per
1,000.

Mean Prison Population. Annual Deaths. Annual Deaths per 1,000,

9,409 153°8 16°3

 

 

In deciding whether this is a high or a low rate of mortality, the age
of the prisoners must be taken into the calculation; and for the present
purpose it may be assumed to be 20-30 years. Of 23,612 committed
in 1837, not less than 14,396 were “aged 30 years and above 16.’’t
We subjoin a comparative view of the annual mortality of different
populations at the age 20-30.

Annual Deaths to 1,000 Living.

Sweden, Belgium, England and Wales, English Prisons, Mich.,
1811-30. 1829. 1813-30. 1826-31.
8 9 10 16

 

* Report on Prisons, by Dr. Bisset Hawkins, 1836, p. 2.
+ Table showing the Number of Criminal Offenders in the year 1837.
DEATHS. | 419

Here it will be observed at a glance that the mortality in the English
prisons was 60 per cent. higher than the mortality at the same ages in
England and Wales.

The extent to which a class of individuals are affected in epidemics
is a good sanitary test of the circumstances in which they are placed.
In the year ending Michaelmas 1832, when cholera was epidemic, the
deaths in the same prisons amounted to 300.

Mean Prison Annual Deaths,
Year. Population. Deaths. per 1,000.
1832 10,497 300 29

The mortality was nearly three times as high as the ordinary mortality
in England and Wales; and we know that the general mortality at the
same age was raised to nothing near this pitch.

Again, the prisoners rarely labour under any serious disease at the
time of their committal. And it will be found by a reference to the
facts, that the mean term of their detention is 48 days: for there were
267,771 committals to 35,503 years of imprisonment, or nearly 7 weeks
to each committal. The prisoners at the time of their committal must
be considered in the same light as those who seek to assure their lives:
they have no dangerous disease, and their health has scarcely time to
become seriously affected in 48 days before they are removed. Of
12,886 persons entering the Equitable Assurance Society, between the
ages 20-40, 48 died in the ensuing year : if they had all been committed
to the English prisons, 210 at least would have perished. In the second
year of the policy 113 died out of 12,361; in the third year, 99 out of
10,982.

If this doctrine of the mortality in prisons be correct, it may be
expected that the health of the prisoners will gradually decline, and the
mortality increase as the imprisonment is protracted. This is the case.
The health of many of the prisoners before they reach the hulks is in a
bad state; and the mortality in the convict hulks is nearly double the
mortality in the prisons. 907 deaths oceurred in the Convict Hulk
Establishment, England in 9 years (1820-9, exclusive of 1821), when
the average convict population was 3,583. The mean term of detention
was 1'22 years, or 1 year 24 months. It gives, therefore, the following
results :—

Annual Mortality per 1,000.

First Year. General Population, Hulk
Equitable Society. | England and Wales. English Prisons. Establishments.

 

3 10 16 28

Such is the effect of inaction, privation, and confinement in a close
atmosphere, upon the criminal. It may be said that the prisoners are
men of bad shattered constitutions. But does this apply to the great
majority ? and would not imprisonment have quite as fatal-an effect
upon persons unaccustomed to privations of any kind ?

After every allowance has been made, if 200 deaths occur in the
English prisons annually, 60 must be set down as the direct effect, of
imprisonment; and 50 of the 100 annual deaths in the hulks must be
ascribed to the punishment. Only 8 criminals were executed in England
and Wales during the year 1837; while in the 5 years ending 1834, the
average annual number of deaths due to imprisonment was 51.

DD 2
420 [Part Iv.

We submit these facts with great deference to those who have
studied criminal punishment, and particularly to those humane indivi-
duais who would abolish capital punishments and substitute solitary
confinement in cells for transportation. Let them bear in mind that
the present system of imprisonment destroys 10 times as many lives,
and produces 1,000 times as much actual suffering, as the executioner.
The mortality of prisons has been greatly reduced: and admits of
further reduction, although no system of pains and penalties can be
conceived, which will not increase sickness and mortality; for it is an
eternal law of our nature that sensation has a tendency to cease, when
deprived of objects, or thrown into agony: mercy has made pain the
gate of death.

We have no means of knowing the mortality among convicts in the
penal colonies; but, judging from all analogies, the immediate cffect
of assembling them in large buildings and solitary cells would be to
raise the mortality very considerably. This is not an insuperable
objection to the Penitentiary system ; but it must be taken into account
as a part of the punishment, which, while it injures the health and
destroys more lives than the executioner, produces little impression upon
the minds of the spectators.

We shall here add, from a paper by Mr. H. Marshall, the mean
number of native prisoners confined in gaols throughout the presidencies
of Bengal and Agra during the year 1833; the number of deaths, and
the ratio of deaths per 1,000, of the mean strength.

Mean Prison
Year. Population. Died. Deaths per 1,000.

 

 

 

 

1833 39,658 2,613 66

Eight hundred and eighty-two of the deaths were from enteritis,
dysentery, and diarrhea, 586 from cholera, 511 from fevers, The ratio
of mortality among the native troops of the same presidencies was 10°6
per 1,000, in 1823.*

Dr. Baly, the physician to the Millbank Penitentiary, has latterly
instituted an extensive inquiry into the mortality and fatal discases of
that and other penal extablishments.f Dr. Baly’s investigations con-
firm and extend the principles laid down in the above sketch, which
appeared in the former edition of this work. In the 18 years, 1825—
1842, the total number of deaths in the Millbank Penitentiary amounted
to 205; the average number of prisoners during the same period was
532; and the average annual mortality was therefore 21 in 1,000,
But besides the 205 prisoners who died in the Penitentiary, 355 were
invalided, or pardoned on medical grounds ; and according to Dr. Baly’s
estimate, 123 of the 365 cases would have terminated fatally before
the completion of imprisonment, had no pardons heen granted. The
mortality to which confinement gave rise was therefore 34, or, excluding
31 deaths from cholera, 31 in a 1,000 annually; while the mortality in

 

* British Annals of Medicine, 1837, p. 490. The materials were derived from a
Report on the Medical Management of the native Guols throughout these Govern-
ments. Mr. M justly adds, that great praise is due to Mr. Hutchinson for collecting
and publishing the statistical materials which are appended to this report.

+ Paper on the Mortality in Prisons, &e., by W. Baly, M.D. Read Feb. 25, 1845.
See Trans. of Med. and Chirurg. Soc. for that year. Dr. Baly’s is one of the best
papers which have appeared in the ‘Transactions of this learned Society, and throws
more hght on the effects of imprisonment than any other publication in this or any
other country.
DEATHS. | 421

London between the ages 15 and 70 is about 16 in 1,000. “ The
“ criminal’s liability to die was more than doubled by imprisonment in
“ the Penitentiary.”

The average number of prisoners (1838-41) in 36 of the largest
county gaols was 8,657, the deaths in the five years 823, or 19 per
1,000 annually ; or after a correction required for pardons 23 per 1,000
annually. The average duration of imprisonment in the English county
gaols was about 46 days; in the Penitentiary 2 years. Dr. Baiy
shows in the following table, that the mortality goes un increasing
from the first to the fourth year of confinement, when it is more than
quadrupled ; for 13 in 1,000 die in the first, 57 in 1,000 in the fourth
year.

 

 

ae a Deaths Prisoners Total Depths 9
Tene: to the Cate in the Pardoned Deaths 1,000

of Death: Penitentiary. (estimated).} Prisoners.
Ist - 3,365 38 20 45 13
2nd 2,682 61 100 96 36
3rd 1,645 41 130 86 52
4th 611 10 72 35 57
5th - 94 —_— 12 4 44

 

 

 

 

In the first 3 months of confinement, not 1 convict was pardoned and
only 1 in 3,571 died; in the second 3 months 15 died in 3,470, and 1
was pardoned.

The mortality of men in twelve great prisons of France during each
of 10 years of imprisonment was 37:6, 57, 59, 55, 41, -£1, 41, 39, 31,
36 to 1,000 living in the first, second, &c¢., years of imprisonment. In
the Kastern Penitentiary, Philadelphia, the mortality was ‘022 in the
first year of imprisonment, ‘O48 in the second, *039 in ihe third
year, and *025 in the fourth year. The highest degree of mortality
appears to be experienced generally in the third and fourth years of
imprisonment.

“ Fever, formerly such a scourge, is now comparatively a rare disease
in the English gaols ; it does not produce in ten years as many deaths
as it formerly caused in one, and I (Dr. Baly) believe never rages in
them as a contagious epidemic. Yet both fevers and bowel complaints
are, even at the present period, much more frequent causes of death
in prisons than amongst the general population.” (P. 61 of Dr. Baly’s
paper.)

The writer shows that the mortality from fevers and bowel com-
plaints among persons between the ages of 15 and 60 in London is
1°2 annually ; while among the prisoners of 32 county gaols it is 3:4,
of Millbank Penitentiary 59; of Wakefield House of Correction 8°9
to 1,000 from the same causes. These diseases are promoted by bad
drainage, dirt, crowding, poor unvaried diet.

Consumption and scrofula are shown by irrefragable evidence to be
the diseases to which the excessive mortality of prisoners under long
confinement is due. Thus while in London 4°4 in 1,000 persons
between the ages of 15 and 70 die annually of consumption, the
proportion of deaths in the Millbank Penitentiary was 7°6 in 1,000;
and it is estimated that 5°6 should be added to them from those
422 [PART Iv.

pardoned; making in all 13°2 per 1,000 or three times the ordinary
mortality of the population from consumption. About 2°87 iu 1,000
convicts die of other scrofula diseases ; which prove fatal to only *03
in 1,000 of the general population. In 1840, of 1,052 prisoners
received into the Penitentiary 12 had symptoms of consumption ; of the
1,040 remaining only 523 were Penitentiary prisoners. Forty-seven of
the 523 came under treatment, and 17 died of consumption before the
end of 1843. Fourteen of the 1,052 prisoners had, on admission, signs
of scrofula, combined in 4 cases with consumption ; 527 of the 1,088
remaining were Penitentiary prisoners, and 37 of them before the end
of 1843 came under treatment for external glandular scrofula, which
was combined in 14 cases with consumption. The development of
these diseases is due to deficient ventilation, cold, sedentary occupa-
tions, and the want of exercise, a listless if not dejected state of mind,
and poorness of diet; some of which have no necessary connection with
a state of incarceration. (McCulloch’s Account of the British Empire,
Art. Vital Statistics, Vol. 2, pp. 565-69.)

Mortality in Public Institutions—The great majority of the people
of England live in detached dwellings; and a certain number reside in
barracks, asylums, workhouses, hospitals, Iunatic asylums, and prisons,
or in public institutions, as they have been called, of various kinds.

The mortality of the inmates of some of these institutions is for
various reasons much above the average; so the inmates having been
returned at the Census, it was thought right to pick out the principal
institutions in which the mortality was likely to be so great as to affect
the mortality of the sub-district in which the institution is situated.

The list has been compiled on this principle, and does not include a
great number of institutions of various kinds. It includes all the
principal hospitals and workhouses.

The Commissioners in Lunacy, the Inspectors of Prisons, and the
Poor Law Commissioners publish in their annual reports accounts of
the respective institutions which come under their cognizance. The
statistics of the hospitals of the country are not given at all, or are not
given upon a uniform plan. Miss Nightingale, who perceived all the
importance of this infcrmation, suggested that.the hospital statistics
should be collected in forms, of which the members of the Statistical
Congress in London approved.* And if the hospital boards carry out
the plan, they will place the hospital statistics on a level with those of
the other institutions of the country.

The number of institutions in the selected list is 853, which held
154,602 inmates on the day of the Census, exclusive of the officers and
servants. 382,437 inmates died in the year; and assuming that the
average is represented by the enumerated population, the mortality was
at the rate of 20°98 per cent., or 210 per 1,000; while the mortality of
the population of all England was at the rate of 22 in 1,000, or 2-163
per cent.

The mortality in these institutions was ten times as high as the
mortality in the population generally.

The annual rate of mortality in the lunatic asylums was at the rate
of 11 per cent., in the workhouses 19 per cent., and in the hospitals 57
per cent.

 

* English Programme of International Congress, pp. 63-5. See also Report of
the Proceedings.
DEATHS. | 423

With respect to hospitals, then, while the annual mortality of the
general population was 2°16 per cent., the mortality of their inmates
was at the rate of 56°87 per cent., or 26 times as high. The inmates
of hospitals are, it is scarcely necessary to say, all suffering from diseases
which tend generally to increase the risk of death.

The hospitals are filled by a succession of inmates, who remain for a
time varying from a day to a month or a year, and the mortality is
often given as so many deaths per cent. on the cases treated. The
mean term of treatment varies in different hospitals; in many it
averages 36°5 days, or the tenth part ofa year. Assuming that term
of treatment to be applicable, the mortality of the cases in these
hospitals was 5°687 per cent. in 36°5 days; or the hospitals to every
100 beds occupied had nearly 57 deaths annually.

Mortatity in Genersr Hospirats in Eneranp and Wauus, 1861.
(Special Hospitals are excluded from this Table.

 

 

 

 

eo a
Numer of | UM BERG ; Morraity
_ Hosrirars. INMATES. Teens in | DEATUS. per cent.
HOSPITAL.
ToTaL HosPirals - 80 8535 107 6220 72°88
Hospitals containing—
300 Inmates and upwards 5 2020 418 2101 100° 63
200 and under 300 - 4 916 239 838 91°78
100 and under 200 - 22 2898 182 2041 70°43
Under 100 - - 49 2634 54 1210 47°08

 

 

 

 

 

 

Hospitals enable the charity of the country to supply the sick with
skilful medical advice upon the cheapest terms, and this has led to the
establishment of the institution upon the voluntary principle in every
county. An eminent physician or a surgeon can visit his patients in a
short time as they lie in the same or in contiguous wards; and he often
consents to attend them without any fee or salary. The collection of the
sick under one roof conduces also to economy in the nursing depart-
ment, in the kitchen as well as domestic service, and in the pharmacy,
as the drugs can be purchased and dispensed at a cheap rate. A
resident medical officer can attend to all the urgent cases.

The cost of the building is generally so great as to make the lodging
much dearer than the best cottage accommodation.

One great evil has often counterbalanced all the advantages. The
collection of a number of persons, exceeding those of an ordinary
family, under one roof, has hitherto always had a tendency to increase
the dangers of disease ; for several diseases are, like fire and ferments,
diffusible. The danger is increased when all the inmates are sick, for
their breath and excretions spread through the wards. ‘The dangers
too are likely to increase in a faster ratio than the numbers, and the
patients are less likely to recover health in the sickly atmosphere of a
Jarge building in a city than in pure country air.

These institutions were accordingly at one time infested by hospital
gangrene and by erysipelas; the lying-in hospitals were depopulated
by fever (metria); infants perished by hundreds in the foundling
hospitals; and even in the present day patients often die of hospital
pyemia, so frustrating the hopes of the skilful surgeon.
424 [PART IV.

It must be stated that scarcely anything could be worse than the
ventilation and all the arrangements of the old hospitals.

The classes of cases which are admitted into particular hospitals, and
the reasons for which patients are discharged, differ largely, so that the
investigation of the effects of hospital air, and of treatment in the
various establishments, requires great cave and skill. It is so important,
however, that it should be undertaken for the sake of the sick, and for
the sake of medical science.

A careful comparison of the duration and of the rate of mortality of
certain well-defined diseases in hospitals and in private practice would
settle the question.

In the meantime it is evident from the preceding table that the
mortality of the sick who are treated in the large general hospitals of
large towns is twice as great as the mortality of the sick who are treated
in small hospitals in small towns.

It remains to be seen whether the mortality in small hospitals is not
twice as great as the mortality of the same diseases in patients who are
treated in cottages.

Should this turn out to be the case, the means of realising the advan-
tages of the hospital system, without its disadvantages, will then
be sought and probably found, as the problem is not insoluble.
(24th Annual Report, pp. 229-31.)

Hospital Treatment of Infectious Diseases.—In the’ interests of
sanitation and of public health, hospital treatment of infectious diseases,
in cases where home-isolation is an impossibility, has been frequently
urged as the only practical means of controlling zymotic fatality, and
the Public Health Acts of 1872 and 1875 have invested local sanitary
authorities with powers to facilitate the erection of hospitals for the
reception of non-pauper cases of these diseases. While the advantage to
the community arising from the removal and treatment in hospital of
cases of infectious diseases occurring in families living in crowded
tenement houses is undoubted, it becomes important to record accurately
the results of hospital treatment in the mortality of the cases. Until
cases of infectious diseases are registered, there will, however, be no
trustworthy basis for calculating the mortality of such cases not treated
in hospitals.

During the year 1876 the Registrar General was favoured, through
the courtesy of the several authorities, with weekly returns of admissions,
discharges, and deaths in the Metropolitan Asylum Small Pox and Fever
Hospitals, and also in the London Fever Hospital. The Registrar
General has to regret that he was unsuccessful in his attempt to obtain
similar returns from the Small Pox Hospital at Highgate.* In the
Metropolitan Asylum hospitals, more than 2,000 cases of small-pox,
more than 800 cases of scarlet fever, nearly 300 of enteric fever, and
145 of typhus were under treatment. In the London Fever Hospital
518 cases of scarlet fever, 93 of enteric fever, and 23 of typhus were
admitted.

At the London Small-Pox Hospital the mortality among 7,850 cases
recorded during the years 1780-99 and 1828-36 was equal to 81-5 per
cent. During the London sinall-pox epidemic in 1870-1-2, 14,808
cases were treated in the Metropolitan Asylum Hospitals, showing a
mortality equal to 18°7 per cent. During 1876 the number of com-
pleted cases treated in the same hospitals was 1,377, and the 338 deaths

 

* These returns have since been furnished to the Registrar General.
DEATHS. | 425

(46 per cent. of all the small-pox deaths in London) were equal to a
mortality 24°5 percent. Thus the mortality during the present epidemic
has been higher than it was during the epidemic five years ago, although
it is considerably lower than it was between 1780 and 1836. The 1,377
cases included 1,018 vaccinated and 359 unvaccinated ; the mortality
was 13°2 per cent. among the vaccinated, and 56°8 per cent. among
the unvaccinated. The proportion of vaccinated cases to total cases
treated was 74 per cent., against 75 per cent. during the epidemic of
1870-1-2.

The 804 completed cases of scarlet fever recorded in the Metropolitan
Asylum Hospitals during 1876 showed a mortality of 10°7 per cent.,
against 14:0 per cent. among the 1,077 cases treated in 1875; among
321 cases at Homerton the mortality in 1876 was only 8:1 per cent.,
whereas it was 12°4 per cent. among the 483 cases treated at Stockwell.
In the London Fever Hospital 551 completed cases of scarlet fever were
reported during 1876, of which 50 were futal cases, equal to a mortality
of 91 per cent.

The completed cases of typhus in the Asylum District Fever Hospitals
were 145 last year, against 76 in 1875, and the mortality 19°3 per cent.
in 1876 and 19°7 per cent. in 1875. In the London Fever Hospital
only 26 eases of typhus were treated, and the 7 deaths give a mortality
of 26-9 per cent.; these numbers are, however, too small for the
calculation ofa trustworthy rate of mortality.

Of enteric fever the treatment of 270 cases was completed at the
Asylum Fever Hospitals, showing a decline of 67 from the number in
1875; the proportional mortality, which was 22:0 per cent. in 1875,
declined to 20°7 per cent. in 1876. In the London Fever Hospital 86
cases of enteric fever were treated in 1876, of which 13 proved fatal,
equal to a mortality of 15°1 per cent.,a rate considerably lower than
that which prevailed in the Asylum Fever Hospitals, either in 1875 or
1876.

It is generally believed that the rate of mortality among cases of
epidemic disease treated in hospital is greater than among those treated
at home. Assuming, however, that the proportion of deaths to recoveries
is the same under both circumstances, it may be estimated that during
the year 1876 the number of persons in London attacked by small-pox
was 2,99-5, by scarlet fever 22,886, by typhus 796, and by enteric fever
4,030. These numbers would be under-estimated if the rate of mortality
out of hospitals is, as supposed, lower than among the cases treated in
hospital. (Weekly Return, No. 51, 1877.)

Mortality of Lunatics in Asylums.—The condition of lunatics in this
country has, within the present century, attracted much public attention ;
and in 1807, 1815, 1816, and 1827, the management of the asyluins
provided for their confinement was investigated by Committees of the
House of Commons. Many abuses were brought to light ; and the last
committee, of which Mr. Gordon was chairman, stated in their report,
after a searching and able inquiry, that the abuses discovered in 1815
still existed. They ‘repeated, adopted, and confirmed” the recom-
mendations of the committees of 1807 and 1815, Enactments sub-
sequently passed the legislature ; and several county asylums (among
which that of Middlesex deserves to be particularly mentioned,) have
since been erected. No parliamentary inquiry has been instituted since
1827 ; but Mr. Ewart has given notice of his intention to move-in the
House of Commons for the appointment of a committee in the present
session of Parliament.
426 (PART IV.

The persons of unsound mind in England amount to several thousands.
They are usually of middle age, frequently parents, and are of all con-
ditions and ranks of life: 494 lunatics confined under the Crown possess
property yielding an annual income of 317,154/.* Men of the highest
intellectual rank—men of genius—are not exempted from the visitations
of this disease ; it stoops to the lowest, and disorders the meanest brain.
It makes the labourer a pauper, and too often ruins the families of the
middle classes. 6,402 idiots, and 7,265 lunatics, have been returned to
Parliament as paupers. Such a disease, which disorders the senses,
perverts the reason, and breaks up the passions in wild confusion ;—
which assails man in his essential nature,—brings down so much misery
on the head of its victims, and is productive of so much social evil—
deserves investigation on its own merits, by statistical as well as other
methods. But it has au additional claim upon the attention of this
society. A considerable portion of the insane are under confinement,
and have to be provided for or watched over by the State ; which, as it
permits them to be deprived of liberty, is bound to afford them protection,
and to assure them the best means of restoration to health.

Great improvements have taken place in the treatment of lunatics.
In the best asylums they are no longer shut up in cells like wild beasts,
nor punished by harsh keepers. Their chains have gradually been struck
off. A further step has been attempted. At the Middlesex Asylum no
strait-waistcoats, straps, or other instruments of personal coercion have
been used since the 21st of September, 1839. The experiment was first
tried at Lincoln, and it is now contended by persons of experience,
ability, and integrity—by Mr. Hill, Dr. Conolly, and the visiting justices
of Middlesex,—that in « house properly built, with skilful medical
supervision, and a sufficient number of humane and intelligent keepers,
personal coercion should be abolished. This is denied by other gentle-
men of equal humanity, who maintain that although all restraint may
be dispensed with, the strait-waistcoat should still be employed as a
remedy in the paroxysms of mania. A keen controversy has heen
waged on the subject. Asylums not only differ widely in the extent to
which restraint is carried, but in the space allotted to patients, in their
employment, food, and medical treatment. The cost of criminal lunatics
at Bethlem is 15s. a-week; of idiots or lunatics in the workhouses,
2s. 10d. to 3s. Gd. a-week. Some of the asylums are under the control
of the visiting justices, others are visited by the Metropolitan Commis-
sioners; the hospitals of Bethlem and St. Luke are not visited at all,
but are managed by the officers and governors; while a very large
number of lunatics are farmed out, or confined in workhouses, by the
parish authorities.

Amidst these various circumstances and conflicting systems, we ask
which is the most advantageous? and it will be replied by all parties,
“that is the best system under which the greatest number of lunatics
“yvecover their reason in the shortest time.’ But in a slow disease,
presenting so much diversity in individuals, it is evident that the supe-
riority of any system of treatment can only be determined by the average
results, by a comparison of the recoveries and deaths, in fine, by statisties ;
and the Statistical Society, as a body quite disinterested, is probably
better qualified than any other society to collect information upon the
subject, and to submit the results to the public, to the parties concerned,
and to all those humane persons who devote attention to a class of our
fellow-creatures suffering under one of the saddest calamities which can
befall our nature.

 

* See Parliamentary Return, Session 1889, No. 378.
DEATHS. | 427

The number of lunatics and dangerous idiots under confinement in
Middlesex, and in the parts of Surrey and Kent within the jurisdiction
of the Metropolitan Commission, is about 3,110.

In the licensed houses 459 men aud 419 women are not paupers; and
many persons insane in different degrees remain at home under the care
of their friends. The London workhouses contain a considerable
number of idiots and lunatics. Hxclusive of these 3,110 persons, others
are confined as lunatics in the public institutions of the metropolis.
When it is considered that insanity is a long disease, which not only
disables the patient, but often renders him difficult to control, and dan-
cerous to himself and to society, the fact that 7 in 10 of the 3,110
lunatics fall upon the public for support and treatment will not be
deemed surprising.

The Hanwell Asylum was opened on May 16, 1831, and the number
of lunatics admitted in the 94 years, ending September 30th, 1840, was
2,029; the number discharged was 1,171; of whom 449 had recovered,
66 had been relieved, and 656 had died; 858 remained in the asylum.
More than half the patients die in Hanwell, and more than one-third
are cured.

It has been a question whether the deaths should be divided, as in
this case, by the 2,029 patients admitted, or by the 1,171 discharged,
in order to obtain the mortality of the cases. It is evident that the
latter is the true divisor; for, if the mortality remained the same, the
probability is that the 858 patients to be discharged would, ceteris
paribus, be discharged cured, relieved, and dead, in the same proportions
as the 1,171 already discharged.

The average number of lunatics in the Hanwell Asylum, since it was
opened, has been about 589, or 250 males and 339 females.

The deaths in the 9} years ending 30th September 1840 were 656
(males 374, females 282); and the insane population out of which
they occurred was = 5,498 living one year; the males 2,334, and
females 3,164. The average number of males resident was = 250, and
250 x 9°34 years, the term of residence, = 2,334 years of life. ‘The
annual mortality of the men was 16 per cent., of the women 9 per cent.,
and of the whole population, without distinction of sex, 12 per cent.

What is the mean term of residence in the Middlesex Asylum ?—
This is not given in the Visiting Justices’ Report, but it may be deduced
from the numbers living, and the numbers discharged. Divide the
5,498 years of residence by 1,171, the number of discharged lunatics,
and the result is 4°48 years; which is an approximation to the average
term of treatment.

Nearly equal numbers of men and women are admitted at the County
Asylum (males 1,013, females 1,016); but the number of women
resident is 36 per cent. greater than the number of men (females 339,
males 250); because women remain there about 6 years on an average,
and men nearly 3°7 years. The men are discharged more rapidly than
the women, both by death and recovery ; 11 men per cent. were annually
discharged cured, or relieved, and only 8 women. This distinction will
explain many anomalous facts; and it should always be taken into
account in estimating the prevalence of diseases. Thus there may be
ten times as many lunatics in civilised, as in barbarous countries and
times ; not because the tendency to insanity is greater, but because the
lunatics live ten times as many months or years. The tendency to
insanity in a class is expressed by the proportion that become insane.

Let us now compare the facts observed in the Hanwell Asylum with
those submitted to the Society by Colonel Sykes, relative to the lunatics
in the licensed houses within the jurisdiction of the Metropolitan Com-
mission. Colonel Sykes’s Returns have been analysed according to the
same methods.
428 [PART IV.

The deaths to 100 cases were more numerous at Hanwell than at the
licensed houses; but, in the annual mortality per cent., the proportions
were reversed.

 

 

Annual
ae ae of Died. Mortality
esidence. per cent,
Licensed Houses, from 30th June ‘
1833 to 81st May 1839 aout 1808 ee
Hanwell, from 16th May 1831 to .
30th September 1840 °} ee oa Me

 

 

 

 

‘The annual mortality per cent. at Hanwell was to that in the licensed
houses as 100 to 1380. For various reasons the patients remain longer
in the Hanwell Asylum than in the licensed houses, from which
37 per cent. were annually discharged alive; while not more than
9-4 per cent. were discharged annually, cured and relieved, from the
County Asylum. The number admitted during the six years, June
1833-89, into the licensed houses was 5,386; making 278 more than
5,108, the number discharged by death, recovery, or otherwise. There
were 1,435 in the licensed houses on 30th June 1888, and 1,713 on
3lst May 18389. The number of inmatcs had increased 19 per cent.,
and, notwithstanding the erection of Hanwell, the increase bore
principally upon paupers, for 202 of the 278 were paupers.

The lunatics in the licensed houses are divided into two classes—
paupers, and other patients belonging to the independent classes of
society. It will be right to compare the paupers in the licensed houses
with the paupers in Hanwell, and, for this purpose, to separate the
paupers from the other class.

The comparative mortality was as follows :-—

 

 

Aaaal Deaths Mean
Mortalit out of term of
: Genk | 100 cases | treatment
pen . discharged. in years.
Paupers in Licensed Houses 21 35 1°67
Hanwell - 12 56 4°48
Other patients in the Licensed Houses ll 23 2-15

 

 

 

 

 

The annual mortality of paupers in the licensed houses is thus shown
to have been excessive.

J proceed to compare the mortality of the male and female paupers
at Hanwell and in the licensed houses, with that of the other class of
lunatics, and the following results have been deduced :—

 

Annual Mortality || Deaths ont of 100 || Mean term of
per Cent. Cases discharged. ||Residence in years.

 

Males. | Females. Males. | Females. |} Males. | Females.

 

 

 

 

Licensed Houses :—

Pauper Lunatics 26°8 16-4 87°5 31°8 1:40 1°93
Other Lunatics 13°2 8:4 95:9 20°3 1°96 2°41
Hanwell 16:0 89 58°5 53°0 3°65 5°94

 

 

 

 

 

 
DEATHS. | 429

It will be observed that the annual mortality of both male and female
paupers in the licensed houses was nearly twice as great as the mortality
of paupers at Hanwell, and twice as great as the mortality of other
lunatics in the licensed houses.

Pauper lunatics were received at six licensed houses during the term
over which Colonel Sykes’s Returns extend, and at the four houses
numbered 18, 32, 33, 85, during the whole period. A small number
of paupers was treated at No. 2, until May 1837, and after that year
at No. 12; the great majority, however, of pauper lunatics was treated
at the four large houses, and although 1,156 other lunatics were treated
there, with 2,563 paupers, the mortality was twice as high as in the
36 smaller houses.

Hach of the four large houses contained 265 patients on an average,
and the annual mortality was 19 per cent. ; in the small houses, con-
taining 17 lunatics on an average, the mortality was 9 per cent., and
the annual mortality in the four houses increased with the number of
lunatics. It was 16 per cent. in the house No. 18; 18 per cent. in
Nos. 82 and 83; and 23 per cent. in No. 35. Of the higher class of
patients, 26 in 100 cases perished in the large houses, and 21 in 100 in
the smaller houses, where the term of treatment was somewhat longer.

What is the mortality among lunatics in favourable circumstances ?
Is insanity a fatal disease ?—Upon the latter question there has been
a considerable diversity of opinion. Some lunatics live to an advanced
age. Of 213 admitted by Dr. Conolly at Hanwell, 15 were aged 60 and
upwards, 1 was between 75 and 80; and 58 of 753 at Hanwell had been
labouring under the disorder between 20 and 50 years. In 1835 an
action (Fisher v. Beaumont) was brought at the York Assizes to
recover from the Providence Assurance Company, 2,000/. insured upon
the life of the Rev. Mr. F * * *. In charging the jury, the judge said
that they had to consider whether insanity had a tendency to shorten
life? Ifinsanity had such atendency, they must find for the defendant ;
if not, for the plaintiff. The medical evidence was conflicting ; and the
jury, after a short deliberation, found for the plaintiff, on the ground
that insanity had no tendency to shorten life !*

We had no means of ascertaining the mortality of lunatics at large ;
but the mortality of lunatics in asylums is much higher than the
mortality of the general population, and the excess cannot be ascribed
entirely, although if may partially, to the confinement, the unwholesome-
ness, or the usages of mad-houses. The mean age of lunatics in
asylums is about 35-40. The average age of the patients admitted at
Bethlem, (1830-34) was 86 years (386°2); and the mean age of 213
admitted at Hanwell by Dr. Conolly was 3863. The mortality at the
age 30-40 is 1°2, and at 40-50 is 1°5 per cent. in England and Wales.
In cities the mortality at a corresponding age is not more than 2 per
cent. annually, Now the annual mortality at Bethlem, where danger-
ous cases are carefully excluded, was 9 per cent., in 1827-39. At
Gloucester, one of the county asylums, at which the treatment is the
most successful, the diet is generous and nutritious, and the patiénts live
as much as possible in the open air,—the annual mortality is 7 per
cent.

The annual mortality of severe cases of insanity cannot, I think, in
favourable circumstances, be less than 6 per cent. ; so that the mortality
is three times greater among lunatics, than among the general popu-
lation, at the same age. We have seen, however, that the annual
mortality among the better class of patients in the licensed houses was

 

* Medical Gazette, August 8th, 1835.
430 [PART IV.

11 per cent., among paupers at Hanwell 12 per cent., among paupers in
the licensed houses 21 per cent., and among pauper men at one licensed
house 27 per cent. ;—as high as the rate of mortality experienced by the
British troops upon the western coast of Africa, and by the population
of London when the plague rendered its habitations desolate!

To what is this excessive mortality to be ascribed—to the disease, or
to the treatment ?—The question cannot be positively answered, nor can
the causes of the difference in the mortality be determined, without a
careful examination of all the circumstances. I shall briefty notice the
chief causes to which the mortality of lunatics in asylums has been, or
may be, ascribed.

The visiting justices of Hanwell state as “an extraordinary and
“ disgraceful fact,” that numbers of patients are sent into the asylum, as
it would seem, to die. Of 656 deaths, 64 occurred within a month after
admission. A similar complaint is made at many hospitals; and there
is probably a tendency to send dangerous cases, or cases in their most
critical stage, to public institutions. The exclusion of such cases from
Bethlem reduces the mortality, but they cannot all be excluded without
giving the asylums the advantages of that selection, which is so profitable
to Assurance Offices. For in a disease so fatal as insanity, a certain
number of lunatics are necessarily on the verge of death at the period of
the disezse when admission into an asylum is usually sought; and a due
proportion of such cases cannot fairly be excluded.

Reference has ulso been made to the fact that out of 834 patients in
Hanwell on December 31st, 1839, about 655 had been in other asylums
or workhouses for considerable periods. Many cases were admitted in
the chronic stages of insanity; but this, though it will account for a
smaller number of recoveries, and the high proportion of fatal cases, will
not account for a high annual rate of mortality. The annual rate of
mortality is greater in the acute than in the chronic stage of insanity.
Thus at the hospitals of Bethlem and St. Luke the annual mortality
among the class called “ curables” was 11 per cent., and only 6 per cent.
among “incurables” (chronic cases). At Hanwell the annual mortality
of lunatics in the state of mania, monomania, or melancholia appears, so
far as it can be determined, te be about 12 per cent., while in cases of
incoherence, imbecility, or dementia, (chronic stages of insanity,) about
8 per cent. die annually.

A return in the Hanwell Report shows the numbers admitted during
each separate year into the asylum, and the numbers discharged cured,
relieved, or dead, year by year. The return extends from May 16th,
1831, to September 30th, 1840, and shows that 422 lunatics were
admitted in the year 1832; that 55 of them were cured or relieved, and
55 died during that year, leaving 312 to enter upon the next year (1833),
when 27 of them were cured or relieved, and 31 died; and so on, year
succeeding year, until September 30th, 1840, when 137 remained in the
asylum. The patients admitted in 1831, and in 1839-40 (the two last
years), have been set aside; and the 1,389 lunatics admitted in the
seven years (1832-38) have been followed to the end of 1889. The
422 lunatics, it may be assumed, were admitted at equal intervals of time
in 1832, or the middle of the year 1832 may be taken as the mean time
of their admission ; whence it follows, that of 422 admitted in the year
1832-55 died in the half-year following; 31 in the next year, &e.
The return, therefore, permits us to trace 422 lunatics admitted in 1832,
to death, recovery, or relief, during 74 years; and 325 admitted in 1838
to the end of 1839, or for a period of only 1} year.

From a summary of the facts in this return, it appears that of 1,389
lunatics entering upon the first period (4 year) 125 were discharged
DEATAS. | 431

cured, 25 relieved, and 152 dead in the next half-year; of 1,087 who
entered upon the second period, 142 were discharged cured, 13 relieved,
and 130 dead in the subsequent year, at the end of which 208 were lost
sight of. For the reason before stated, it will be observed that the first
period extends to the end of the 6th month; the second from the end of
the 6th to the end of the 18th month; the third from 14 to 24 years,
&e.

From such an arrangement of the facts, the annual rate of mortality
and recovery in the several stages of insanity, subsequent to admission,
at Hanwell, may be deduced.

Insane Persons living, cured, and dead; and the ANNUAL RaTE oF
Mortatity in different stages of Insanity.

 

 

 

 

 

 

Out of 100 living, one year.
Period of the dis- | Number| Cured poe ce eo
No. | ease from the date | living or Died Anved
of Admission. | one year.| relieved. sured or :
* relieved, Died.
Years.

1 0 0% 619 150 152 24:2 24°6
2 ob 1b 944 155 130 16°4 13-8
3 1h 3h 1,033 320) 87 aL 84
4 3h 5a 673 20 48 3°0 71
5 57 383 9 27 2°3 7:0
0 7h 3,652 | 366 | 444 | 10-0 | 129

 

 

 

 

The numbers stated to have been relieved were 14 per cent. of the
numbers cured and relieved; and as the proportion remained nearly
the same through the seven years, the two classes of facts have not
been distinguished.

The annual rate of recovery in the first half-year was 24 per cent.;
and the rate of mortality was nearly 25 per cent. The two rates remain
high in the second period (the rate of recovery 16, and of mortality 14,
per cent.), while they declined respectively to 3, and to 8 per cent. in
the third period; and to 2°38, and 7:0 per cent. annually, between the
534 and 7} years after admission into the asylum.

The rate of mortality in a unit of time increases as the malady
advances up to a certain point, and then declines regularly, in all diseases
which have hitherto been investigated arithmetically. In cholera the
rate of mortality is highest at 18 to 24 hours; in small-pox, the mor-
fality is highest from the 10th to the 15th day ; in consumption the rate
to mortality appears to be greatest from the 6th to the 9th month.

Insanity is regulated by analogous laws; and a majority of the
patients are admitted at Hanwell before the disease has passed the point
at which the mortality declines, although many are admitted afterwards,
when the rate of recovery is reduced much more than the rate of
mortality.

At Hanwell, 18 in 100 living die annually in the first 14 year; and
8 in 100 annually for 6 years afterwards. If an asylum, therefore,
contained none but persons in the first year and a half of the disease,
(after admission is always understood,) the mortality would be 18 per
cent.; while it would be 8 per cent. in un asylum for chronic cases
between 14 and 7} years. Without implying any disparagement to the
treatment in the former case, the rate of recovery in the two asylums
would differ in a still greater degree, as it would be 19 per cent. in the
432 [PART Iv.

first asylum, and only 3 per cent. in the second, set apart for the
exclusive reception of the advanced cases. This separation seldom
takes place in practice. The chronic and acute cases are always mixed
in an institution like Hanwell; but it is evident that in the first years
after it was opened, the proportion of cases in the carly stages must
have been greatest, and the proportion of lunatics in advanced periods
of the disease must have since progressively increased. According to
the above laws, the proportion of deaths and recoveries should gradually
have declined, and this was the fact.

The annual mortality was 17 per cent. in the first three years, 11 per
cent. in the second, and 10 per cent. in the last three years; the annual
rate of recovery was 14 per cent. in the first, 7 per cent. in the second,
and 8 per cent. in the last period. In the licensed houses which have
been many years in existence, the annual rate of mortality was 13°6 per
cent. in 1838-36, and 17°2 in 1836-39 !

When the rates of mortality and recovery in the several stages of
insanity are ascertained, the effects of treatment and external influences
can be compared in asylums containing the various classes of paticnts,
in proportions as different as at Hanwell in 1831-33 and 1839-40.
The rule is :—multiply the number of lunatics existing at the several
periods of the disease by the corresponding rates of mortality and
recovery (0°242, 0°246, &c.), and the sum of the products will
represent the number of deaths and recoveries. By this rule the deaths
in Hanwell during the 12 year ending September 30th, 1840 should
have been about 149, and they were 128; the numbers cured or relieved
should have been about 126, and they were 154,

It will be found by this rule that the rate of mortality among paupers
in the licensed houses, and in Hanwell, has differed less than the first
results of the returns would lead us to suppose, although it has been
excessive in both. The paupers remain little more than a year anda
half (1°67) in the licensed houses, in which the annual mortality was
21 per cent.; at Hanwell the annual mortality in the first 1} year after
admission was 18 per cent.

From the facts previously referred to part of a table of mortality and
recovery may be constructed for lunatics.

NosometricaL TABLE.

 

Period of | The number of Lunaties who || Casesterminating in each Period.
the Disease
dating
from the Enter

day of jupon each
Admission.| Period.

 

Will Will die Total By By
Recover.| Insane. || Number. | Recovery.) Death.

 

Years. a b ce d e f

i 0 1,000 380 620 217 108 109
2 0°5 783 272 511 213 112 101
3 1°5 570 160 410 61 21 40
4 2°5 509 139 370 48 12 36
5 3°5 461 127 334 43 Il 32
6 A*5 418 116 302 41 11 30
7 5:5 377 105 272 35 9 26
8) 65 342 96 246 32 8 o4
9 7°5 310 88 222 — =

 

 

 

 

 

 

 

 

 

 

 

The above table shows that if we take 1,000 lunatics at the stage of
the disease corresponding to the time of admission at Hanwell, 217 will
DEATHS. | 433

be discharged (108 recovered or relieved, and 109 dead) in the half-year
following, leaving 783 to enter upon the second period, to be reduced
year by year, until at the end of 7} years only 3810 remain. he range
of the present series of observations extends no further, but the relative
proportion of recoveries and deaths remains nearly as 88 to 222 during
the last six years; and to complete the scheme of the table it may be
assumed that 88 of the 310 will recover, and 222 will die. Of 1,000
cases, 380 will recover, and 620 die; at the end of 14 year, 160 will
recover and 410 will die.

In the first half-year out of 1389 cases, 150 were cured, and 152 died ;
consequently, 108 were cured, and 109 died out of 1,000 cases. As
217 cases terminated during the first half-year, 783 entered upon the
second period, when the amount of recovery having been = 75%, and
the mortality = +132, exactly 112 recovered, and 101 died. By con-
tinuing the process, the deaths and recoveries are obtained for each year.

Halley invented the Table of Mortality, which consists of three
columns, showing the number of persons who die or survive in each
successive year. The events it exhibits are of one kind; all the persons
die. But cases of disease may terminate in two ways—by death, and
by recovery. A different tabular construction was therefore required
for sick persons, such as the one preceding, from which the mean future
duration, the probable duration, the probability of recovery, and the
probability of a fatal termination in any given time, can be determined
at any period of the disease.

The mean future duration of insanity, or the expectation of disease,
cannot be deduced from the preceding table, because it breaks off at
the end of 74 years; but if the annual rate continued the same (1-10),
7 of 310 would remain insane 40 years, and the mean future duration
of insanity at the period of admission at Hanwell would be 6°7 years;
at the end of half a year it would be 8 years; and after 14 years, it
would be 10 years.

In the six years 1834-39, when the inmates were = 2,875 living
l year, 706 were discharged; one in 5°5 therefore was discharged
annually. Ifthe institution had existed several years, and the numbers
admitted and discharged had been equal, the mean duration would have
agreed with this, and have been 5°5 years; but as Hanwell was opened
in 1831, and only 1,179, out of 2,029 admitted, had been discharged on
the 30th September 1840, the 6°7 years is probably nearer the true
mean duration.

In determining the mean ierm of treatment, which was attempted in
the early part of this paper, it may at first sight seem that the years of
residence should have been divided by the mean of the numbers
admitted (2,029), and discharged (1,171). This method would make
4-8 years the mean term of treatment in the six years ending 1839—
(for 484° = 4°8); and 1-9 years the mean term of treatment in 1831-3 ;
when 920 were admitted, 362 discharged, and the years of residence
were = J,248, Divide 1,248 by the number discharged (362), and
3°44 years would be the given term of treatment; but even this, as the
experience of the six following years evinces, is much below the truth.
The errors are the same as if the division of the children under three
years old by the mean number of births and deaths, or by the deaths
alone, were supposed to give the expectation of life at birth; whereas
the division by the deaths at that early period, though the nearest
approximation of the two, gives a less number than the expectation of
life in years.

Dr. Conolly ascertained the previous duration of the disorder in 191
cases (exclusive of 10 congenital cases) admitted during the year; 66

EE
434 [PART IV.

had been labouring under the disease less than six months ; 26 between
6 and 12 months; 24 between 1 and 2 years; and 1 had been insane
39 years. The mean previous duration was 3°4 years. But, as little
more than ha/f the number had been insane ¢welve months, the time at
admission may be represented by 1, or 1} year.

The mean age of 213 persons at admission was 86} years; the mean
age of 195 at the time of the first attack of insanity was stated to be
32k years,

The probable future duration of insanity is shown to be 24 years at
the time of admission ; for, in 24 years, the 1,000 cases are reduced to
509. The chances that a patient will, or will not, remain insane 24
years are 509 to 491, or nearly equal. Among those who remain insane
half a year after admission, the probable future duration of the disease
is nearly 4 years.

The probability of recovery at admission = 5°, = *880; of dying
insane = 482%, = °620. Half a year after admission the probability of
recovery is 243 = +347; of dying insane 313 = °653. The numbers
in juxtaposition, in columns 6 and c, express the respective chances
of death and recovery ;. thus, 5} years after admission at Hanwell,
the chances are 272 to 105 that a lunatic will not recover. All these
probabilities depend more or less on the assumption that 88 in 310,
remaining at the end of 74 years, will ultimately recover.

The probability of recovery, or of dying, within any year or years
up to 74, is accurately shown by the table. In the first half-year the

no SI

probability of recovering is 75 = °108; the probability of recovering
in 3} years is 389527 = 2o%) = °253. Out of 1,000 cases, 253 recover

in that time; hence *253 is the probability of recovery. The proba-
bility of dying in the first half-year is = 7429, = ‘109; in the two
years following 5147379 = 141 = +180.

From a table of this kind the lives of lunatics can be insured; and,
from the present table, they may be insured for a limited number of

ears.

The table is an instrument by which the effects of treatment on the
mortality—the number of recoveries—and the duration of all diseases,
can be accurately measured. It enables us to compare two or three
different plans of treatment, and to determine their effects upon the
principal results at which all medical treatment aims—the reduction of
the mortality, and of the duration of the disease. Thus, if 139 of 509
lunatics that have been 24 years in Hanwell will recover under the
present treatment, and 200 recover under any new mode of treatment
that may be introduced, the advantages of the latter would be obvious ;
and still more so, if the probable duration of the disease were reduced
from 10 to 5, or 2, years.

The returns from the licensed houses do not state the ages; and the
ages of few lunatics are given in the interesting report of Dr. Conolly.
From other observations it is known generally that the mortality in-
creases, and that the probability of recovery declines, as age advances.

The sex, age, and stage of the disease are the principal internal
causes that influence the mortality, except the form of the disease, which,
exclusive of congenital idiocy, may be, perhaps, reduced to an element
already discussed—the “stage of the disease.” The influence of com-
plications, of sex, and of age, may be assumed to be nearly the same in
the licensed houses and Hanwell, as in ordinary asylums—the asylum,
for instance, at Gloucester, where the mortality does not exceed 7 per
cent. annually. The mortality of 7 per cent. may be fairly ascribed to
insanity. The excess above this must be attributed to the diseases
generated by the limited space in which the unhappy lunatics are
DEATHS. | 435

confined—to the collection of large numbers under the same roof—
the impurity of the atmosphere—the want of exercise and warmth—the
poor unvaried diet—and the deficiency of medical attendance.* But the
influence of these agents can only be ascertained by a Parliamentary
inquiry; and it will not be denied that the causes should be investigated
which raised the mortality of lunatics above the standard—57 per cent.
among private patients, 71 per cent. at Hanwell, and 200 per cent.
among paupers in the large licensed houses !

The Bethlem Hospital differs essentially from the Hanwell Asylum
as well as from the majority of the licensed houses, in the stricter
selection of patients for admission. By the rules the following cases are
inadmissible :—lunatics who have been insane for more than twelve
months ; who have been discharged uncured from other hospitals; in a
state of idiotcy ; afflicted with palsy, or with epileptic, or convulsive,
fits; and suffering from any dangerous disease. Notwithstanding tha
instructions in the admission papers, the petitions of 58 out of 311
(19 per cent.), who applied in 1836, were rejected. The patients are
not allowed to remain longer than one year. 253 lunatics admitted in
1836 had been insane 83 days, on an average; 117 had been insane less
than a month.

It would be exceedingly interesting to determine the mortality of this
selected class of lunatics for 12 months. But, if dangerous symptoms
come on at Beihlem, the patients are dismissed, when practicable, as
improper objects. ‘Thus, of 3,026 discharged in 10 years, 829 were
dismissed uncured, 483 as improper objects, and 145 dead. A great
number of the “improper objects” would die soon after they left
Bethlem; and their dangerous state, or supposed incurability, was the
alleged cause of their dismissal. Paralysis, however slight, even of a
finger, is the forerunner of death in the insane; and of 210 dismissed
as improper objects (1831-36), 87 were paralytic, 59 “sick and weak,”
24 epileptic, 4 apoplectic, 2 had “ fits,” and 28 were idiotic. The lunatics
at Bethlem are divided into three classes; ‘‘curables,” “incurables,” and
“ criminals.”

Of the lunatics on the list of the hospital, 21 were constantly out
on leave of absence; and during the 13 years, 122 individuals were
discharged as “out on leave of absence.”

Of 100 “curable” patients discharged, 54°5 were cured, 5*2 died.
The mean term of treatment was ‘586 of a year, = 7 months; or °49 of
a year, = 6 months, if the time spent out of the hospital, on leave of
absence, be excluded. The lunatics discharged as “ improper objects”
were 14°5 per cent.; a considerable portion of whom would have heen
numbered with the dead ‘if they had remained.

The annual mortality was 8°8; the recoveries 92'0 per cent. ; 24°5
per cent. were discharged as improper objects, 43°4 were discharged
uncured; 2°1 were out on leave of absence. 171 were discharged
annually out of a constant population of 100.

If the. deaths which occur among those out on leave of absence are
not recorded, the annual mortality to 100 resident in Bethlem is 10°5.

Incurables—72 “incurables” were admitted; 72 discharged (33
men, 89 women), and the average number resident for 13 years was
64:2. The years of life were therefore = 64:2 x 13 = 834. Nine

 

* The diet and the condition of lunatics at Tlanwell have been latterly ameliorated
very considerably by the Visiting Justices, at the suggestion of the present physician
(Dr. Conolly); and the mortality may be expected to be reduced in proportion.
It is also right to state that in some licensed houses the mortality of private patients
does not exceed 7 per cent.

EE 2
436 [PART Iv.

incurables were cured, 39 died, and 24 were discharged at the request
of their friends.

Of 100 cases, 13 revovered, 33 did not recover, and 54 died. One
in 11°6, =6 per cent. were discharged annually; the mean term of
residence was 11°6 years. lin 21,=4°7 per cent..died, and 1 per
cent. was cured annually.

‘“ Incurables” is an improper term; but it is a recognition of the law
that recovery is infrequent in advanced stages of insanity.

Criminals—In the 18 years 71 criminal lunatics were admitted at
Bethlem (56 men, 15 women) ; 51 were discharged, namely, 26 died,
2 escaped, and 23 recovered. The average number resident was 57:3,
the years of life 745.

Of 100 cases, £5 recovered, 51 died. The annual rate of mortality
was 3°5, of recovery 3°1 per cent.; the mean term of treatment
deduced from the years of life, and the number discharged, was 144
years. The numbers admitted and discharged in the 11 years (1827-37)
were nearly equal (36 and 89); and the years of life divided hy the
number discharged = %& 2 = 16°7 years.

It is evident that several of tke criminals, such as Oxford, cannot
properly be said to labour under insanity—in the sense of a disease. It
is, if anything, like idiocy, a congenital misdevelopment of the brain.

The number of recoveries is considerable at Bethlem, but less than
at some private asylums, notwithstanding the careful selection of cases.
The mortality is reduced by excluding dangerous cases, and by dis-
missing the patients on the verge of death, as “improper objects.” It
is difficult, under these circumstances, to account for the death of nine
or ten in 100 annually, upon any other supposition than that the
mortality is high at the early stage of the disease in Bethlem.

The last Committee ot the House of Commons on Lunatics, stated in
their report, “It hag been clearly established in evidence, that there is
* no due precaution with respect to the certificates of admission, to the
“ consideration of discharge, ov to the application uf any curative pro-
“ cess, to the mental malady.”* Lunatics under confinement, it should
be well recollected, are prisoners ; and every one will admit that the
depriving a man of his personal liberty, or turning loose a lunatic on
suciety, are acts involving great responsibility,—a responsibility which,
if it exist at all, is very imperfect in the present state of the law. In
order to deprive a lunatic of his estates, « formal inquiry is publicly
instituted ; but a person who has been seven days chargeable to the
parish may be committed as a lunatic to the County Asylum by two
justices of the peace on the certificate of any physician, surgeon, or
apothecary, asserting that the ‘said person appears to be insane of
“ mind.” 2,780 pauper lunatics are confined under these certificates in
the county asylums.f But there are 1,389 lunatics, and 7,007 idiots,
‘under the care of the parish officers as indoor or outdoor paupers.”
Many of them are necessarily under restraint, without cither warrant or
certificate, which is only required when the parishes think it necessary
to send them to a public asylum, where their treatment costs two or
three times as much as the workhouse fare.

Paupers may be sent to licensed mad-houses by a justice, or by the
officiating clergyman and overseer, with one medical certificate ; and
other persons may be seut to a licensed house by any layman, upon the
certificates of any tivo medical men.{ It appears also that by law, any

 

 

* Report, 1827, p. 4.
{ Return to the House of Commons, 5th July, 1836.
£9 Geo. 1V.¢c. 40; 2 & 3 Will. LV. vc. 107: 3 & 4 Will. IV. ¢. 107.
DEATHS. | 437

persou whom the governors choose to admit as a lunatic, may be confined
at Bethlem, or St. Luke’s Hospital, for an unlimited time.

The liberation of persons in confinement as lunatics, takes place under
no better regulation. Medical visitors have been appointed, in the
words of Lord Lyndhurst, “to see that the Chancery lunatics are well
“ cared for, but above all to watch the least glimmering of returning
“ sanity, and see that the parties are not detained one day longer than
“ necessary.” The relatives, parish-officers, proprietors, justices in
petty-sessions, and the Metropolitan Commissioners, release lunatics
from the licensed houses; but the mode in which this is effected is by
no means satisfactory. “When once,” says Colonel Sykes, “ they
“ (pauper lunatics) get shut up in a mad-house, it is indeed difficult for
“ them to regain their liberty.”* Lunatics are discharged at the discre-
tion of the visiting justices from the county asylums; by the governors
from Bethlem, St. Luke’s, and other hospitals supported by subscription ;
and by the parish officers from workhouses.

Many cases of abuse have occurred under the present system, which
will be probably thought by the Society to require extensive alterations.
And although there would be much difference of opinion on many points,
all will probably agree that no person should be placed under restraint
as a lunatic in asylums, hospitals, or houses of any kind, who has not
been examined by a public officer, practically acquainted with insanity.
I would therefore suggest that by some modification of the present
system of inspection, the circumstances of every lunatic confined should
be investigated personally by a crown officer, and recorded previous to
committal, at the expiration of every quarter of a year after admission,
and at the time of dismissal. The sex, and age, the stage, form, and
complications of insanity should be registered, on entering and leaving
the several institutions, by impartial officers. This would be a protec-
tion to lunatics, and to the public; the deaths and recoveries would be
registered on a uniform plan, and an invalnable statistical check on the
results of treatment would be obtained.

We may then discover the causes of insanity, the laws which regulate
its course, the circumstances by which it is influenced, and either avert
its visitations, or mitigate their severity ; perhaps, in a later age, save
mankind from its inflictions, or, if this cannot be, at any rate ensure the
sufferers merciful treatment. (Journal of Statistical Society, Vol. IV.,
pp. 17-38.)

Correction of Local Death-rates for Deaths in Public Institutions ;
Workhouses——In calculating the mortality of the respective London
districts, the deaths and population of these outlying workhouses were
taken from those districts in which they happen to be situated, and
placed in the districts to which the inmates belong. No other correc-
tion for workhouses is required, unless it is attempted to calculate the
mortality of sub-districts. ‘Then if the workhouse population, and the
paupers who die, can be referred to their respective sub-districts, that is
tbe proper course for determining the relative mortality of the sub-
districts among themselves. The condition of the workhouse is an
important element in the health of the district ; and sub-districts supply
the workhouse with paupers in very different proportions ; but when the
localities from which workhouse paupers come is unknown, no better
general rule can be laid down than the following : distribute the deaths
in the workhouse, at each age, over the several sub-districts, in the
proportions of the deaths registered out of the workhouse in those sub-
districts ; distribute the population in the workhouse, at each age, over

 

* Journal of the Statistical Society, vol. iii., p. 146.
438 [PART Iv.

the several sub-districts, in the proportions of the population enumerated
in those sub-districts ; and then divide, as usual, the deaths by the living
at corresponding ages.

Hospitals. In deducing the mortality of the several London districts,
the population and the deaths in the hospitals were subtracted from the
population and deaths of the respective districts in which the hospitals
happened to be situated.—(See Tables, in 8th Report, folio, pp. cxviii—
cxxix.) The hospital population and deaths at each age were then
distributed over all the districts of the metropolis by the following
formula :—

Pes ely ‘
pe ape mM’, = m,: OY

(APY, +«P,+4D,+«D,) =A¢,; andre, + Am’, =am,:
in which P,, = the population of London at any age 2;

P’, = the population of London at the same age a, exclusive
of the population of the same age in hospitals ;

D, = the deaths in London at the age a;

D’, = the deaths in London at the age a, exclusive of the
deaths at the same age in hospitals; m’, = the rate of
mortality at the age #in any district, without correc-
tion for deaths and population in hospitals, of persons
belonging to that district.

m, = the corrected rate of mortality at the age x.

(9th Annual Report, p. 160.)

10. MarriaGe AND: Morratiry.

Influence of Marriage on the Mortality of the French People—The
changes which age induces in the vital forces bave been calculated.
The differences in the mortality of the two sexes are known. Men
have investigated the effects on life of air, water, hills, plains and
marshes—of the sun in various seasons and climates—of food, animal
and vegetable—and of alcholic drinks. The fatality of foul exhalations
of every kind has been made manifest. But the life of man is affected
by still more subtle agencies. The action of the various parts of the
body in industrial occupations produces specific effects. Every science
modifies its cultivators. The play of the passions transfigures the
human frame. How do they influence its existence ?

These are some of the higher fields of speculation which have not
yet been explored by sanitary research. I have now, however, to
submit to the department the results of an inquiry into intermediate
phenomena.

The family is the social unit ; and it is founded in its perfect state by
marriage. The influence of this form of existence is therefore one of
the fundamental problems of social science.

A remarkable series of observations, extending over the whole of
Frnnce, enables us to determine for the first time the effect of conjugal
condition on the life of a large population. The French people may be
classed in three great groups, exclusive of minors under age:

I. The married consisting of two groups: (a.) Husbands, 6,986,223,
and (4.) wives 6,948,828, making a total of 13,935,051.

II. The celibate, who have never married, namely, (a.) bachelors,
4,031,582 ; and (6.) spinsters, 4,547,952, making a total of
8,579,534.

Til. The widowed in two groups, (a.) widowers, 836,509; and
(4.) widows, 1,687,583 ; making a total of 2,524,092,
DEATHS. | 439

Deparcicux, in the middle of the last century, investigated the
relative mortality of monks and nuns in France; and he compared their
life with that of Tonitine annuitants, consisting partly of married
and partly of unmarried persons. From the age of 20 to 40 the
mortality of the monks and nuns living in “single blessedness” was
lower, and after the age of 40 it was higher than the mortality of the
annuitants. The excess of mortality was considerable in the monks,
The condition of these members of religious houses is at all times
peculiar, and besides their vows of chastity involved a peculiar discipline
likely to affect their lives. Many of them lived in Paris. We can now
deal with the whole population of France, amounting, in 1851, to thirty-
six millions of people * * * * It contained in the year 1851
nearly fourteen million married people of both sexes. What was their
rate of mortality? Under the French law, young men of the age
of 18, and young women of the age of 15 can legally marry. Of
the few young married pairs living, the mortality in both husbands and
wives was excessively high under the age of 20. Twice as many
wives under 20 died in the year as died out of the same number of
the unmarried ; and the mortality was much higher than it was among
husbands and wives in the subsequent decennial of life. The result
confirms the common opinion of the evil consequences of marriage in
many cases under the age of 20, before the growth of the individual
man or woman is completed.

The wives of the next 20 years of age experience a rate of
mortality half as high again as that which the husbands of those ages
suffer.

The mortality of the husbands is exceedingly low, 6°5 and 7:1, while
wives of 20 to 30 die at the rate of 9°3 in 1,000, in rather higher
proportions than the wives of the subsequent age, 30 to 40, when the
mortality is 9'1. This excess is fairly ascribable to the sorrows of
childbearing, and to no small extent to ignorant midwives.

At the age 40 to 50 the mortality of the husbands (10°8) is slightly
higher than that of the wives, and so it remains higher ever afterwards,
but the difference is not considerable.

 

Age. Husbands. Wives.
50-60 18°3 16°3
60-70 35°5 - - 385°4
70-80 - - 88°6 - - 84:9
80-90 - - 183°6 - 180°4

Thus, to 1,000 husbands living at the age 60 to 70 there are 35°4
deaths; to 1,000 wives 35°4 deaths. And so the old people go on in
the table tottering down the hill till they “sleep together at the foot.”

How fares it with the unmarried—the celibate ?
At the younger ages under 20 the mortality is, as I have already
stated, much lower in the two sexes than it is in the married.

Age unmarried. Males. Females.

— —,

15-20 “Gey <x 7°7 in 1,000 die.

At all the ages from 20 to 60 unmarried men experience a much
higher rate of mortality than unmarried women. The excess of the
mortality of males at the age of 20-30 was in the ratio of 11-3 to 8°7.
It was aggravated by the deaths of the soldiers dying in Algeria, and
in the Casernes at home; but in the subsequent periods this element
does not interfere to any extent.
440 [PART Iv.

Annual deaths to 1,000 living :—

 

 

Age of the unmarried. Males. Females.
30-40 - 12°4 7 7 10°3
40-50 - 5 17°7 - 13°8
50-60 = - 29°5 . - = 23°5

At the age 60 and upwards the unmarried of both sexes are nearly
equally mortal.

But how is it as between the married and the unmarried women ?

Why at 20-25 the maidens have the advantage, and the difference is
not inconsiderable.

Of 1,000 Females. Married. , Unmarried.

 

 

 

Annual deaths 9°8 - 8:5

At the age 25-30 the mortality of the unmarried is slightly in excess
(9°2 to 9°0). At the next age (30-40) the wives are the halest; the
mortality of the wives being 9:1, and of the unmarried women 10°3.
At the age of 40 the married women experience a much lower rate of
mortality than the unmarried :—

 

 

Married. Unmarried.
40-50 - 10°0 - 13°8
50-60 - - 16°3 - 23°5
60-70 - - 35°4 - - 49°8

and so it runs through all ages.

The contrast between the health of the bachelors and of the married

men is still more striking; the young bachelors enjoy an advantage, the
old ones suffering in the comparison.

Mortality per 1,000 among married men and bachelors :—

 

 

Married. Unmarried.
15-20 29°3* - - 6°7
20-80 - 6°5 11°3
30-40 71 12-4
40-50 - 10°3 - 17°7
50-60 - 18°3 29°5
60-70 35°4 - 49°9

And after the ages of 80. the mortality of the two classes becomes
nearly equal.

If unmarried people suffer from disease in undue proportion the
have-been-married suffer still more. At the ages under 40 the
mortality of widows is higher than the mortality of unmarried women.
At the earlier ages the mortality is doubled. At 40 and upwards
their mortality is lower than the mortality of unmarried women of
corresponding ages. At all ages widows are more mortal than wives.

Young widowers under the age of 30, and even under the age of
40, experience a very heavy rate of mortality; and after 60 the
widowers die more rapidly, not only than husbands, but more rapidly
than old bachelors.

This is the general result :—Marriage is a healthy estate. The
single individual is more likely to be wrecked on his voyage than the
lives joined together in matrimony. Q

* * * * *

* This is an accidental exaggeration ; the facts are insufficient.
DEATHS. | 441

Finally, it is held generally that the suppression of a physiological
function is prejudicial to health, which our tables confirm, and at the same
time qualify. Chastity in itself does not, as in the case of Deparcieux’s
nuns, raise the mortality of women under forty ; and notwithstanding
the consequences of vice in the vicious, the selection operating against
the unmarried, and the pangs of disappointed love, the mortality of
unmarried women in all France is lower than the mortality of married
women. After that age the health of the nuns gave way to some
extent; but this was, perhaps, as Deparcieux asserts, the consequence
in that period of various kinds of austerities, an absence of personal
cleanliness, and the want of little comforts which were found in the
dwellings of simple artizans, who knew how to keep their houses in
order. The effects of religious chastity in France have been recently
discussed by Dr. Mayer, who with some Catholic authorities contends
that it has in itself no prejudicial effect; but this is not the prevalent
opinion. Levy professes the contrary doctrine.

* DS * * *

France.—Rate of Mortality per Cent. in 1853.

 

 

 

Mates. Fremaes,
AGES. cS 7 g .

|e] Ee] | 2] &

‘g E 3 5 E 3

a 3 a a 3 =

5 a =z 5 a =
All Ages 2°093 1°756 7°249 2024 1°534 5° 804
15- '668 2°934 | 18°688 °772 1°364 | 10°673
20- 1°128 *654 2°877 *874 0°930 2°310
30- 1°236 ‘714 1°849 1°030 0-911 1°365
40- .1°774 1°026 2°005 1°381 0-999 1°366
50- 2°945 1°830 2°952 2°347 1°627 2°169
60- 4:986 3°544 5°414 4°977 3°540 4°670
70- - 10°974 8*859 | 12°871 | 11°337 8°490 | 10°717
80- - 21°072 | 18°363 | 24°799 | 24-143 | 18-044 | 22°850
90- - 28°096 | 26°016 | 41°344 | 29-580 | 18°778 | 36°273
100- - 76°767 | 98°674 | 48°605 | 45-847 | 70°505 | 42°856

 

 

 

 

 

 

 

 

The table may be read thus :—In 1853 to every 100 unmarried men
living in France of the age 20—-30 there were 1:128 deaths of
unmarried men or 11 in 1,000; to every 100 married men at the same
age 654 deaths of married men, or nearly 7 in 1,000
100 widowers, 2-887 deaths of widowers, or 29 in 1,000.

A correction has been made for increase of population, on the
assumption that the increase has been uniform at every age, and that
the same rate of increase has taken place since 1851 as was observed
between 1846 and 1851. A correction has also been made both in
population and deaths for ages not stated—(Transactions of the
National Association for the promotion of Social Science, 1858
pp. 504-12.) ,

; and to every

 
443

CONTENTS

OF

PART V.—LIFE TABLES.

IntTROpUCTION.

Death, Registration, and Life and Annuity Tables——Mortality at Groups of
Ages for Life Table purposes.—History of Life Tables.-—-Rural and Urban
Life Tables ; Surrey, London, and Liverpool.——-Uncertainty of Individual Life,
and Constancy of Averages.—Mean Duration of Life and Mean Age at Death.—
Mean Duration of Life deduced from incomplete Observations.-—Construction of
Life Tables; De Moivre’s Hypothesis-A Short Method of Constructing Life
Tables.-Mean Duration of Life in Metropolitan Districts——Properties and
Applications of Life Tables; Dr. Price’s Fallacies.--Mortality in Increasing
Populations.—Statistical Methods for Determining the relative Health and
Mortality of different Classes of the Population.—Relative Duration of Life
among Males in Manchester and in England Expectation of Life; after-
lifetime.—English Life Tables, Nos. 1 and 2.—Old and New Northampton
Life Tables ; Carlisle Table; Experience Table.—Selection of Lives for Insu-
rance.—Rise and Progress of Life Insurance.—Construction of the English
Life Table No. 3.—Constitution of wu Life Table, or Normal Population.—
The Rate of Mortality and the Probability of Dying.—General Description
of a Life Table; Healthy Districts——Basis and Uses of the Healthy District
Life Table.
445

PART V.—LIFE TABLES.

INTRODUCTION.

One of the most valuable uses to which trustworthy rates of mortality
can be put is for the construction of life tables ; and it may further
be asserted that the construction of life tables is almost necessary in
order to give scientific value to death rates. The first extract in the
following selections bearing upon the inter-relations of death-rates and
life tables shows that even in the First Annual Report Dr. Farr fully
appreciated the enormous value of the civil registration of deaths (showing
the ages at death and the causes of death), not only as the basis of
mortality statistics for stimulating sanitary progress, but as a means for
the construction of true life tables, that would give increased trust-
worthiness to death-rates, to life insurance, and to the system of life
annuities. It will be evident, to those who read these selections from
his writings, how much thought and labour were devoted, from time
to time, by Dr. Farr to the utilisation of the accumulating mortality
statistics derived from the national Death Register for life table
purposes. The first of Dr. Farr’s English life tables, known as No. 1,
was published in the Registrar General’s 5th Annual Report, and was
based upon the enumerated population in 1841 and the registered deaths
in the same year. The following extracts include several from this
report, in which appeared a general dissertation upon the history,
construction, and properties of life tables, in addition to a detailed
description of the English Life Table No. 1. This report also contained
shortened life tables for the Metropolis, for Liverpool, and for the
county of Surrey, which exemplified scieutifically the effect of extreme
urban and of rural death-rates upon the lifetime of a population.

In the Registrar General’s 12th Report was published Dr. Farr’s
English Life Table No. 2, which was constructed upon a more extended
basis, namely, the registered deaths in the seven years 1838-1844, and
the Census enumerations in 1831 and 1841. The last of Dr. Farr’s
national life tables was based upon the recorded deaths in the 17 years
1838-54, and upon the three Census enumerations of population in 1831.
1841, and 1851. Such an extended series of observed facts had never
before served as the basis of a life table. The near agreement of the
resalts arrived at in these three English life tables is very remarkable,
and accentuates the fact that English mortality, notwithstanding fluctua-
tions from year to year, was, on the whole, notably stationary during the
first. 33 years of civil registration, 1838-70.

The English Life Table INo. 3 was not only based upon a far larger
series of observations than either of the Tables No. 1 or No. 2, but
contained a far more complete and elaborate series of tables. This life
table* was published as a separate volume, coutaining more than 500
pages, « great portion of which was devoted to joint life tables.

 

* English Life Table. Tables of Lifetimes, Annuities, and Premiums; with an
introduction by William Farr, M.D., F.R.S. Longman & Co.; 1864.
446 [PART Y.

The limits of this volume forbade the selection of but comparatively
few extracts of more general interest, and necessitated the omission
of much possessing intrinsic mathematical and actuarial value. The
main object of the selection was to take those portions of the reports
which dealt with general principles and possessed value or interest for
those who use the life table as a scientific exponent of mortality, rather
than as a guide to insurance or annuity operations. It is necessary,
therefore, to refer those who would study the more purely mathematical
aspect of the question to the original reports in which the several life
tables were published.

The Healthy District Life Table was based upon the mortality during
the five years 1849-53, in 63 English registration districts which showed
a mean annual death-rate not exceeding 17 per 1,000 persons living
during the ten years 1841-50. This life table formed the subject of a
Paper read by Dr. Farr before the Royal Society on 7 April, 1859, and
printed in the Journal of the Transactions of the Society for that year.
The tables based upon this Healthy District experience were afterwards
added to and extended; and a selection from them was published in an
Appendix to the Registrar General’s 33rd Annual Report. Dr. Farr
pointed out that this Healthy District Life Table expresses “ very accu-
“ rately the actual duration of life among the clergy and other classes
“ of the community living under favourable circumstances.” As repre-
senting, therefore, a standard of attained healthiness* (it is impossible,
however, to say how much it is below an attainable standard), this
healthy district mortality is most valuable as a means for measuring
the excess of mortality due to insanitary condition, and generally to
preventable causes,

The careful study of the following selection of extracts from Dr. Farr’s
writings on the construction and use of life tables caunot fail to con-
vince all students of vital statistics that a life table supplies the only
scientific and thoroughly trustworthy method for ascertaining the true
import of rates of mortality in increasing or decreasing populations,
whether such increase or decrease be due to the difference between
birth-rates and death-rates, or to the effect of migration. The con-
struction of a life table by Dr. Farr’s shortened method (see description
and formule on pp. 465-7) does not entail an amount of labour that
should deter medical officers of health for large urban districts from
undertaking it. A detailed and thoroughly practical description of the
construction of an extended life table (for each year of age from 1 to
100) may be found in « Paper read before the Statistical Socicty in
April 1883.f This description was written with a view to facilitate
the operation for those whose knowledge and practice of this branch of
mathematics might be insufficient to enable them to work with the
sole help of Dr. Farr’s formule, a selection from which is to be found
in the following extracts.

Exigencies of space alone prompted the rejection for the purposes of
this volume ofa valuable contribution on what Dr. Farr called “ Finance
“ of Life Insurance,’ and which he describes as “a branch of the
“ science of life insurance which has hitherto (in 1850) been much
“ neglected, and is only noticed cursorily in the standard works of Price,
“ Morgan, Baily, and Milne.” This branch of the subject, however, is
not only of a thoroughly technical character, but its interest is mainly
confined to those practically engaged in the business of life insurance.

 

* Dr. Farr wrote, respecting these so-called healthy districts, “the sanitary
condition of the people in these districts is, however, still in muny respects
defective.”

+ Journal of the Statistical Society, vol. xlvi., pp. 189-213.
LIFE TABLES. | 447

This contribution may be found in the Registrar General’s 12th Annual
Report, pp. xvi-xxxiv.

Among Dr. Farr’s other life table contributions which have been
necessarily omitted from these selections through want of space, ib is
especially desirable to call attention to the shortened life tables for
England and Wales, the Healthy Districts, London, Liverpool, and
the fifteen great towns. These tables, together with others (which
may be called Life Tables of Disease), showing of what diseases
and at what ages a million live-born children may be expected to die in
England and Wales, the Healthy Districts, Liverpool, &c., were published
in that mine of statistical information and suggestion, the Supplement to
the Registrar General’s 385th Annual Report, in the preliminary tables,
pp. Ixxxiii~clxxxv. .

(Enitor.)

Death Registration, and Life and Annuity Tables.—in the Abstract
of Deaths (the registration of which even for this first year has been
effected with signal success) are shown the deaths of persons of each
sex at every successive year of age. Such details are of acknowledged
value as data for determining the laws of mortality—as bases for
calculations materially affecting the interests of millions. Tables
exhibiting the proportion of deaths at every successive year of age are
among the most important materials from which are deduced the true
principles on which should be founded the systems of life annuities
and of life insurance, and the rules of Friendly Societies established
for the use of the poorer classes. The materials hitherto accessible are
admitted to have been too limited for framing, satisfactorily, tables to
regulate the amount of contribution at various ages, by which members
of such societies may become entitled to allowances in old age, or to
sums payable at death. The insufficiency of the data hitherto collected,
and the contradictory nature of the several tables founded on them are
strongly set forth in the Report of the Select Committee of the House
of Commons, in 1827, on the laws respecting Friendly Socicties. It is
there stated that, “ according to the Northampton Tables, out of 1,000
“ persons existing at the age of 25, there survive at the age of 65, 343
‘“* persons. By the Carlisle Tables, no fewer than 513 persons will
survive ;” whereby it appears “ that a society which should adopt the
“ Northampton Tables would, if the mortality among its members should
“ correspond with the Carlisle Tables, have three annuitants where it
“ calculated upon ¢wo. Of those annuitants, moreover, a larger proportion
“ would live to enjoy the annuity for a considerable number of years ;
“ for instance, of the 343 persons, who would be annuitants according to
“ the Northampton Tables, 98 would live for 15 years; according to the
“ Carlisle Tables, 162 persons would survive through that period, and
“ attain the age of 80 years.” But still more clearly will it appear how
great is the want of further facts for the elucidation of these important
subjects, and the establishment of a safe standard, by viewing ina tabular
form a comparison of the various results of seven approved tables of
mortality (see the following table), extracted from the above-mentioned
report. The recommendation of that report, that measures be adopted for
making “an accurate and extensive collection of facts,” whereby may be
facilitated “the solution of all questions depending upon the duration
“ of human life,” is at length carried into effect ; ample materials, thus
conducing to ameliorate the condition of the working classes, are now
afforded in the certified copies of registers deposited in the General
448 [PART V.

Register Office; and each year’s accumulation will increase the value
of such records, by augmenting the number of facts upon which
calculation may be brought to bear.

In pursuance of these objects, I have felt that it was of great
importance not only to give an abstract for the whole kingdom of
England and Wales, but to exhibit the difference which prevails in
different portions of the kingdom; to compare town with country—-
agricultural districts with manufacturing and mining districts—the hilly
with the low and level—the maritime with the inland—the eastern and
northern with the western and southern parts. Nor are these diversities
matters of merely curious speculation, but they may be made the source
of important benefits, especially to the poorer classes. It was stated
in evidence before the Committee on Parochial Registration in
1833, by the Actuary of the National Debt Office, that the extent
of difference which then existed was utterly unknown—that tables for
the use of the poor, in reference to sickness and mortality, and in
reference to the regulation of their Friendly Societies, could not then
be consiructed for two districts differing in character, from the want
of such information as an improved system would afford; and that,

 

 

*
sg ae 3a a, | #26 By Mr. Finlaison’s
os 3 “3 3 2 38 gg Tables, founded on the
5 ee ae 24 | 835 experience of the
242/88 | && Be | G6Gio Government Life
ZEEE IES oe, BO | was Annuitants.
O.5S gs 2s 3 aa weg
FS. | 2 oS See
5 8 | ge Ses | og 233 / 22 $28
S85 | Bm BES] SE | Aaa) £85 % SS
205/35 | 458] ZF 6681/8 “3 posta
a-s| oe i“ as aed a 2aeda
Ae | BR ga § |S2o| 2.88 Be
ese (25 | 388] a6 |Seq/ S8ls | eess
Se3|/25 | 885] 25 |&oe| S885 | “SSs
cos | ae Bag) ge ss | hes Mass
a4 G.| Pos rs +038 AS oOR aIgs
= 2£/S48/RE5) 28 [SSH] SHES | Sy8e
Age |SSe/See| SS |F5E/ SEEE | SEEE
ne | pan | oo De a) 8A aR sea
1 cq [as] A FQ <q <
Mean Mean
of both of both
Of 100,000 persons, aged) Sexes. Sexes.
25, there would be alive 34,286 | 43,187 | 51,033 | 51,335 | 49,330 53,470 53,950
at theage of 65 - |
Of 100,000 persons, aged
65, there would be alive 28,738 | 23,704 | 29,878 | 31,577 | 37,267 38,655 37,355
atthe ageof80 - -)
Expectation of life atthe?) o,. ayy ans . ‘ ‘ Eg
age of 25 years - xf 30°85 | 34°58 | 37°17 | 37°86 | 37°45 38°35 38°52
Expectation of life at the , e ! 9° . Orr
age of 6S years - <5 10°88 | 10°10 | 11°25 | 11°79 | 12°35 12°81 12°50
Value ofan Annuity ot 11. £ £ £ £ £ eR £
onalife aged 25, interest ¢| 15°438 | 16°839 | 17°420 | 17°645 | 17°494 17°534 17°634
being at 4 percent. = -
Value ofan Annuity of 1.
on alife aged 65, interest 7°761 | 7°328 | 8°039 | 8°307| 8°635 8°896 8°751
being at 4. percent. = -
Value of a deferred An-
nuity of 12. commencing (|p. .» 4. ane . ‘ i ’ .
at 68,0 a life now aged 0°55424 /0°65842 |0°85452 |0°88823 |0°S8728 | 0°99078 0° 98334
25, interest at 4 per cent.

 

 

 

 

 

 

 

 

 

 

* Inall the Tables above mentioned, it is to be observed that the Mortality is deduced from
an equal, or nearly equal, number of each sex, with the single exception of Mr. Davies’s Tahle,
founded on the experience of the Equitable, in which office, from the practical objects of life
insurance, it is evident the male sex must have composed the vast majority of lives subjected
1o mortality. Butas it is agreed on all hands that the duration of life among females exceeds
that of males, it follows thut the results of Mr. Davies’s Table fall materially short of what they
ene have been, if the facts on which he has reasoned had comprehended an equal number of
each sex.
LIFE TABLES. | 449

if two societies of poor men residing in districts of a totally different
character were, at the same time, to apply to him for tables to guide
them in preserving their societies solvent, he “should be under the
“ necessity of giving the same tables to both, though knowing perfectly
“« that the rates which were adequate in one case were inadequate in
“ the other” It was also stated to the Committee on Laws respecting
Friendly Societies, by another eminent actuary (Mr. Milne), that no
one table or scale of contributions can, with propriety, be adopted by all
Friendly Societies ; that one composed of members living in or near a
manufacturing town required a table very different from that which
would be required in places where the population is less dense, and
where a considerable proportion of the members are chiefly employed in
the open air; but that these are differences which he could not “ pre-
“ tend to estimate for want of data.” The useful principle of com-
parison may, if requisite, be carried out into a more minute system of
subdivision than I have, in this first instance, deemed it necessary to
adopt. But there was danger lest, in attempting a more subtle dis-
crimination, we should lose sight of broad distinctions which it was
important to observe; and it was necessary to remember, that to
dimiuish by subdivision the number of facts on which calculation could
be brought to bear was materially to diminish their value. The extent
to which division should be carried is a question not to be decided by
any established rule, and which necessarily admits of much diversity of
opinion; and it has been sought to pursue a middle course between the
opposite extremes of subdivision and condensation, by dividing the
kingdom into the twenty-five portions in which are exhibited abstracts
of deaths at different ages. In doing this, regard has been had not so
much to the observance of established boundaries as to those circum-
stances from which diversity may be expected to arise; in some
instances, contiguous counties, similar in soil, climate, elevation, and the
employments of the people, have been included in the same table,
while, ‘in other instances, the boundary of the county has been disregarded
where it was desirable to compare two large portions of its inhabitants
pursuing very different occupations.—(1st Annual Report, pp. 15-18.)

Mortality at Groups of Ages for Life Table Purposes——The most
important use of Abstracts of Deaths is their application to the con-
struction of tables of mortality, which, it must be remembered, are
constructed, not from enumerations of deaths alone, but from two series
of facts—the numbers living at different ages, and the numbers dying at
the same ages—and the observed relation between those facts. This
relation of the living to the dying is varying daily ; but it is obvious
that however complete might be the record of facts, complete beyond
all conceivable possibility of attainment, these variations in the minuter
portions of time would be too irregular for the safe deduction of any
general laws; and that it is only by including large numbers of facts,
and long portions of time, that we surmount the difficulties which such
casual irregularities create, and arrive at the ascertainment of any
well-founded laws of mortality.

In the assignment of these periods, the quinquennial division is
found to be recommended, both by its correspondence with the enumera-
tion we nlready possess of the ages of the living and by the authority of
those who have already adopted it. The ages of the living in 1821
were enumerated for quinquennial periods up to the age of 20, and for
decennial periods after that age. The numbers of the living at different
ages were not enumerated in 1831. It is earnestly to be wished that
such enumeration may be made in future, and for quinquennial periods

FEF
450 [PART Vv.

beyond the age of 20; but it is useless to expect that an enumeration
more minute than for quinquennial periods for all above childhood can
be effected with success. If, therefore, the utmost to be expected with
respect to the future enumeration of the living is that it be given for
quinquennial periods, it becomes advisable that the age at which
persons have died should be given in a corresponding manner. I may
further observe, that no authentic table of mortality in practical use has
ever been been calculated from an enumeration of deaths at every
separate year of age; and that no actuary has yet shown that tables
can be deduced more accurately from deaths so enumerated than from
quinquennial or decennial periods. The well-known Carlisle Table of
Mortality was calculated by Mr. Milne from Dr. Heysham’s Tables
of the Living and Dying, in which the ages of the latter are arranged
in the same manner as in the present abstracts, except that the divisions
were less minute, containing only decennial divisions after the twentieth
ear.

- The Swedish Table was calculated by Dr. Price from abstracts of the
numbers of the living and dying in Sweden during 21 years, arranged
in quinquennial periods after the fifth year. The Northampton Table,
the Montpellier Table, and Deparcieux’s Table of Annuitants, though
calculated upon data less complete than those which were the bases of
the Carlisle and Swedish Tables, were formed by regulating the
decrements, or by taking the mean mortality of quinquennial or
decennial periods; and in addition to the eminent writers on the
law of mortality above mentioned, I may quote, in support of such
arrangement, Mr. Morgan and Mr. Edmonds.—(2nd Annual Report,
pp. 13-14.)

History of Life Tables—The table called by different writers a
Table of Mortality, a Table of Vitality, ov a Life Table, was invented
in England by Halley the illustrious astronomer, who “ first ventured
“ to predict the return of a comet which appeared accordingly in
“ 1759.” By this simple and elegant table the mean duration of human
life, uncertain as it appears to be, and as it is with reference to
individuals, can be determined with the greatest accuracy in nations,
or in still smaller communities. I refer to the form, and not to the
mode of construction, which has been since greatly improved.

Halley’s Table was calculated on the deaths in the city of Breslau,
which for various reasons he selected from the imperfect data at his
disposal “as the most proper for a standard, and the rather for that the
“ births did a small matter exceed the funerals.” He was aware that
“ he wanted the number of the whole people” for an accurate calcula-
tion ; but Halley’s Table, constructed upon nearly the same hypothesis
as the Northampton Table, represented the mortality of mankind with
as little inaccuracy, and was upon the whole quite as good a “ standard.”
He observes “it may be objected that the different salubrity of places
“ does hinder the proposal from being universal, nor can it be denied ;”
“ but” he concludes, “it is desired that in imitation hereof the curious
“ in other cities would attempt something of the same nature, than which
nothing perhaps can be more useful.” The table, which gave “a more
Just idea of the state and condition of mankind than anything then
extant, had manifold uses, showing among other things the chances of
mortality at all ages, and likewise how to make certain estimate of
the value or annuity for lives, which had been previously done by an
imaginary valuation.”

The Government of the Revolution, it will be recollected, introduced
the system of borrowing money upon Life Annuities, and after having

as

‘

‘

a 8

“«

an «a
LIFE TABLES. | 451

failed to procure subscriptions upon the terms of the Act of 1691,
succeeded in making good the deficiency by granting Life Annuities in
the following year at 14 per cent. Halley, referring to the measure in
his paper, remarks that his calculation shows “the great advantage of
“ putting money into the present fund lately granted to their Majesties
“ giving 14 per cent. per annum, or at the rate of 7 years’ purchase for
“ a life, when young lives at the usual rate of interest are worth above
“ 13 years’ purchase.” In the ignorance then prevailing as to the
duration of life, annuities were granted at the same rate to persons of
every age; and Halley pointed out “the advantage of young lives over
“‘ those in years, a life of 10 years being almost worth 13) years
* purchase, whereas one of 36 is worth but 11.”*

Tables of the lives of French annuitants, monks and nuns, were
published by Deparcieux in 1746; and in 1783 Dr. Price constructed
a correct Life Table from the population and deaths in Sweden and
Finland. This was the first National Life Table ever made, and redounds
much more to Dr. Price’s fame than the Northampton ‘Table of Mortality
—so called—which, founded upon the misapplication of an hypothesis,
never represented the mortality of Northampton, or of any other
community, and ought not to have been published after the appearance
of the admirable essay and tables of Deparcieux in 1746. :

The Carlisle Table was calculated by Mr. Milne, on two enumerations
of the population of Carlisle, and its environs, made by Dr. Heysham
in 1779 and 1787, with the deaths in nine years. The mean population
was 8177, and the deaths 1840. Mr. Milne has described, in his
treatise,t the care with which the observations were taken, and the
method employed in the construction of this justly celebrated table,
which was the first correct representation of the vitality of any portion
of the English population. :

“ Although the data necessary for determining the law of mortality
among the people, and the value of pecuniary interests dependent upon
the continuance or failure of human life, cannot be obtained,” observed
Mr. Milne, in 1831, “‘ without the active concurrence of many persons
of influence and authority, yet for all the tables containing intormation
of that kind relative to this country, and published before the year 1829,
the public were indebted to the zeal and industry, and the separate
efforts of a few individuals. But in March 1819, Mr. Finlaison was
appointed by Government, with all the aids they could afford him,
including proper assistants, and access to the registers of the nominees
in tontines, and others on whose lives annuities had been granted by
Government for more than a hundred years before, in which registers
the exact ages at which the annuitants were nominated, and those at
which they died, were stated. Thus the data not otherwise accessible
being provided, and the labour lessened by the number of calenlators
employed, the expense also being defrayed by the public, at the end
of 10 years, viz., in March 1829, Mr. Finlaison made a report to
the Lords of the Treasury, which was printed by order of the House
of Commons, and in tables filling 50 folio pages, shows the rates of
mortality and the values of annuities on single lives at all ages, among

 

* An estimate of the mortality of mankind, drawn from various tables of the
births and funerals in the City of Breslau, with an attempt to ascertain the price of ©
annuities upon lives, by Mr. H. Halley, T'ransactions of Royal Society, London,
vol. xvii., 1693, p. 596, No. 196.

{ Essai sur les Probabilités de la Durée de la Vie Humaine, 1746.

t Milne on Annuities, 1815. See also two articles by Mr. Milne in the Encyclo-
pedia Britannica,— Annuities ” and “ Mortality.”

FR 2
452 [PART V.

many different classes of annuitants, both separate and combined, the
sexes being generally distinguished in exhibiting both the law of
mortality and the value of annuities.”*

The Equitable Assurance Society published in 1834 a valuable
abstract of the accumulated facts in their possession, from which
Mr. Morgan deduced a table of mortality. The excellent example of
the Equitable Society was followed by the Amicable Society. The
Societies’ abstracts distinguished the persons who entered at each year
of age, a point which, it is to be regretted, was neglected in Mr. Fin-
laison’s tables, although the granting of annuities calculated on the lives
of persons, sick or healthy—to selected persons in health, particularly at
advanced ages, is well known to be, and has since proved, a matter of
serious importance in a pecuniary point of view.

At the suggestion of Dr. Cleland, the civic authorities of Glasgow,
with a laudable zeal, enumerated the ages of the population of that city
in 1831; and the registration of deaths was so complete, that Mr. Milne
was enabled to construct “a table of mortality, which he expects to
publish,” from the observations made in the 10 years 1820-30. I
am not aware that any other set of observations has appeared from
which a true life table can be constructed. 1 have already stated that
Sweden is the only nation for which tables of this kind have been
constructed upon correct principles. France has no accurate life table ;f
nor have the data from which a life table can be constructed, namely,
the ages of the living and the dying, ever been published. No life
tables have been constructed for the population of Prussia or of Austria ;
but the data exist, and have to a certain extent been published, though
in forms which present considerable obstacles to the calculation. The
Census of Prussia, in which the ages are distinguished, is taken every
three years; and periodical abstracts of the deaths have been carefully
made by Mr. Hoffman. The ages of the living are, however, unfortu-
nately divided in an irregular manner, entirely different from the
correct divisions adopted by Mr. Hoffman in the returns of deaths:
which renders it impossible, without a preparatory interpolation, to
compare the deaths with the living at the several given ages. The
same objection applies to the forms of the Austrian returns. Registers
of deaths are kept by the clergy of the Russian empire ; but I am not
aware that life tables have been framed for any portion of the Russian
population. The Census has been taken decennially with great
regularity in the United States of America, and the ages are pruperly
distinguished ; but abstracts of the registers of deaths have only been
published by the cities of New York, Philadelphia, Boston, and some
of the more advanced towns where property has accumuiated, and life
is watched over with more care or facility than in the back settlements
—scantily peopled, with a fluctuating population. No correct life table
can therefore be formed for the population of America, until they adopt
in addition to the Census, the system of registration which exists in
European States.

 

* “ Annuities,” Encyclopedia Britannica, 1831, p. 203.

} Duvillard states that his table, which is used by French life offices, and is given
every year in the Annuaire de France, was founded on 100,542 deaths, at different
ages, in different parts of France, among a population of 2,920,672. He has said
very little about the data. The mean duration of life in France, according to
Duvillard’s table, is only 28°76 years. The duration of life is, I believe, longer in
Iingland than in any other country; but it is scarcely credible that the lives of
Frenchman should be 12 years shorter than the lives of Englishmen, and 10 years

shorter than the lives of Swedes. The table probably involves the same errors as
the Northampton Table.
LIFE TABLES. | 453

Since an English life table has now been framed from the necessary
data, I venture to express a hope that the facts may be collected and
abstracted, from which life tables for other nations can be constructed.
A comparison of the duration of successive generations in England,
France, Prussia, Austria, Russia, America, and other States, would
throw much light on the physical condition of the respective populations,
and suggest to scientific and benevolent individuals in every country—
and to the Governments—many ways of diminishing the sufferings, and
ameliorating the health and condition of the people; for the longer life
of a nation denotes more than it does in an individual—a happier life—
a life more exempt from sickness and infirmity—a life of greater energy
and industry, of greater experience and wisdom. By these comparisons
a noble national emulation might be excited: and rival nations would
read of sickness diminished, deformity banished, life saved—of victories
over death and the grave,—with as much enthusiasm as of victories
over each other’s armies in the field ; and the triumph of one would not
be the humiliation of the other; for in this contention none could lose
territory, or honour, or blood, but all would gain strength. (5th Annual
Report, pp. 16-19.)

Rural and Urban Life Tables ; Surrey, London, and Liverpool.
As it might be expected, from the similarity of the human organisation,
that all classes of men would, ceteris paribus, live on an average the same
number of years, it becomes important to. ascertain whether this be the
case ; and if it be not, to determine to what extent life is shortened in
unfavourable circumstances. The life table answers this purpose ; and
is as indispensable in sanitary inquiries as the barometer or thermo-
meter, and other instruments in physical research. Upon applying it
in a number of well-selected cases the influence of any external cause
or combination of causes can be analysed; while without its aid and
extended observation and calculation we are liable to be misled at every
step by vague opinions, well-concocted stories, or interested statements,
in estimating the relative duration of life; which can no more be accu-
rately made out by conjecture than the relative diameters of the sun,
moon, and planets of our system.

Three examples of the application of the table to the determination
of the relative duration of life in three different portions of the popula-
tion of this country have been calculated; the population of Surrey
(out of the Metropolis), of the Metropolis, and of Liverpool. - Surrey
presents a specimen of the rate at which life wastes in the country
population ; Liverpool is an example at the other extreme, of the effects
of concentration in towns, without any adequate provision for removing
the effluvia, and for securing by art the degree of purity in the dwellings
and atmosphere which is partiaily maintained by nature in an open
cultivated country. It should be distinctly understood that Surrey has
not been selected as the healthiest county, and to state that it will
probably be found upon inquiry that there are parts of most towns in
England as unfavourable to human life as Liverpool.

The population of the extra-metropolitan parts of Surrey happens to
be a little greater than the population of Liverpool, yet in 1841 the
deaths in Surrey were 4,256, the deaths in Liverpool 7,556. Out of
14,450 boys under 5 years of age 2,087 died in Liverpool ; of 14,045
boys in Surrey, only 699 died in the same time. By this immense
mortality in Liverpool the number of males living at the age of 10-15
is reduced much below the number in Surrey at a corresponding age ;
the living in Surrey aged 20-30 were 18,746, but the influx of immi-
grants into Liverpool raised the number of males living there at that
454 [PART Vv.

age to 23,494, who were rapidly cut down by sickness and death ; so
that at the age 45-55, only 7,504 males were enumerated in Liverpool,
whils 9,281 were living in Surrey. From the Life Tables we shall
be able to determine how many survive each successive age, and to
calculate the expectation of life.

According to the Surrey observations 75,423 of 100,000 children
born, attain the age of 10 years; 52,060 live to the age of 50; 28,038
to 70: in Liverpool only 48,211 of 100,000 live 10 years; 25,878 live
50 years ; and 8,373 live 70 years: in the Metropolis 64,921 live 10
years ; 41,309 live 50 years; and 16,344 live 70 years, The probable
duration of lifein Surrey is 53 years, in the Metropolis 40 years, in
Liverpool 7 or 8 years: the Expectation of life does not differ so
enormously ; it is, however, 45 years in Surrey, 37 years in the Metro-
polis, and only 26 years in Liverpool; at the age of 30 the expectation
of life is 35 years in Surrey, 27 years in Liverpool ; at 50 the expectation
of life is 21 years in Surrey, 16 years in Liverpool.

EXPECTATION OF LIFE (an Years).

 

 

 

PERSONS. MALtzEs. FEMALEs.
ai L M. M L L
iver- | Metro- Liver- | Metro- iver- | Metro-

Suerey: pool. | polis. Surrey. pool. | polis. Brey. pool. | polis.

0 45 26 37 44 25 35 46 27 33
1 50 33 43 50 33 41 50 34 44
2 51 38 46 51 37 45 52 39 48
3 52 Al 47 52 40 46 52 42 49
4 52 42 48 52 41 46 52 43 50
5 52 43 48 51 42 46 52 43 50
10 49 41 45 49 41 44 49 42 47
15 45 37 41 45 37 40 45 88 43
20 42 34 38 42 33 36 42 34 39
25 38 30 34 38 30 32 38 31 35
30 35 27 30 35 2 29 35 OT 2,
35 3l 24 a7 31 23 25 31 24 28
40 28 21 24 28 21 22 28 22 25
45 24 18 20 24 18 19 24 18 22
50 21 16 18 21 16 17 21 17 18

 

 

 

 

 

 

 

 

 

 

 

 

It might be cited as an illustration of the necessity of registration and
of calculation in these matters, that, before the Annual Abstracts of
Deaths were published, some of the best informed people believed
Liverpool one of the healthiest spots in England; and the late
Mr. Rickman inserted, doubtless on what he at the time considered
good authority, the following note in the Population Abstracts of 1831:
—“‘The great increase in the town of Liverpool is attributed to the
“ salubrity of the air, and the progressive improvement in its trade,
“ commerce, steam navigation, and railroads.”

It has been stated that the mean duration of life in Surrey is about
45, in Liverpool about 26 years; now if all the inhabitants lived 45
years in Surrey and 26 years in Liverpool, the difference would be
obvious ; but such is not the law of nature; in both a certain number of
deaths takes place at all ages, and at the Census 3 males and 11 females
were returned as living in Liverpool at the advanced age of 95 years
and upwards. Little dependence, it is true, can be placed upon the
statements of age in the table deduced from the returns in one year
LIFE TABLES. | 455

(1841) after the age of 90; but though it is quite possible that isolated
individuals may live 100 years in Liverpool, they have little or no effect
on the average duration of life, which differs from that of Surrey, as
has been already seen, in the proportion of 26 to 45 years. —(5th Annual
Report, pp. 31-7.)

Uncertainty of Individual Life and Constancy of Averages.—
Addison, in one of his popular papers, “The Vision of Mirza,” has an
allegory which was probably suggested by Halley’s table; he compares
“ human life to a bridge consisting of threescore and ten entire arches,
‘* with several broken arches, which, added to those which were entire,
“ made up the number to about a hundred.” “TI see multitudes of
** people passing over it,” said I, “and a black cloud hanging on each
“end of it. As I looked more attentively, I saw several of the
“ passengers dropping through the bridge into the great tide that
“ flowed underneath it; and upon further examination perceived there
‘“‘ were innumerable trap-doors that lay concealed in the bridge, which
“ the passengers no sooner trod upon, than they fell through into the
“ tide, and immediately disappeared. These hidden pitfalls were set
“ very thick at the entrance of the bridge, so that throngs of people
“* no sooner broke through the cloud, but many of them fell into them.
“ They grew thinner towards the middle, but multiplied and lay closer
“ together towards the end of the arches that were entire.” Our life
table follows “a throng” of 100,000 that “brake through the cloul”
into life at the same moment, and counts them as they step on every
arch. It shows, therefore, how many fall through the “ hidden pitfalls.”
The danger is exactly measured. The arches over which sickly multi-
tudes pass, are the same in number as those traversed by a healthy
people; but the “trap-doors” and “hidden pitfalls ” in their way are
twice as numerous, though they can only be perceived by careful
observation and counting ; while a difference of 26 and 45 “arches”
would be obvious to the unassisted eye.

In the law which regulates the waste of life two things have been
reconciled : the uncertainty of the hour of death, and the constancy in
the same circumstances of the mean duration of man’s existence. The
days of successive generations are numbered, yet a child born to day
may die in any day, hour, or minute, of the next hundred years ; and
until a very advanced age the chances always are that the time of
death will be several years distant: the danger of death we know
varies at different ages, and in different states of health ; but if the
limit of life be 100 years, it is on an average 36,525 to one that a person
will not die on a given day; 876,600 to one that he will not die on a
given hour, and 52,596,200 to one that he wiil not die at a given
minute. These chances—which vary as life advances—are so low
that practically they have little or no influence in ordinary affairs ;
and as a general rule men have no fear of dying upon any day;
yet the knowledge that they may die at any instant exercises a
salutary check upon their conduct; and, notwithstanding its sometimes
appalling effects, the changing certainty or uncertainty of life, according
to the different aspects and points of view, is in harmony with the
feelings, hopes, moral constitution, and destinies of mankind.

The serious disadvantage which arose from the difficulty of perceiving
the changes in the duration of life, and consequently the influence of
external causes upon health and longevity, has now been overcome in
this country by the arduous labours of scientific inquirers, and by the
conjoint enumeration of the ages of the population and the registration
of births and deaths,
456 [PART V.

Man docs not pass through all the stages of his physiological and
intellectual development in less than 70 years: yet it has been shown
that in the most favourable circumstances in which large bodies of the
English population are placed, the mean life attained is only 45 years;
and that other large bodies of the people fall short of this relatively low
standard, to the extent of nineteen years—years of childhood and
youth principally—years of toil too and poverty perhaps, but of life—
years also of manhood in its prime, wisdom in its maturity, virtue in its
height of usefulness and glory. The facts and calculations upon which
these results rest, will not be disputed by those who have studied the
subject. most deeply; I believe that they will be confirmed by the still
more extended data which are every year accumulating under the
present system of Registration. In the mean time enough has been
advanced to direct public attention to the “ hidden pitfalls,” which had
so long lain concealed, which destroy every year thousands of lives, and
which it is believed admit, to a considerable extent, of removal by
the judicious application of sanitary measures.—(5th Annual Report,
pp. 37-8.)

Mean Duration of Life and Mean Age at Death—As the mean
duration of life, technically called the expectation of life, ditfers very
widely from the “mean age at death,” and from some estimates which
have been made of the relative health of different portions of the
population, it may be right, before I close this Report, to point out
the errors into which inquirers are liahle to fall in reasoning upon
the “age at death ;” or, which is the same thing, constructing life
tables from the deaths alone. Mr. Milne has very clearly pointed out
the fallacies of all calculations and pretended tables of mortality, founded
upon returns of the ages at death alone; and 1 should consider it
sufficient to refer to his able article “ Mortality” in the “ Hneyclopedia
Britannica,” if the error had not survived and assumed new forms very
much calculated to mislead those who have had time to pay but a
cursory attention to the subject.

The duration of life in England is 41 years; if the population were
stationary the mean age of those who died would be 41 years; and
1 in 41 would die every year. The population has however increased
1-41 per cent. annually during the last 40 years; and we find that tle
mean age of the persons who died in the year 1841, instead of being 41,
is 29 years; while 1 in 46 of the population died. This agrees with
what Mr. Milne lays down as the result of other observations, that
“when the population has been increasing, the mean duration of life
“* according to the table will be less than the number out of which one
“ person dies annually in that population, but the difference will be
“ small except under particular circumstances ;” and again, that the mean
age at which persons die “ will fall short of the number of the people
“out of which one dies annually by a much greater wumber than in
“ the case we have just been considering.” “ When the proportion of
the people dying annually is known,” he adds, “it will not be
“ difficult to judge whether a table of mortality tor that people has
“* been constructed properly from the necessary data; or, what is much
more common and more easily effected, by summation of the deaths
“at all ages.”* “The mean age at death,” it may be here stated, is
obtained by simply summing up the ages at which people die, and

6

 

* By applying this test, Mr. Milne has shown that some recent life tables—the
mode of constructing which has not been explained—have been constructed from
the ages at death alone-—apparently without any kind of correction—Sce Article
“ Mortality ” before referred to, :
LIFE TABLES. | 457

dividing the number of years by the number of deaths. It is only a
pity that the method is not as accurate as it is easy.

Its errors may be further illustrated by comparing the English with
two foreign observations :

 

Mean duration Mean Age One Death
of Life. at Death. in

England, (1841) - 41 years. 29 years. 46 Living.
France, (1817-31) - 40 ,, 34 Cs, 42,
Sweden, (1801-5) 30 «(Cy BL ys 41 4

The average age of the persons who died, or the “mean age at death,”
was 34 years in France, 31 years in Sweden, 29 years in England; yet
we know that the “expectation of life” is greater in England than in
Sweden or in France. A Society that granted life annuities to children
in England would have to make 40 annual payments on an average, and
only 88 in Sweden. ‘he annual funerals were inversely as the “ mean
“ age at death,” or 1 in 41 in Sweden; | in 42 in France; 1 in 46 in
England. Mr. Milne has stated the fact, at first sight paradoxical, that
in an increasing population the average age at death is less, and the
annual mortality less, than in a stationary population having the same
expectation of life. I will endeavour to explain the cause of this as
briefly as possible.

The births exceed the deaths in England, and in the year 1841 the
births registered amounted io 512,158, the deaths to 343,847. If
the population were stationary the births would be 843,847; they
would maintain the existing population; but the annual excess of
168,311 children, more or less, which have been thrown for many years
into the English population has produced a preponderance of the
youthful over the aged part of the population. If the law of mortality
had remained constant, and the births and deaths had been equal for
the last century, it would have been found that on an average about 35
in 100 of the people were under 20, and 14 in 100 above 60 years of
age ; but it appears from the last Census that 46 in 100 were under
under 20, and ouly 7 in 100 above 60 years of age.

The people are younger than in France, or Sweden; the mean age
obtained by dividing the sum of the ages of those who die in England
by the number of deaths is consequently lower than the age at death in
Sweden and France. But why, it may be asked, is the mortality 1 in
46 if the expectation of life be 41 years? ‘The reason is, that as the
increase of the population has been long and progressive, an excess has
been accumulated of persons between the ages of 5 and 55, among
whom the mortality is lower than it is among persons of all ages. With
the reduction in the relative numbers above the age of 60 this has
more than compensated for the high rate of mortality among the
excessive number of children under 3 years of age; and has reduced
the mortality below 1 in 41 annually, which it would be if the popula-
lation were stationary. As the populations of France and Sweden have
not increased more than half as fast as the Hnglish population, the
diminution of the age at death has been less considerable, though
sufficient to derange all calculations and all comparisons, such as that
of the “mean age at death” deduced upon the supposition that in the
populations compared the births and deaths have been equal,—the
mortality uniform,—-for a long series of years.

The deaths of children under 1 year of age were 74,210 in the year
1841, and the total deaths 343,847. But it must not be inferred in cases
of this kind, as it has been frequently, and as it always is in tables of
458 [PART v.

mortality deduced from the ages at death alone, that 74,210 of 343,847
children die in their first year. Nothing can be more erroneous: the
deaths occurred out of a number certainly not less, and probably more,
than 512,000; for though all the births have not been registered, the
births of 512,158 children were registered in the year 1841, and 502,303
in 1840. The error is as striking when the deaths under 5 years of age
are compared with the total deaths, instead of the births, in the precedizg
years.

If the reasoning upon “the mean age at death” be employed to
determine the relative salubrity of towns and professions as well as of
different classes of the community, the nature of the results may be
readily divined. The mean age at death is 29 years in England, 29
years in the Metropolis, 34 years in Surrey; the true mean durations of
life being nearly 41, 37, and 45 years, so that the errors by this method
amount to 12 years, 8 years, and 11 years! The rate of increase, the
duration of the increase of population, the emigration, the relative
numbers of children and adults, the mean age of the living—upon all of
which the “ mean age at death” depends—differ in town and in country,
in agricultural and manufacturing districts, to an extent which renders
any application of the method to the construction of local life tables,
or to the calculation of the relative duration of life, difficult and doubtful,
if the proper corrections be made; absurd and misleading, if the “ mean
age at death ” be taken to represent the expectation of life.

The numbers following different professions fluctuate more than the
general population ; the relative proportion of young and aged persons
varies from year to year; certain professions, stations, and ranks are
only attained by persons advanced in years; and some occupations are
only followed in youth; hence it requires no great amount of sagacity
to perceive that “the mean age at death,” or the age at which the
greatest number of deaths occurs, cannot be depended upon in investi-
gating the influence of occupation, rank, and profession upon health and
longevity. If it were found, upon an inquiry into the health of the
officers of the army on full pay, that “the mean age at death” of
“Cornets, Ensigns, and Second ; Lieutenants” was 22 years; of “ Lieu-
“ tenants” 29 years; of “ Captains” 37 years; of “ Majors” 44 years;
of ‘“ Lieutenant-Colonels” 48 years; of general Officers, ages still
further advanced—and that the ages of Curates, Rectors, and Bishops ;
of Barristers of seven years’ standing, leading Counsel and venerable
Judges—differed to an equal or greater extent, a strong case may no
doubt be made out on behalf of those young, but early-dying Cornets,
Curates, and Juvenile Barristers, whose ‘‘mean age at death” was
under 80! It would be almost necessary to make them Generals,
Bishops, and Judges—for the sake of their health. The Assurance
Societies are happily so considerate and liberal that they do not attach
the slightest importance to the mean age at death, but assure the lives of
young men of all the professions at the age of 24 upon the assumption
that they will live 38 or at the least 31 years, and pay 38 or 31 annual
premiums on an average before they die; while they make the Bishops,
Judges, and Generals who go to insure their lives at 60 pay as if they
would live but 13 or 14 years.

It has been somewhere stated that the “mean age at death” of dress-
makers is exceedingly low, and this has been adduced as a proof of the
destructive effects of their employment. If the inquiries had been
extended to boarding schools, or to the boys at Christ’s Hospital, the
“mean age at death” would have been found still lower. Mr. Grainger
states, in his interesting Report, that the majority of dress-makers are
between the ages of 16 and 26; and it is understood that if they die
LIFE TABLES. | 459

after they marry they are not often designated by that title in the
register. This source of error and the increase of population will be
found to affect the estimate of the influence of other occupations. That
the lives of dress-makers are very much shortened by the severe hard-
ships aud ignorant mistreatment to which they are exposed cannot be
doubted ; but false arguments injure instead of aiding their cause.

In a thriving commercial country like England there is a general
movement, such as has been noticed in the army and the liberal pro-
fessions—from the lower into the higher ranks of society. The servant
becomes a master; shop-boys grow into merchants or aldermen; the
tradesman retires and is classed either as “independent,” “in easy
“ circumstances,’ or a “gentleman,” at the Census, and in the
mortuary registers. But these promotions as a general rule are slow ;
and those only attain the higher positions who live long. If the mean
age, at which masters and servants, the wealthy and indigent die, were
noted and made the basis of any reasoning respecting the relative health
and longevity of the lower and upper classes, the differences would
evidently be exaggerated. The exaggeration is increased in another
way; many poor people are reduced to seek an asylum at advanced ages
in the workhouses, and are not often designated by the occupations
which they followed in manhood, but by the general name “ paupers ” :
the ages of those who die in the ranks of their respective trades and
professions are thus reduced to the same extent as the ages of the
paupers who die in workhouses are raised above the average. In 1841
the mean age of 45,507 persons who died in London was 29 years ; the
mortality was 1 in 40; in the same year 4282 persons died in the
London workhouses at the advanced age of 49 years, which they must
have nearly attained before they entered those establishments, inasmuch
as the mortality there appears to have been about 22 per cent., or 1 in
5 annually.* Contrast 49, the “mean age at death,” of paupers in the
workhouses, with other statements, which make the “mean age at
“ death” of the same or a superior class of persons 16 or 20 years.

One in 116 of the boys in Christ’s Hospital died annually, in the 12
years 1831-42; the mean age of the hoys who died was11 years. The
“mean age at death” and the mortality were both low. This illus-
tration, taken from an extreme instance, shows why, while the mortality
is lower, the mean age at death is less in England than in some other
countries. The English population contains more young persons, more
of the age of the Christ’s Hospital boys, than the foreign populations.

The life table affords the most satisfactory measure of the relative
duration of life, either of classes or of different communities. The
mortality obtained by dividing the deaths by the living at each age, is
also an unimpeachable test ; it is the preliminary to the construction of a
true life table. The ratio of the total deaths to the total population
affords the next best test that can be employed; if the populations
compared be of the same age, their relative mortality will be correctly
given by this method; if the ages and the rate of increase differ, the
“mean duration of life will be less than the number out of which one
“ dies annually, but the difference will be small in the increasing popu-
“ lation.” The “mean age at death,” or pretended life tables con-
structed from the deaths, without reference to the ages of the living, or
the ages of the living without the ages of the dying. are, as I have already
stated, only calculated to mislead in inquiries of this kind, unless great
care and discrimination be employed in their application. It happens,
nevertheless, in some cases that they afford the only resource; the total

 

* The pauper population of the London Workhouses was 19,412 at the time the
Census was taken in June ; it would probably be greater in Winter.
460 [PART Vv.

deaths are not registered, or the ages of the living have never been
enumerated ; the ages at death may then be compared with the ages at
death of other populations—hnown to be increasing at nearly the same
rate, or corrections may be made upon the hypothesis of a uniform rate
of increase during a certain number of years.

In France, for instance, where the ages of the living have never been
abstracted, M. Demonferrand has constructed a life table, which is
probably not very erroneous, from the ages at death ; assisted, however,
most essentially by the complete registration of births, and the annual
enumeration of the young men who attain the age of 20. In Ireland,
where the deaths are not registered, abstracts have been made of the
ages of the population; and the Commissioners of the last Irish Census
included in “the personal return a table in which every head of a
“ family was requested to insert all the deaths which had occurred in
“ his family within the last ten years, stating the cause of each death,
“and the age and occupation of the deceased.” In addition to this, .
they sent to every hospital and lunatic asylum forms which were filled
up. From the ages at death thus obtained they constructed tables,
which will be found in pages 80-82 of their Report—a Report, I may
remark in passing, which is replete with valuable information. As the
population of Ireland, notwithstanding the emigration going on, increased
14:19 per cent. in the 10 years ending 1831, and 5:25 per cent. in the
10 years ending in 1841, the births must exceed the deaths. The tables,
which could only be correct if the births and deaths had been ,equal,
and there had been no emigration, are therefore not true life tables ;
and the “ expectation of life” deduced from them, which is 29 years at
birth in the “rural,” and 24 years in the “civic” districts, must be
understated to a certain but unknown extent. The deaths returned for
the year 1840 were 141,536, making the mortality 1 in 57°5: thereturn
is evidently defective, but, as the Commissioners correctly remark, this
will not atfect “the mean age at death,” provided that the deaths omitted
occurred at the same ages as those returned. The Commissioners had
not at their disposal the data requisite for calculating the true
“expectation of life” in Ireland: the application of the term is an
inadvertency rather than an error, and I should not have noticed it here,
if the tables had not afforded some interesting points of comparison
with the English observations. Tables have been constructed from the
deaths in England, upon the same plan as the Trish tables ; and if the
population of the two Divisions of the United Kingdom had increased
for many years at nearly the same rate, or if the emigration had been
nearly in the same proportion, the “expectations of life,’ as we may
call them for a moment, will be equally erroneous: they may therefore
be compared. ‘The results are given in the following tables.

EXpecTATION OF Lire.—MaLes AND FEMALES.
(Erroneously deduced from the Deaths alone.)

 

 

 

i Males. Females,
Age. | Ireland, | Ireland, Treland, | Ireland,
England. |__ Civic Rural || England.| Civic Rural
Districts. | Districts. Districts. | Districts.
0 28 24 30 31 24 29
5 42 35 Al 42 35 40
29 35 28 34 36 29 33
40 25 19 23 27 20 23
60 14 11 13 15 12 12

 

 

 

 

 

 

 

 
LIFE TABLES. | 461

EXPECTATION OF LiFE.—PERSONS.
(Erroneously deduced from the Deaths alone.)

 

 

 

 

 

 

Treland. England.
oer c Rural || England London,* | London,t
ivi . cou ondon, ei
Districts. | Districts. || and Wales, | SY7eY-| Metropolis. | Liverpool. | "Tras-37, |” 1759-68.
o| 24 29 29 34 29 2it 19 26
5 | 35 4l 42 44 42 36 36 39
20] 28 33 35 37 33 28 29 29
40| 19 23 26 27 22 19 20 20
60/ 11 13 14 15 12 11 12 12

 

 

 

 

 

 

 

 

* From Simpson’s Select Exercises. The observations were corrected (?) by Simpson.
+ Deduced from Dr, Price’s Table 13. :
t+ The more exact “mean age at death” in Liverpool is 20°54.

The “expectations of life” (if we may call them so,) are the same at
birth in the “rural districts” of Ireland as in all England ; they are less
after 20, but agree remarkably at all ages with the expectation of life in
the Metropolis. This resemblance between a table of the ages at death
in a city, and the ages at death in the rural districts of Ireland, would
be caused to a certain extent bya diminution in the latter of the propor-
tion of births within the last 10 years. The (erroneous) ‘expectations
“ of life,” in the “civic” districts agree after 20 with those of Liverpool ;
at birth the expectation is higher in the Irish towns than in Liverpool,
but lower than in London, The “ expectation of life” therefore is not
so low as it is represented in the tables of the Commissioners. Judging
from the analogy of the English tables, the expectation of life is less in
Ireland than in England; the inhabitants of the “civic” districts,
perhaps, attaining a mean age of 30 years, while in the rural districts
they live on an average to 37. The life tables of the Metropolis, and
Liverpool or Manchester, would probably apply to the two sections of
the Irish population ; but this can of course be only conjecture. The
Trish tables may be corrected to a considerable extent by means of the
ascertained rate of increase, and the enumerated ages of the living ; some
of the methods to be employed were investigated by Euler, and are
given by Lacroix in his “Traité élémentaire des Probabilités,”* p. 207.
Implicit confidence, however, could not be placed in the results.

It is a curious feature of the Irish tables that the men appear to live
longer than the women in “rural” districts ; and the women longer than
the men in “civic” districts. Frenchmen live longer after 20 than the
women, if the expectations of life in the two sexes be equally correct
or incorrect in M, Demonferrand’s tables. In England the lives of
females exceed those of males by about a year—except at birth, when
the difference is greater. In Surrey the females from the age of one
year and upwards live little longer than the males; the difference is
greater in the Metropolis, where it amounts, at some ages, to two or
three years. This may, perlaps, account for the differences in the
expectations of life deduced from male and female annuitants. Accord-
ing to Mr. Finlaison’s tables—the lives of men are from four to six
years shorter than those of women ; a discrepancy which in its extent js
entirely at variance with all other observations. If the majority of the
annuitants before 1829 were inhabitants of London, and more than a

 

* Mémoires de l’Académie de Berlin, anno 1760, p. 144.
462 [parr V.

due proportion of the women lived in the country, such a discordant
result would however be produced.—(5th Annual Report, pp. 38-46.)

Mean Duration of Life deduced from incomplete Observations.—A

publication has appeared professing to give the mortality which has
prevailed among seventeen life offices.* The author, Mr. Jones, states
that “ by the liberality of several of the life offices, and the disinterested
“ zeal and services of a committee of some of the most experienced
“ and eminent of the actuaries, we have now data for the construction
“ of a rate of mortality, not simply of the experience of the Equitable
“ and Amicable, but of the combined experience of no less than 17 life
“ offices, embracing 83,905 policies; and a rate of mortality has been
“ adjusted by one of the most eminent mathematicians on the committee,
from the combined town and country experience, embracing 62,537
“ assurances.”—(Jnt,, p. x.) ‘The committee state that ‘the most
“ striking features exhibited in these tables are the great mortality
“ that prevails among Irish lives, and the marhed difference in the
“ rate of mortality among males and females. The near agreement with
“ each other of the tables for ‘town’ and ‘ country’ assurances is also
“ very remarkable, considering that no adjustment has been employed.”
“ (p. xvi.) The committee very justly observe that their tables
“ represent a lower rate of mortality than can be expected to prevail
“ in a longer period of time than that over which the present observa-
“ tions extend; for the average duration of policies embraced in nearly
“ one-half of the experience is under 54 years; and taking the whole
“ of the experience together, which includes that of the ‘ Equitable’
“ and ‘ Amicable,’ the two oldest offices existing, the average duration
of all the policies is not 84 years.” (p. xix.)
These tables are exceedingly interesting, as they show the experience
of the life offices so far as it extends, and the actual effect of their more
or less imperfect selection of lives. It is an objection to all tables
framed in this manner, on the experience of life offices and on annuitants,
that you have to wait 50 or 100 years before all the lives have expired,
and have then, in applying them practically, to assume that the future
annuitants, &c., will be selected on the same principles, and be placed
in the same circumstances.

The most conflicting results are necessarily obtained by the incomplete
observations; thus, while Mr. Finlaison’s Table makes females at 20 live
44-0 years, and males 35°4 years, the Actuaries’ Table presents a result
exactly the reverse: females selected for assurance at 20 have, according
to their table, an expectation of 35-9 years, males of 39°8 years!

It will be observed that the expectation of life among males, by the
English Table, lies between the expectations of life for males by Mr.
Finlaison’s and the Actuaries’ Tables; it agrees very closely with the
mean expectation of the two tables. The expectation by the former,
at the age of 41, is 26°39 years, by the latter 25°42; the mean is 25°91
years; and the expectation of life is 25°91 by the English Table; so
it happens that neither of the tables from incomplete observations
is very incorrect for males. With regard to the expectations of females,
Mr. Finlaison’s and the actuaries’ statements differ to the extent of
eight years at the age of 20; at the age of 26 the expectations,
according to the two statements, are 40°17 years and 33°79 years
—difference, 6°38 years—mean, 36°98 years. The expectation of life
for a woman aged 26 is 36°86 years by the English Table; Mr. Fin-
laison’s result is 3°19 years above, the Actuaries’ 3:07 years below the

a

.
a

 

* A Series of Tables, &c., by Jenkin Jones, 1843.
LIFE TABLES. | 463

average of the national table; while the expectation of life for males
is nearly the same at 26 by the three tables—namely, 35°41, 35°88,
and 35°65 years.

Dirverences from the English Table, by excess or defect, in the
Expectations of Life deduced from Mr. Finlaison’s and the
Actuaries’ Tables.

 

 

 

 

 

 

 

 

 

MALEs. FEMALES.
Expecta- Differences by Differences by Expecta-
_ tion of _tion of

ane ae ee My. Finlai- | Actuaries’ Actuaries’ | Mr. Finlai- ai eee

son’s Table. Table. Table, son’s Table.

Defect in | Excess in
Years. Year. Year. Years. Years. Years.
20 39°88 —*49 —'04 —4°95 +3°18 40°81
25 36°47 —'57 +°'16 —3°'ll +3°29 37°52
30 33°13 +°04 +°04 —2°52 +3°32 34°25
35 29°83 +°34 —'3l1 —1°92 +3°32 30°99
40 26°56 +°46 —°50 —1°36 +3°40 a7 92
45 23°30 + °45 —'67 —1:22 +3°38 24°43
50 20:02 +°28 —'61 —1:'02 +3°28 21°07
55 16°68 +°47 —'47 —0°85 +3°16 17°63
60 13°59 +°80 —'12 —0°62 +2°92 14°40
65 10°86 +°77 +°01 —0°92 + 2°48 11°52
70 8°51 +°71 -'17 -—1:°10 +1°96 9°03
75 6°53 +°59 —°50 —1°55 +1°54 6°92
80 4°92 + °02 —°'17 —0°45 +1°30 5:20

 

 

 

 

 

 

Thus, at the age of 40, the mean future duration of life is 26°56
years for males, according to the English Table; or ‘46 of a year more
by Mr, Finlaison’s Table; and 0-50 years less by the Actuaries’ Table :
at the same age for females, the Actuaries’ Table differs from the
English Table 1-36 year by defect; Mr. Finlaison’s Table 3°40 years
by excess. The sign +, plus, denotes excess over the expectation by
the English Table. The sign —, minus, denotes the reverse.

The expectation of life is less for males by Mr. Finlaison’s than by
the Actuaries’ Table up to the age of 30: it is afterwards more; but in
females the difference in the expectation is enormous.

 

Difference in the Expectation
of Life by Mr. Finlaison’s and
Age. the Actuaries’ Tables.
Males. Females.
Years. Years.
20 — °45 48°13
25 — +73 +6°40
30 “00 +5°84
35 + °65 + 5°24
40 + °96 +4°76
45 +1'12 , +4°60
50 + *89 +4730
55 + 94 +4:°01
60 + °92 +3°54
65 + °76 +3°40
70 + *88 +3°06
75 +1°09 +3°09
80 + °19 +1°%5

 

 

 

 

 

The sign + denotes excess of the expectation by Mr. Finlaison’s ove
by the Actuaries’ Table. nee
464 [PART y.

Although the tables of the “ Actuaries” and their remarks, referred
to in this publication are, from some cause not satisfactorily explained,
inaccessible to the public, it would appear from the statements of
Mr. Jones thut the tables are considered by them incomplete, and
not a safe basis for the guidance of pecuniary transactions. It is
scarcely necessary to add that, although no such great difference in the
longevity of the two sexes exists in nature, it can readily be conceived
that men and women may be selected whose lives differ, or appear from
an incomplete series of observations to differ, as much as the lives of
the males and females in the Actuaries’ and Mr. Finlaison’s Tables.
(5th Annual Report, pp. 338-41.)

Construction of Life Tables; De Moivre’s Hypothesis.—De Moivre
gave his name to an hypothesis, according to which the numbers living
decrease in an arithmetical progression down to nothing, at the age
86.* It has been since assumed, as stated by Mr. Milne, that “the
“ number of the living in any year of their age is an arithmetical mean
“ proportional between the numbers that annually enter upon and that.
“ annually complete that year.”t If 8 deaths occur in a year, upon
this hypothesis, they are assumed to take place “ at 3 equal intervals” ;
and it is by the same hypothesis that, in calculating the expectation
of life, writers assume that “the number of living of the age of 2 years
“ and upwards is less than the sum of those that annually complete
“ that and all the greater ages by half the number that annually com-
“ plete that year of their age.”—(Milne, pp. 85-6.) This hypothesis,
which is interwoven into all the calculations of interest and of life
annuities, brings them within the range of algebra; for, without the
assumption that the interest of money and the mortality remained uni-
form for some certain definite time, the resources of the calculus must.
be called into requisition. The errors which result in life assurance
from the hypothesis of an equal decrement are small and quite insig-
nificant when compared with the errors of observation, and the errors
incurred by the assumption that the interest cf money and the mortality
will remain stationary for a long series of years. Still, it must be
borne in mind that the rate of mortality varies (insensibly) every
moment, and that the errors involved in the hypothesis are greatest in
the first year of life. By making the births the basis of the table
(if the births are all registered), the decrement in the first year, where
the error would, by the other method, be of some magnitude, will be
correctly represented. ‘The deaths in the second year of life, out of
100 constantly living, were 6°508; and, by the hypothesis, 1°03252
would be alive at the beginning, -96748 at the end of the second year ;
the fraction 26548, would therefore express the chance of living the
second year. If 43,104 were alive at the beginning, 40,388 would
be alive at the end of the second year; for 108252 : 96748 : : 48104 :
40388 ; or S&t8, x 48104 = 40388. In this manner the series, down
to 5 years may be calculated. The mortality against the age 5-10,
namely, ‘00955, was taken to represent the mortality of the middle
year (in this instance 7-8), and the mortality of the intermediate years
was interpolated. As the series is short, and terminates ai 10-15, it
is not easy to test any theory of interpolation, particularly as the
mortality at 10-15 is, I believe, through the error of speaking in tens,
understated. It is improbable that the mortality of 10-15 should be
50 per cent. lower than the mortality at 15-20. Neither this nor any

 

* Treatise of Annuities on Lives; Preface, &c., by De Moivre.
t+ Milne on Annuities and Life Assurances, p. 85.
LIFE TABLES. | 465

other table which I have seen, derived directly from observation, is very
satisfactory up to the age of 15; although the earlier ages must generally
be known, they have not been so correctly stated at the censuses as
could be desired. Whatever system of interpolation may be employed,
however, the expectation of life will not be much affected by it from
1 to 15; and the numbers after 15 are quite independent of those
before 15. In framing the English Table (No. 1), the mortality at
every age was interpolated by the logarithm which expressed the ratio
of the increase in the mortality at every year of life; and the chance
—1m

se 1
of living each year was deduced from T+ in

I do not find that Dr. Price ever explained the method of interpo-
lation which he employed in framing the Northampton or Swedish
Tables of Mortality. It was probably empirical. Mr. Milne has
adduced, in his excellent Treatise, 1 method by which he says, “when
“ the number of the liviag and of the annual deaths are taken for
“ intervals of several years each, the number of the living in each
“ particular year of their age, included in any one of those intervals,
‘“‘ may be interpolated with sufficient exactness.’* He has also given,
in the eighteenth table of his work, “the logarithm of the fraction
“ which measures the probability that a life of an assigned age will
“ survive one year, according to the Carlisle Table of Mortality.”
(5th Annual Report, pp. 349-50.)

A Short Method of constructing Life Tables—The arithmetical
labour involved in the construction of correct life tables, showing the
living at every year of age, is very considerable. But for a great many
purposes the number surviving every five years, after the five first, and
the expectations of life at those intervals, furnish quite sufficient infor-
mation. These results were obtained by employing the following
method in calculating the life tables for the Metropolis, Surrey, and
Liverpool :—

Up to the age of five years the method is the same as that already
described, and it was thus found that of 50,521 boys born in Surrey,
43,637 live a year, 41,857 two years, 40,704 three years, 40,031 four
years, 89,550 five years. The next point was to determine how many
of the 39,550 attain the age of 10 years. The living enumerated at
the age 5-10 were 13,588, the deaths 145; and after the proper

correction the mortality m was ascertained to be °01050; so m=

L—im_ -99475

*00525, and 7 + dm = 1-00525 = '98955 the probability of living

 

 

one year at the middle of the period, or at seven and a half years of
— 1m? cr
; = : ) = p;,, = the probability

of living the five years from the age of 5 to10; and (°98955)'=
*94885; which, multiplied by 39550, gives 37527 = the numbers
surviving at the age of LO.

 

age. But it may be assumed that (

eS

* Annuities and Assurances, p. 100.
fT See previous extract, p. 464.
466 [PART Y.

If the calculation be continued down to 15, 20, 25, and every fifth
year to the end, the following table will be obtained :—

Surrey Lire Tapre—Males (1841).

Quinquennial Quinquennial
Age. Living. Periods + 3lm. Age. Living. Periods + $l.
0 50,521 476,444 40 29,822 179,047
Sa 45 28,069 149,225
1 43,637 50 25,973 121,156
2 41,857 55 23,892 95,183
3 40,704 60 21,459
4 40,031 65 18,235
70 18,976
5 39,550 425,923 75 9,836
10 37,527 386,373 80 5,393
15 36,469 348,846 85 2,031
20 35,338 312,377 90 290
25 34,061 277,039 95 58
30 32,742 242,978 100 11
35 31,189 210,236 105 2

 

Add up the column headed “living” to the number 39,550 (against
the age 5 years), and the sum will be the number of five years—of
lustres—which the 39,550 persons will live + Bee = 19,775. Sub-
tract, therefore, 19,775 from the sum 425,923, and 406,148 will remain ;
which, divided by 39,550, gives for quotient 10°269 lustres as the
expectation of life at that age. A lustre is five years; consequently
the expectation of life in years is five times 10°269, or 51°3 years.
If 425,923 be divided by 39,550, the quotient will be 10°769; and
10°769 — -5 = 10°269, the same result as before. The expectation of
life will be found to be 34°5 years at the age of 30.

The number of living at every five years except the first, deduced
by this method, may be considered nearly correct; the expectation of
life is slightly overstated by the assumption that the living at the ages
5, 6, 7, 8,9, 10; and 10, 11, &e., are series in arithmetical progression.
The error does not exceed one-tenth part of a year from 5 to 60 years
of age. At birth, and after 70, it does not exceed half a year, which
may be subtracted as a correction. But by calculating the number
surviving every year up to the age of five, a sufficiently close approxi-
mation to the expectation of life at birth will be obtained. The years
of life under five are : x 256,300 = 213,583; and the years of life,

after the age of five = 5 x (425,923 — 19,775) = 2,030,740, and

2,030,740 + 213,583 ‘ : : :
ee 44:4, a boy’s expectation of life at birth in

50,521
Surrey.
A life table still shorter may be constructed by taking intervals of
ves 0
10 years, and using ( rein) . The errors in the calculation of the

expectation of life from the living at every tenth year, can be corrected.
They are always of the same nature. If we take the numbers “ living”
against every 10th year from the English Table, it will be found that
the excess of the expectations of life, ranges at the ages 10 to 50, from
‘lto ‘2or ‘3 ofa year. At birth the true expectation will be obtained
very nearly by subtracting one year from the expectation, derived from
the decennial table.

By adding up the column headed “living,” in the subjoined table,
dividing by the first number 100,000, multiplying by 10, and sub-
LIFE TABLES. | 467

tracting 5, we obtain 42°05 years as the expectation of life, which is
too much by nine-tenths of a year.

Years.
470,530 2 iy
so = 47°05; ‘05 — 5 = 42°05
Age 0 100,000 x 10 = 47°05; and 47°05 — 5 2
True expectation of life 41°16
——
Error °89
370,530
ooo x 10 = 52°47; and 52°47 —5 = 47°47
Agel0 70612 :
True expectation of life 47°44
Error °03
Decennmat Lire Tasie.—(From the English Table.)
Years. Living. Expectation of Life.
0 100,000 42°05 — °89 = 41°16
10 70,612 47°47 — -03 = 47°44
20 66,059 40°40 — +06 = 40°34
30 60,332 33°76 — -08 = 33°68
40 53,825 27°23 — :09 = 27°14
50 46,621 20°67 — +12 = 20°55
60 37,996 14°23 — +23 = 14°00
70 24,531 9°29 — "51 = 8°78
ll I ll
80 9,398 2 °
a 'S B s
a E £
90 1,140 a e g
g 5
ro 3S
o
100 16 a a
b> mb
FQ -Q

(5th Annual Report, pp. 362-5.)
Mean Duration of Life in Metropolitan Districts——When sufficient
data have been collected, it is proposed to calculate the mean duration of
life, or the expectation of life, for different parts of the metropolis,
Several corrections have to be made. The following is a specimen of a
Decennial Life Table for two districts.. It was computed and corrected
(in the manner already described)* on the population and deaths of 1841,

St. Gzrorce, HANOVER-SQUARE.

 

 

 

Decennial Life Table. Expectation of Life.
Age. Persons. Males. Females, Males. Females.
0 100,000 51,949 48,051 B7°4 39°7
10. 63,732 33,011 30,721 47°0 50°2
20 60,434 31,176 29,258 39°5 42°5
30 57,178 29,016 28,162 32°1 34°0
40 52,266 26,097 26,169 25°2 26°2
50 45,451 22,279 23,172 18°7 19°0
60 36,048 17,926 18,122 12°2 13-1
70 22,229 10,493 11,736
80 6,502 2,942 3,560
90 601 329 272

 

 

 

 

 

 

 

 

 

 

* See previous extract, p. 465-7.
GG 2
468 [PART v-

 

 

 

 

 

WHITECHAPEL.
Decennial Life Table. Expectation of Life.
| Age. Persons. Males. Females. Males. Females.
0 100,000 50,991 49,009 31:0 34°3
10 58,125 29,141 28,984 41°6 45°6
20 55,464 27,720 27,744 383°5 37°5
30 50,773 24,847 25,926 26°7 29°8
40 43,865 20,917 22,948 21:1 23°1
50 35,369 16,186 19,183 15°9 16°7
60 24,024 11,245 12,779 10°9 12°8
70 13,458 5,721 7,737
80 4,004 1,345 2,659
90 399 137 262

 

 

 

 

 

when the mortality was low in both districts. The deaths in St. George’s
Hospital and the London Hospital were al! excluded, except the propor-
tion at the several ages due to these districts, in common with others in
which there were no hospitals. (5th Annual Report, p. 443.)

Properties and Applications of Life Tables ; Dr. Price’s Fallacies.—
The applications and uses of national life tables are almost innumer-
able; without an intimate knowledge of their properties it is impossible
to determine the laws of population, which are the bases of statistics, or
to reason upon such matters without falling into great errors, of which,
if it were not invidious, too many instances might be cited from current
works on population and public health. I therefore strongly recom-
mend the student to make himself master of this subject, by a careful
perusal of the writings of Halley, Deparcieux, Demoivre, Simpson,
Price, Duvillard, Baily, Milne, Gompertz, Davies, Edmonds, De Morgan.
Babbage, and others.

A great improvement in the life table, suggested by Graunt and
invented by Halley, was made in 1806 by Duvillard. Barrett dis-
covered the advantages of an analogous construction in calculating life
annuities; Mr. Baily explained some of the uses of the new column,
and showed its applicability to joint life tables in the description
of Barrett’s method, appended to his “ Doctrine of Life Annuities and
“ Assurances ” (1813). Mathieu has given for some years, in the
“© Annuaire de France,” a table deduced directly from Duvillard’s new
eolumn (S.y) ; it is the development, as Mathieu remarks, of a shorter
table in Duvillard’s work.* Mr. Griffith Davies, adopting Barrett’s
method, extended it, und facilitated its application to the calculation
of life annuities and assurances, in a small and very useful volume
-—“ Tables of Life Contingencies ” (1825); which was to have been
followed by “a more extensive work,” containing ‘a New Theory
“ of the Doctrine of Annuities and Assurances,’—unfortunately never
completed. Mr. Davies’s views have been, however, developed in the
work of Mr. David Jones on Annuities; and De Morgan has described
the construction, arrangement, and use of the new tabular form in two

 

* Analyse et Tableaux de l’Influence de la Petite Vérole, p. 123; 1806. Duvillard
states that his table, which is evidently constructed on imperfect data, was presented
to the Institute, An. V of the Republic.
LIFE TABLES. | 469

elegant papers inserted in the Companions to the British Almanac for
1840 and 1842.

The English Life Table shows, out of 100,0V0 children born alive,
the respective numbers of males and females born, and the numbers
attaining each age, or birth-day, from the first to the 110th, according
to the rates and Jaws of mortality, deduced from the Returns of the
Population, Births and Deaths in England (1841). Thus, in 100,000
children born alive, 51,274 are boys, and 48,726 girls ; 33,060 males,
and 32,464 females attain the age of 21; and 11,824 males, 12,708
females, live to 70. The males and females are not distinguished in
Halley’s Tables, in the Northampton Table, or in Mr. Milne’s Carlisle
Table. Dr. Price constructed three life tables from the Swedish
observations ; one for males, another for females, and a third for “ males
“ and females collectively.” * He made 10,000 males and 10,000
females the bases of his male and female tables; to which there can be
no objection, except that the construction does not show the relative
numbers of the two sexes born, and living together at each age. The
table of “ males and females collectively,” is constructed from the other
two tables, upon an erroneous principle, which Dr. Price lays down,
and thus illustrates :—‘ ‘Table 44 shows, that of 2,701 males living at
“ 60 years of age, 560 will die in five years ; and that of 3,167 females
‘ living at the same age, 588 will die in the same time. From hence
“ it may be easily deduced, that of 2,930 persons living at 60, consisting
“ one half of males and one half of females, 576 will die in the same
‘« time. The number, therefore, living at 60 will at 65 be reduced
to 2,354; which number must again be supposed to consist one half
“ of males and the other half of females, and the proper decrement
“ for the next five years deduced in the same manner from Table 44.
“ And it is in this method that the whole of this Table (45) has been
“* constructed, which, therefore, must exhibit more accurately than any
other the probabilities of living among the general mass of mankind,
consisting of males and females taken collectively.” Granting that
the 2,930 persons at the age of 60 consist of an equal number of
males and females, we shall have the following results, according to
Dr. Price’s data :—

a

a

‘

a

a 8

‘

‘

s

 

 

 

Persons. Males. Females.
Living at the age of 60 - 2,980 1,465 1,465
Die in the next five years 576 304 272

Actually living at the age of 65,

according to Dr. Price’s facts 2,354 1,161 1,193
Living at the age of 65, according

to Dr. Price’s new supposition 2,354 1,177 1,177
Errors in the supposition - + 16 — 16

Dr. Price arbitrarily substituted 16 males for 16 females at the end
of five years, and proceeded to calculate the reduction in the next
quinquennial period on 1,177 instead of 1,161 males, and 1,177 instead
of 1,193 females. As the mortality of inales in the five years is greater
than that of females (at the age 60-65, the ratio is -207 to 186), the
mortality is exaggerated, and the same error pervades the whole table,
and the subsequent tables of the value of annuities on single and joint
lives in general; for it is evident that if annuities were granted to

 

* Price’s Works, by Morgan, 7th edition ; vol. ii., pp. 406-414.
470 [PART v.

equal numbers of males and females, at 60 or any other age, the
excess of surviving female annuitants could not at the end of every five
years be arbitrarily set aside and replaced by males.*

The Swedish Table of Mr. Milne is free from the errorst of the dis-
tinguished writer who had the merit of first constructing a national
life table, and shows the numbers of males and females who complete
every year of age out of 10,210 males, and 9,790 females born in that
kingdom. It is, therefore, to this eminent man that we are indebted for
the first correct national life table. The numbers in Mr. Milne’s Table 5
multiplied hy 10, and those of Table 4 multiplied by 5, (oF 5) may be
compared with the English Life Table; the basis of which is 100,000
children born alive = 51,274 boys + 48,726 girls. The numbers in the
English Table are connected by simple laws, derived directly from and
representing the mean results of the observed facts; it terminates, if we
descend no lower than unity, naturally at 103; but, according to the
same law, more than two in 10 millions born see their 108th birthday.
The registers give a proportionally greater number of centenarians ; but
the evidence of these advanced ages is almost always unsatisfactory, and
it was thought right in this instance to deviate from the observations,
and to carry out the table according to the law deduced from the more
numerous and more accurate statements of the earlier part of old age;
the result of which is a middle course between the tables of old writers,
that terminated at 84, 90, or 96 years, and the recorded instances of
very advanced age. (6th Annual Report, pp. 524-6.)

Mortality in Increasing Populations.—It is frequently stated that
the proportion of deaths to the population is raised in an increasing
population by the excess of young children, among whom the mortality
is greater than it is among adults; but this is not borne out either by
experience or by theory. The mortality among males in England is
2°29 per cent.; three births are registered to two deaths, and the
mortality would be 2°49 per cent. if the births and deaths were equal.
The solution of the following question may throw some light upon this
subject.

A population has been stationary and the mortality the same for a
century. The births, which had been equal to the deaths, are suddenly
increased in the proportion of 3 to 2, and remain the same, or one-half
more than they had been. How many annual deaths will occur to
100 living of all ages, assuming that the law of mortality remains
invariable ?

Taking the English Table for males, the radix of 51,274 births will
become 76,911, which will in 10 years add 192,593 ($Q),1) to the
population, originally 2,059,501 ; but the deaths to the 192,593 at
that age will be = $D,;,,) = 7,855; and the ratio of the deaths to
the population will be 59,129 : 2,252,094. The formula will be in all

Dy + gDoty :

cases 3 and by making y successively 0, 10, 20, 30, 40,

0 2X0 |
50, 60, 80, and 105, and taking the numbers out from the table, the
following results are obtained :—

 

* Dr. Price’s Swedish table of mortality is printed without comment by Baily
and Mr. David Jones. Baily has since adverted to the error.

} Milue on Annuities, &c., Tables 4, 5, pp. 566, 569.
LIFE TABLES. | 471

 

 

 

 

 

 

 

Population | Therease of Annual | Annual Annual
pene Population ; Deaths in| Deaths | moa) Mortality.
ginal number| « by the é Total the or inthe | annual
fannual |,imerease of | Population. | _ ginal new | Deaths.
Ly Binh 3 |25,637 annual Popula- | Popula- Per |One
ears. (= 51,274). Births. tion. tion. Cent. as
Do+ |100D,} Q,
1 1 1H oad
Q BQory |Qo+zQoy, Do | aDoiv| ap,,, | Q, | Dz
0 | 2,059,501 _ 2,059,501 | 51,274 _ 51,274 | 2°490 | 40
10 | 2,059,501 | 192,593 | 2,252,094 | 51,274 | 7,855 | 59,129 | 2-626 | 38
20 | 2,059,501 865,238 | 2,424,739 | 51,274 | 8,975 | 60,249 | 2°485 | 40
30 | 2,059,501 | 524,925 | 2,584,426 | 51,274 | 10,400 | 61,674 | 2°386 | 42
40 | 2,059,501 669,163 | 2,728,664 | 51,274 | 12,065 | 63,339 | 2°321 | 43.
50 | 2,059,501 795,633 | 2,855,134 | 51,274 | 18,949 | 65,223 | 2-284 | 44
GO | 2,059,501 901,922 | 2,961,423 | 51,274 | 16,233 | 67,507 | 2°280 | 44
80 | 2,059,501 | 1,019,083 | 3,078,584 | 51,274 | 23,479 | 74,753 | 2428 | 41
105 | 2,059,501 | 1,029,751 | 3,089,252 | 51,274 |25,637 | 76,911 | 2-490 | 40

 

 

 

 

 

 

 

 

 

 

The mortality of the new population in the first 10 years is much
greater than -02490; after 20 it becomes less, and the aggregate mor-
tality remains less than ‘02490 until the constitution of the population,
in respect to age, is restored to its original state.

If the births, from any cause, increased in a geometrical progression,
and the rate of increase were r annually, the column D would become
(Ltr). Dy + (h-+r)?. Dios + 1 +2)*- Dog +... +77" . Dos
and all the other columns of the table being derivable from D, it is
evident that, the law of mortality remaining the same, the numbers dying
(C,) and living (P,) would, relatively to the total numbers, be increased
at the earlier ages, while the proportion of deaths to the population
would be diminished. If the increase were temporary, the contrary
result might be produced.

The annual mortality of persons of all ages, and of persons of the age

; D,. D
of 20 and upwards is nearly the same, for Q, is nearly equal Q,," If
20

the population of a city were for a century recruited partly by emigrants
from the country at the age of 20, the proportion of deaths to the
population would not be much disturbed by that circumstance ; but, if
the immigrants entered at 25, the apparent mortality would be increased,

D. D
for ato > Qe (6th Annual Report, pp. 534-5.)
0 25

Statistical Methods for determining the relative Health and Mor-
tality of different Classes of the Population.—It is universally admitted
by persons acquainted with the subject, that the relative mortality of a
mixed population, consisting of persons of all ages in different propor-
tions, can only be accurately determined by ascertaining the proportion
of the deaths, in a given time, to-the living at the several quinquennial,
or decennial periods of age; and that the mean duration of life attained
by such a population can only be positively and conveniently ascertained
by a construction which is called a “ Table of Mortality,” or a “ Life
“ Table.” The two series of facts—(1) the living at different ages, and
(2) the dying at the same ages, are not always known; and two methods
of approximation have been proposed and employed in such cases with
various success,
472 [PART Vv.

The first method is this: The ages of those who die are added up,
and the sum is divided by the number of deaths; the quotient is the
“mean age at death.” The health of two populations and their mean
lifetime are supposed to be in the ratio of the “mean age at death” so
obtained. This method was first employed in the 17th and 18th cen-
turies, before any Census of the population was taken; and certain
corrections of the errors in its results were proposed by Dr. Price in
the construction of the Northampton Table ; which, deduced from the
deaths at different ages in All Souls’ Parish, gave the ‘mean age at
“ death,” and not the “ expectation of life,” in Northampton.

The other method of determining the relative mortality which has
been employed in the present century by statists is equally simple : the
mean population is divided by the annual deaths; or the proportion
dying in a year to 100 living of all ages is found; and the relative
mortality of two districts, or counties, is thus compared.

The two roethods are subject to error from the disproportion in the
numbers of young and old people, which may arise from the marriages
being earlier or later, from emigration, immigration, and a great variety
of causes, besides the mortality. In an increasing population, with an
excess of children and young adults, the “ mean age at death” is reduced
in acertain ratio to the rate of increase, and there is nothing to neutralize
the tendency or to diminish the error. By the second method, as the
mortality is highest in the first year of life, and lowest about the age of
10-15, there are two elements in an increasing or decreasing population,
acting in an opposite direction ; the introduction of an excess of children
under four years of age tending to raise the aggregate mortality, ou the
one hand ; on the other, the excess of young persons above five years
tending to depress it below the average. The inquirer who has made
himself master of the nature of a life table, or even takes the fact just
stated into account, can have no difficulty in deciding upon the relative
merits of the two methods.

Attention has been latterly attracted to the health of towns, and of
particular parts and streets; and, as it may be hoped that the vast
importance of these difficult local inquiries will induce those who have
entered upon them to prosecute their researches with renewed vigour, I
have endeavoured to state, in a popular manner, the best method of
determining the relative mortality, and to point out the fallacies to
which the old method of the “ mean age at death” is peculiarly Hable.

If 100,000 persons born at the same moment were followed through
life, the numbers that died in each year of age noted, and the sum of
their ages divided by 100,000, the average ages which they lived would
be obtained. It would be the mean duration of their lives, or what: is
often called their “expectation of life.” Say that it is found to be 41
years. If another 100,000 were taken in worse circumstances, dealt
with in the same manner, and their average duration of life were found
to be 26 years, you infer that life is shortened 15 years in the latter
circumstances.

By taking the population living in the middle of a year (1841 for
instance) at cach age—O-], 1-2, 2-8, 3-4, 4-5, 5-10, &c., and the
deaths in the same year at the same ages, we find how many die in each
year of age out of a given number living ; and can calculate, therefore,
how many will arrive at the age of 1, 2, 3, 4, 5, 20, 30, &c. years ; or
determine the true mean duration of life. This was the method
which Dr. Price pursued in framing the Swedish Table. This was
the method which Mr. Milne pursued in framing the Carlisle Table.
Everybody admits that this method gives as correct a result as can be
obtained.
LIFE TABLES. | 473

If there is no emigration or immigration, and the births and deaths
are nearly equal for 100 years, the “ mean age at death ” will coincide
with the “mean future lifetime” or the expectation of life. Thus, if
the births and deaths had for a long time been equal in England, all
persons born had died in it, and no strangers had entered, or if those
who entered were of the same age as those who emigrated, “ the mean
“ age at death ” would be 41 years; but the births exceed the deaths
more than 40 per'cent., and the “mean age at death” in England,
instead of 41 years, is 29 years, while it was 33 years in Mr. Rickman’s
time !

When tested, the error in the result by this method is 12 years in 41

ears !

: But it may be asked, Will not this method serve as a meaus of com-
parison, where there are not the data, nor skill, nor time requisite for
calculating the true duration of life? Does not this method give
results more accurate than those deducible from a comparison of the
“proportion of the deaths to the population?” To this the answer
must be in the negative. Neither method gives the true mean duration
of life. Nobody pretends that the latter does; but it gives the nearest
approximation, for, as a general rule, wherever the mortality is high the
duration of life is low, and the reverse. I know no exceptiou to this
rule. In the last Report instances were given in which the indications
of “the mean age at death” are altogether erroneous; thus, the “ mean
“ age at death” is higher in France, where the true duration of life is
lower and the mortality higher than in Kngland.

 

 

 

 

 

 

L 2 3
/ Mean Life-
Mortality : or | “Mean Age at| time; or the
one Death Death.” “ Expectation
of Life.”
England (1841) - -| In 46 living 29 years 41 years.
France 9 42 4, 34, 40 y» (?)
Sweden 3 = 41 ,, 31 ,, 39 3
Metropolis ,, - 41% 5 29 37s
Liverpool ,, 30, 21, 26 —C«,
Surrey (extra-Metropolitan) 52 Cy, 34, 45s,

 

 

 

 

 

 

* One in 89 was the average of five years, 1838-42.

The last column gives the true mean duration of life ; where this has
not been determined, the method, of which the first column contains the
results, gives an approximation, sufliciently near for many purposes, to
the relative mortality. Thus, according to that column, we should

arrange the six classes of people in the following order of healthiness :—

(1) Surrey, 52; England, 46; France, 42; Sweden, 41; Metropolis,
39 (average of five years) ; Liverpool, 30.

And this is the order in which they are placed according to the
expectations of life, which are as follows :—

(2) Surrey, 45; England, 41; France, 40; Sweden, 39; Metropolis,
87; Liverpool, 26.

Let us test the method of the “mean age at death” in the same way,
by substituting the numbers in the second column for the others :—

(8) Surrey, 84; France, 34; Sweden, 31; England, 29; Metropolis,
29; Liverpool, 21.
474 [PART V.

Now, according to this method, the French live five years longer
than the English, and the duration of life is the same in the metropolis
as in all England. The method, like a rough and very bad instrument,
gives you some idea of the thing which it pretends to measure, but
its indications are, in many cases, entirely wrong. It neither gives
the tree duration of life, nor the relative duration of life in different
circumstances.

Up to the date of the first edition of Dr. Price’s book, the method (of
which that of the “mean age at death” is a rude fragment), was the
only one in use ; the deaths could not be compared with the population
of London in the 18th century, because the population had not been
enumerated. Dr. Price’s Table, and the previous Table of Simpson,
gave the “mean age at death,” as deduced by them from the London
Bills of Mortality,* with a correction for the adults who came to settle
in London. Dr. Price believed that the births did not, in his time,
exceed the deaths in England, and upon this hypothesis, which he
supported very ingeniously, the “expectation of life,’ and the “mean
“ age at death,” would have been the same. Halley, Simpson, Price—
all the great writers on the subject in the sixteenth and seventeenth
centuries—could not obtain returns of the ages of the living, and had
to calculate their tables from the deaths alone as given in the Bills of
Mortality then in use. To avoid the errors introduced by comparing
the ages at death of populations in which the births and deaths are not
equal, they expressly selected towns, &c., in which they were led to
believe the births and deaths were nearly equal. As the populations
of England and Europe formerly increased very slowly, their tables
(of Breslau, London, Northampton) are not very erroneous at advanced
periods of life.

Mr. Milne’s views} have been misunderstood and misrepresented ; he

distinguished (1) The “ mean life,” or “expectation of life.’ (2) The
mortality expressed by the numbers out of which one death occurred
annaally ; and (3) The mean life deduced from the deaths alone, or the
“ mean age at death.” Thus in 1801-5 the true “mean duration of
life” in Sweden, he says, was 39°39 years; one died annually in 40°90
living, and the “‘ mean age at death” was only 30°86 years in the same
period. Mr. Milne shows, from ten examples, that the two first sets of
numbers are the same in a stationary population and differ slightly in
an increasing or decreasing population. He shows that the “ages of
death ” differ from these two sets of numbers in an increasing popula-
tion; thus in Sweden the difference was 40°90 — 30°86 = 10°04 years.
In other instances the difference amounts to 6, 7, 9, 10 years; in
England it is 12 years.
Mr. Milne says, “ When tables of mortality are constructed from the
numbers of deaths only in the different intervals of age, without com-
paring them with the numbers of living persons in the same intervals
“ * * * and the population is increasing, the number of years in
“ the mean duration of life from birth (‘ages of death’) will fall short
“ of the number of the people out of which one dies annually (‘ propor-
“ ¢ tions of deaths to the population’) by a much greater number than in
“ the case we have just been considering, of the table of mortality having
“ been properly constructed from the | necessary data, as the following
statement will show.” (Here follows a table with 10 examples
showing the differences.)

na

‘
‘

‘6

n

 

* Price’s Works, by Morgan—the London Tables; also Simpson on Annuities,
pel.

+ See Art. “Mortality,” in Ency. Britannica.
LIFE TABLES. | 475

Mr. Milne’s Carlisle Table of mortality,* as he explains, represents a
population in which the births are equal to the deaths, and in which
there is neither immigration nor emigration, such as everybody knows
does not exist in nature. All correct life tables are constructed upon
the same hypothesis, and therefore admit of comparison. Tables might
be constructed representing populations in which the births exceeded
the deaths,.or the contrary; but they would not admit of comparison
unless the births bore the same proportion to the deaths in the two
cases. Such tables would not show the survivors at each year of age
out of a given number born, or 4 given number attaining any age; the
probable duration of life could not be calculated from them, nor the mean
duration of life.

The “adjustment,” which makes a life table represent as nearly as
possible the progress of a human generation year by year through life,
has been employed upon the same principle that astronomers “ reduce
“ as it is termed, all their observations, both of right ascension and
“ declination, to some common and convenient epoch.” * * “ By the
“ term correcting or equating the observation. for nutation,” says
Herschell,f “is always understood, in astronomy, the getting rid of a
“‘ periodical cause of fluctuation, and presenting a result, not as it was
“ observed, but as it would have been observed, had that cause of
“ fluctuation had no existence.”

The method of the “ mean age at death,” taking the crude results of
observation on a population subject to fluctuations in births and deaths,
immigration and emigration, only furnishes true results in a perfectly
stationary population ; while with the tables deduced from the propor-
tion of deaths at cach age to the living at each age—the method employed
in the construction of the Swedish, Carlisle, and English Tables—
“ Whether the population be stationary, or increasing, or decreasing,
and whether such changes be produced by procreation, mortality, or
migration, or by the joint operation of any two or more of those
“ causes, provided that the mode of their uperation be uniform, or
“ nearly so, and not by sudden starts, the law of mortality may be
approached near enough for any useful purpose by actual enwmeration
“ and the Bills of Mortality.”

Several illustrations were given in the last Report of the errors pro-
duced by applying the “ mean-age-at-death” method to fluctuating
populations. In many cases, the mortality and unhealthiness of two
classes of persons are inversely as the mean age of death. Without
entering into any mathematical details, I will now show that the “ mean
“ age of death,” considered as a measure of health, must give erroneous
contradictory, exaggerated results.

The mean age of death is determined by adding up the ages of all the
persons whose deaths are registered in a parish or other register—say,
during a year—and dividing the sum of the ages thus obtained by the
number of persops who lived those ages. The error consists in the
assumption that this average age represents the average age which
the inhabitants (the same rate of mortality prevailing) will live, or the
average age which would be obtained by following 1,000 children, born
in the parish, through life, adding up the ages which the 1,000 attained,
and dividing the sum by 1,000. The results of these two methods are
the same in a stationary population, and totally different in an increasing,
decreasing, or migratory population. The population is increasing in

 

* Art. “ Mortality,” Ency. Britannica.
t Herschell, Astronomy, p. 174.
{ Milne.
476 [PART v.

almost every district of England, and there is a constant flow of popula-
tion to the towns. To show the effects of these movements, I give two
or three extreme instances.

(1.) Let us suppose that in two contiguous parishes, equally healthy—
A and B—all the children are born in A and remain there up to the age
of 20, and if they die are registered in the parish register; that at 20 all
the survivors emigrate year by year to B, and when they die are registered
by the clergyman of B in his register. Now if the mean age of death
were taken in the parish A, it would be about four years (according to
the present rate of mortality in England), while it would be 60 years in
the parish B. The numbers living, out of which one death would take
place annually, would be | in 43 in A and | in 40 in B. The mortality
and healthiness, taking the difference of age into account, would be the
same in A avdin B. Notwithstanding the difference of the mean age
at death produced by emigration, a comparison of the deaths with the
living at each age would demonstrate, that although the deaths of none
above twenty were registered in A, fwo in every three born in A sur-
vived the age of 20, and died at more advanced ages elsewhere. In B,
as none died under 20, it would be inferred that none entered the parish
under that age.

The emigration of a part of the adult population to towns produces
an effect of precisely the same kind, though to a less extent.

(2.) In the former illustration, the births were supposed to be equal
on an average to the deaths iu A. and B; and the error in the mean
age at death would be got rid of by combining the deaths in A and B
in one table, instead of placing them in contrast. Suppose the two
parishes united—that after a stationary stage, through the women
marrying earlier and in greater numbers, the births rise from 1,000 to
2,000 annually —while the salubrity, and the mortality at the respective
ages remain precisely the same; what would be the effect of an abstract
of the parish registers 20 years after the increase had set in? Why
that, without any increase in the mortality, the deaths under 20 would
be doubled; and the mean age at death, instead of being 41 years,
would be less by many years. The comparison of the past and present
mean ages at death in the united parishes would be absurd; so would
the comparison with any other parish in which the increase and
emigration had proceeded differently. But upon comparing the deaths
with the living at each age—as by the hypothesis the living under
the age of 20, as well as the deaths under the age of 20, would be
found twice as numerous in the year as they were 20 years ago—
the ratio between the two would be found to be the same; the
survivors year by year, and their expectation of life, could be
determined. With regard to the proportion of deaths at all ages
to the living at all ages, a sort of compensation would be produced
—the excess of infants under 5 years of age tending to raise the
relative number of deaths; the excess of persons from 5 to 50, and the
diminished proportion of persons above 60, having a tendency exactly
the reverse.

In England, during the whole of the present century, there have been
more than 3 births to 2 deaths; and the result, as has been shown,
has reduced the mean age of death to 33 years in 1831, and to 29 years
in 1841; while the real duration of life—the expectation of life—is
41 years, and has varied little. The number living to 1 death was 46 in
1841, and 45 in the preceding four years.

(8.) Take a street (C) in a town, where, from the erection of new
factories, or from any new field of labour being thrown open, a con-
siderable number of young men and women have been attracted within
LIFE TABLES. | 477

the last 10 or 15 years; there is a demand for the labour of children ;
marriages take place ; nearly all the young couples have children, two,
three, or four in a family. Take another street (D) inhabited by
-artizans, whose business and numbers have remained nearly stationary,
and tradespeople who have succeeded to old shops established by their
fathers ;—Suppose the salubrily of the two streets, and the rate of
mortality at the corresponding ages, the same,—it is evident that as the
street C contains no old people, and the mortality in the first two or three
years is always relatively high, the deaths registered will be at early ages
—the mean age of death low; while in the street D, the deaths will
many of them be at old ages, and the mean age at death relatively high.
Tf all the inhabitants of the two streets died in one year, the mortality
would be the same. Yet the mean age at death would differ in the same
ratio as the mean age of the living. The same results would be pro-
duced by the death of one thirtieth of the inhabitants in each street.
The cases which have been put will enable us to understand such a case
as is said to have occurred in Leicester, where the mean age at death
was 13} years in the undrained streets, and 233 in the drained streets.
That the real mortality was higher in the one class of streets than in the
other is probable; but this is not proved by the method, for the
undrained streets may be new streets, inhabited by young people—a
part of the 8,600 in 46,000 not born in Leicestershire; while the
drained streets may be cld streets inbabited by the old inhabitants of
the town.* On account of the system of compensation which it involves,
the method of comparing the total deaths to the population of the streets
gives results nearer the truth; but no one acquainted with inquiries of
the kind would place much confidence in any other method, as applied
to particular streets or small districts, than that upon which the Life
Table is founded—the comparison of the numbers living with the
numbers born and dying at the several periods of life. In the Registrar-
General’s Report, the mortality is only given for statistical districts of
an average population of 50,000.

The correct method, to which I have so often adverted, yields uniform
consistent results; and next to this in accuracy is that obtained by
the proportion of the deaths to the living among numbers, or over a
time, sufficient to obviate errors liable to be introduced by accidental
fluctuations.

The papers of Mr. Edmonds in The Lancet} may be referred to as
early models of the methods of determining the relative mortality of
particular localities, and at particular ages, both with complete and
imperfect data. See also Mr. Chadwick’s Paper “On the best mode of
“ representing accurately, by statistical returns, the duration of life,” in
the Statistical Journal, vol. vii., p. 1; and the following Paper in the
same Journal, p. 40, ““On a method recently proposed for conducting
“ inquiries into the sanitary condition of various districts,’ by
Mr. Neison, who has given several striking illustrations of the results
of the new method.—(6th Annual Report, pp. 570-6.)

Relative Duration of Life among Males in Manchester and in
England.—The mortality of Manchester and Liverpool is nearly the
same, or only differs at scme ages; it is rather the highest at certain
ages in the former town. The enormous extent of the mortality in
both these large places is appalling. The excess over the mortality
of Surrey shows to what an extent it is unnatural and susceptible of
remedy.

 

* T find, upon turning to the Census Returns, that the populations of some of the
new and old streets in Leicester differ in the manner described.
t See The Lancet volumes for the years 1833-39.
478 [part v.

Retative Duration of Lire among Marrs in MAncHESTER and in
ALL ENGLAND.

 

 

 

 

 

Manchester. England.
Manchester
below the Average.
Precise Age. Expectation of Life.
Years. Years. Years.
O 24°2 40'°2 16:0
1 33°1 46°7 13°6
10 40°6 47°1 6°5
20 33°3 39°9 6°6
30 26°6 33°1 6°5
40 20°6 26°6 6°0
50 15-2 20°0 4:8
60 10°3 13°6 3°3
70 6°8 8°5 I*7
80 4°6 4:9 *
90 3°2 27
100 12 1:5

 

 

 

 

 

* The facts for MANCHESTER are too few to admit of a comparison after the age of 80.

The mean duration of life among Males in MANCHESTER is 24°2 years, or 16'0 years less than
40°2 years, the duration of life in all ENGLAND.

By another method the expectation of life at birth is 25°5 years in MANCHESTER.

Many of the irregularities in the columns of the life table from
which the expectation of life in Manchester given in the above table
has been calculated are from erroneous statements of age; the ages
guessed at being almost always referred to the round numbers 20, 30,
40, 50, &c., make the numbers in the corresponding quinquennia
excessive. These errors are not of great importance, and have not been
corrected in this table, which, by a very simple arrangement of the
facts, enables us to answer very readily many questions relative to the
population of Manchester. The mean age, for instance, of the people of
Manchester, males and females, is 25 years ; as is shown by dividing the
number of years lived (4,141,701) by the number of persons (163,561).
The mean age of persons above 20 is 38 years. Other properties and
uses of the Table are sufficiently obvious.——(7th Annual Report,
pp. 329-39.)

Expectation of Life; afterlifetime—Expectation of life is an in-
correct term: the time which it 1s eapected a person will live is the time
which it is an even chance he will live; it is the we probable of the
French, and is correctly expressed by “ probable lifetime.” The after-
lifetime can only be the same as the probable lifetime on Demoivre’s
hypothesis—that the surviving form an arithmeticai progression. The
term “ expectation of life,” first used by Demoivre, is correct, on that
supposition, which is, however, in itself quite erroneous. The idea
intended to be expressed by “expectation of life” is the mean time
which a number of persons at any instant of age will live after that
instant: itis the French ve moyenne ; and this technical idea is strictly
and shortly expressed by afterl:fetime, a pure English word, formed on
the same analogy as afterlife, aftertimes, afterage, afterhours. See the
words in Johnson. Among the examples he quotes are,—

“ What an opinion will afterages entertain of their religion ?’—

Addison.
LIFE TABLEs. | 479

‘* So smile the heavens upon this holy act,
That afterhours with sorrow chide us not.”—Shakespeare.
“ You promised once a progeny divine

Of Romans, rising from the Trojan line,

In aftertimes should hold the world in awe,

And to the land and ocean give the law.”——Dryden.
Todd adds “afterlife” from Dryden, Heywood, and Butler. “ Afterlife :
the remainder of life.”

“ All of a tenor was their afterlife,
No day discolored with domestic strife.”—Dryden.
The afterlifetime of men at the age of 30 is 33 years by the English

Life Table : 33 years is not the precise time probably that any one of
that age will live, but the average time that a number of men of that
age will live, taken one with another. Age + afterlifetime = life-
time. At 30 this is 30 + 83 = 63, the average age which men now
aged 30 will attain. At birth this isO + 40 = 40; when lefeteme and
afterlifetime are the same thing. The lifetime simply, without the
addition at a given age, will serve to express in one word what is often
improperly called the expectation of life at birth: thus the lifetime of
males in England is 40 years, the lifetime of males in Manchester is
24 years. Those who from habit prefer “expectation of life,” can
always substitute it for afterlifetime; from the use of which in this
paper no ambiguity can arise-—(8th Annual Report, pp. 279-80.)

English Life Tables, Nos. 1 and 2,—The Ninth Report contained an
elaborate series of tables, showing from the returns of deaths in the
seven years 1838-44, and from the Census returns of 1841, the mortality
of males and females at different ages in England and Wales, as well
as severally in the 11 divisions, 44 counties, &c., and 324 groups of
districts. The population was 15,914,148; the deaths in the seven
years 2,436,648. A second English Life Table for males during this
period has been constructed, as well as several new series of tables of use
in all the ordinary operations of life insurance. The Life Tables (1 and 2),
it will be seen, agree very closely, although the one is constructed on
the deaths in 1841, the other on the deaths in the seven years 1838-44 ;
the population of 1841 serving as the basis of both.

Resutts deduced from the Two Eneisu Lire Tasres (Males).

 

Ages.

o | 10 | 20 | 30 40 | 50 | 60

 

 

 

Afterlifetime or Expecta-

 

tion of Life :—
(1841) English Table,No.1] 40°17 | 47°08 | 89°88] 38°13 | 26°57] 20°03 | 18°59] 8°52
(1888-44) n No.2] 40°36 | 47°47 | 39°99] 83°21 | 26°46] 19°87] 13°60 | 8°55
Annual Premium to in-
sure 1002,:— Es dl£s. dds. dJ£ x d& 6 djJ£ s. al£ s. dl£& s, dl
English Table, No.1-|2 5610/1 56 0/11111)/2 1 1/214 7/317 6/6 2 7}10 3 Qi
” No.2-/2 5 7/1 4 5/111 8/2 0 9)21411/818 6/6 2 7/10 2 O

 

Present Value of Annuity
of £1 (payable at the
end of every Year) :—

 

 

English Table, No. 1 - | 18°2167| 23°0333) 21°1765) 19*1847| 16°7209] 18°7365) 10°0598 el
» No. 2+ | 18°2660) 23°2042) 21°2334) 19°1943) 16°6689) 13°6272] 10°0572| 6°6837

 

 

 

 

 

 

 

 

 
480 [PART V.

Various methods of graduation were tried. ‘The abstracts of the
population for 1841 distinguish the numbers living at each quinquennial
period of life, and the abstracts of deaths are taken at corresponding
periods, except in the first five years of age, when the rate of mortality
varies so rapidly that every year and even month is marked by a change.
But by a careful examination of the facts it was found that the rate of
mortality in decennial periods, after the age of 15, furnishes the most
satisfactory basis for determining the series of fractions to express the
probabilities of life. At the earlier ages the mortality for each year
was directly deduced from the returns, and, after careful comparison,
the first series of logarithms was drawn gradually into the second—the
second into the third. At another time I hope to be able to discuss
in detail the various methods of graduation, and to describe that
which was found most successful in practice. (12th Annual Report,
pp. i-ii.)

Old and New Northampton Life Tables ; Carlisle Table ; Expe-
rience Table—Life tables have been constructed in two ways :—

(1) By a comparison of the deaths and the Living at each age, which
gives the rates of mortality and survivorship. Tables so constructed,
in the words of Dr. Price, “ must be correct.”

(2) From the deaths alone, or with reference only to the ages at
which the deaths have taken place. Tables so constructed are
only correct if the “population” of the place among whom the
deaths occur is stationary, if the births and deaths are equal, and
if there is no disturbing migration for a century. It was in this
second way that the Northampton Table, from the want of better
materials, was constructed by Dr. Price.

I was enabled to obtain data for constructing two new Northampton
Tables; one on the plan of the Northampton Tables by Dr. Price, in
common use, the other on the plan which “ must be correct.”

It is a remarkable circumstance that the new Northampton T'able
(2) which was constructed, like that of Dr. Price, on the deaths alone,
yielded similar results. The mean lifetime, or duration of life, by the
table of Dr. Price was 25°18 years, by the other table 24°88 years ;
and the same agreement in the resulting expectation of life, the values
of annuities, and the premiums of insurance, is maintained at all ages.

But the correct Northampton Table, deduced from the Census of the
living at each age in 1841, and the deaths in the seven years 1838-44,
differs entirely and largely from both the other tables; thus, the mean
duration of life in Northampton is found to be 37°57 years, or thirteen
years longer than it is given by the untrue table; and at all the earlier
ages the values of annuities and the rates of premiums, by the true
table, agree generally with the English and other tables, constructed
from adequate data, but differ totally from those based on the old
Northampton Table, on which so large a part of the insurance business
of this country has hitherto been transacted.

It is shown in the paper referred to that the lifetime in Northampton
was about 30 years when Dr. Price’s observations were taken, whereas
it is now 37} years* ; that the town contained then, as it does now,
great numbers of Baptists, who repudiate infant baptism, and thus,
consequently, by reducing the ratio of the christenings to the births,
induced Dr. Price to believe that the population was stationary, although,
as shown from other sources, it was, like the staple shoe trade of the
place, constantly increasing. Dr. Price assumed that the population of

 

* Reg. Gen. 8th Report, pp. 277-348,
LIFF TABLES. | 481

the parish was kept up by immigration, and that all the immigrants
entered at the age of 20; asa correction for this disturbance he was
induced to alter his facts, and the alteration had the effect of increasing
the error of the original table. ;

Dr. Price had not the data for constructing a true Northampton
Table; for this reason he failed. He constructed from proper data
a Swedish Table, which is nearly correct; and he recommended, in
the first instance, his Chester Table, which is less erroneous than the
Northampton Table; but the directors of the Equitable “ judged it less
safe.”

The deaths, Mr. Morgan says, were afterwards found to be one third
less in the Equitable experience than the Table indicated.

Great injustice has been done by the use of this Northampton Table ;
which, in mutual offices makes one member pay 40, 30, 25, 20, or 10 per
cent. more than the premium which is required to secure a policy of
the same value, and distributes the surplus thus acquired unequally.
The old offices, which have used the Northampton Table, have a great
difficulty in setting themselves right. By its use the proprietary offices
have exacted enormous and unequal premiums from the portions of the
community who happened to be ill-versed and ill-instructed in the
intricate science of life insurance.

A false life table can be defended by the same arguments as a depre-
ciated currency ; and the substitution of a correct table causes the same
kind of disturbance in the value of the shares of members as a re-coinage
of clipped money, or a return from a depreciated paper to a metallic
currency, introduces into the value of commodities and securities. The
Northampton Table has still silent adherents, but few open defenders ;
and some of the old.offices have, greatly to their credit, since the error
in that table has been placed beyond doubt, abandoned its use.

The Carlisle Table was deduced from two enumerations of the popu-
lation of the parishes of Saint Mary and Saint-Cuthbert, Carlisle; the
first in January 1780, when the inhabitants were 7,677 and the second
in December 1787, when the inhabitants amounted to 8,677, namely,
3,864 males and 4,813 females. The deaths in the two parishes were
1840, males 881, females 959, in the nine years 1779-1787. Itis now
well established that the mortality in towns is understated at the age
15-35, when they are entered by healthy immigrants from the country :
of whom many reside while they continue healthy in comfortable “ situa-
tions” as domestic servants, and when they are attacked by consumption
return to the country to die. The fact that the females in these
parishes exceeded the males by nearly 1,000, and the great excess in
the number of persons (1,501) of the age of 20-30 over those in the
town of the age of 30-40 (991), indicate the character of the population
with tolerable distinctness. Some of the irregularities in the graduation
of the Carlisle Table may he referred to the limited extent of the obser-
vations ; for the deaths in each decennial period (20-90) only ranged
from 89 to 173 in number.

The “ Experience” Table is the result in part of a highly praise-
worthy effort which was made by a Committee of Actuaries to collect
all the extant observations on the mortality of persons whose lives have
been insured. The Egwitable and the Amicable Life Offices had before
published their experience ; and had thus offered a valuable and liberal
contribution to the science of life insurance. The Committee of
Actuaries induced the following 15 offices out of more than a hundred
then existing, to contribute but not to publish tieir experience :—the
Alliance, British, Commercial, Crown, Economic, Guardian, Imperial,

HH
482 [PaRT Y.

Law Life, London Life, Norwich Union, Promoter, Scottish Widows
Fund, Sun, Universal, and the University.* (12th Annual Report,
pp. iv-vi.)

Selection of Lives for Insurance.—-When life insurance was first
commenced, in the absence of experience it was uncertain whether the
rate of mortality among persons who insured their lives would be
higher or lower than the rate of mortality prevailing in the nation
generally of which they formed a part.

Dr. Price anticipated an excessive rate of mortality in insurance
societies, for he says :—‘‘ Those persons will be most for flying to these
“ establishments who have feeble constitutions, or are subject to
“ distempers which they know render their lives particularly precarious ;
“ and it is to be feared that no caution will be sufficient to prevent all
“ danger from hence.”

Mr. W. Morgan in 1829, after fifty years experience as actuary in
the Equitable Life Office, thus expresses himself on this subject :—

“ Between a number of select lives and the general mass of mankind
“ the difference in the rate of mortality will at first be considerably
“in favour of the former; but this difference will be continually
** lessening, till in process of time it will vanish altogether, as it is
“ found to have done among the lives of long standing in the Equitable
“ Society. Should any institution, therefore, of this kind, in the early
“< period of its existence be tempted, by the higher probability of life
“ among its members, either to reduce its premiums or to adopt any
“ other violent measures for impairing its resources, the consequences,
“ though not immediate, musi ultimately terminate in disappointment
« and ruin.’ }

Mr. Milne, after much experience, also observes on the same subject: §
« Although the members of such a society [as the Equitable] when
“ they first enter are select lives, they are not even then so much
“ better than the common average as many persons suppose; for the
“ more precarious a life is, the stronger is the inducement for parties
“ interested in its continuance to get it insured, so that. bad risks are
“ frequently offered to such companies. And many proposals for insurance
“are accepted by the directors that are not thought very eligible at
“ the time, in cases where they are not aware of any specific objection
“to the life proposed. Besides, it is to be considered that of the
“ number in a society at any one time but a small proportion can have
“ been recently admitted, and in a few years from the time of admis-
“ sion the members will generally have come down to the common
“ average of persons of the same ages.”

* A few copies only of the “ Experience” Table were printed and circulated,
it appears exclusively among the insurances offices. Unlike the Equitable and
the Amicable societies, the Directors of the insurance companies have not yet
evinced such an anxiety to promote the science of life insurance, or to supply
the English public with information, as might reasonably be expected from a
class so enlightened and so anxious to promote the general good. The few
facts in the text are derived from the subjoined works, and they agree closely
with the similar results derived from the Equitable experience by Mr. Morgan,
and recently by Mr. Peter Hardy :

Life Contingency Tables. By Edwin James Farren. Part I.

A Series of Tables of Annuities and Assurances. By Jenkin Jones.

Insurance Magazine,

t Works, vol. i. pp. 176-7.

} A View of the Rise and Progress of the Equitable Society. By W. Morgan,
E.B.S., 1829, p. 46.

§ Human Mortality, Encyclopedia Britannica, vol, xv., part II., page 555.
LIFE TABLES. | 483

The effect of selection is now well known, and the facts have been
investigated by Mr. E. Farren, who has separately deduced the
mortality among insured lives during the first year, and the mortality
among the same lives in the first as well as subsequent years ; he has
also compared the results with those derived from the first English
Life Table.

The mortality per 1,000 at 5 ages is thus given.*

 

 

 

 

Among insured Lives. Among the

A general Male

ge. First and Population of
First Year. subsequent Years. England.
30 - 6°584 8°732 10°220
40 . 8°588 10°796 13°195
50 - - 14°595 16°398 16°994
60 - 28°368 31°082 31°441
70 = . 54°382 62°676 67°001

A Cc P

 

 

 

 

 

 

 

After eliminating the influence of selection over the first year
Mr. Farren concludes that the rates of mortality of persons insured
“ would not particularly differ from those prevailing among the male
“* population at large, taken indiscrimately without regard to health.”

The observations of the most distinguished writers, these recent
investigations, and the nature of the case, clearly show that in the
present state of our knowledge the National Life Table—or a table
derived from the same facts—is the soundest and justest basis of the
life insurance business of the country; for if there is a disposition to
pass an undue proportion of “bad lives” into an insurance society,
such arrangements can be made as, when skilfully conducted, reduce
the mortality below the average of mankind in general, Any favourable
result of this application of technical skill may be set down as legitimate
profit, for if such skill is not applied the mortality will be above the
average of the nation, and the result “loss.”

The selection of lives is not yet fully understood, but it may be
broadly stated that 27 in 1,000 men of the population, of the age of 20
and under 60, are suffering from some kind of disease or other ; that
several of the diseases are of long duration, that others are recurrent,
and that some are hereditary ; that, consumption, the most common fatal
disease, lasts on an average two years, although it varies considerably in
duration; and that cancer, another form of chronic fatal disease, is
much more common in women than it isin men.f On all these grounds
it is evident that selection will diminish the mortality in the first year,
or two or three or four years subsequent to its exercise. As age
advances the influence of selection increases ; and in this way it is
stated that a former Government incurred heavy losses by the sale of
life annuities on old lives to unscrupulous speculators.

Investigations seem to indicate that selection under the existing tests
is more effective in the case of females than in the case of males; and
that it is not safe at present to insure females at lower premiums than
males. (12th Annual Report, pp. vi-xi.)

 

* The Chances of Premature Death, and the Value of Selection among assured
Lives. By E. J. Farren, 1850, Part I., p. x. and p. xiii.
t Walshe on Cancer.
HH 2
484 [PART Vv.

Rise and Progress of Life Insurance.-—Up to the 17th century the
population of England experienced at intervals periodical plagues which
destroyed a third or a fourth part of the population of London and of
other cities ; at the same time the interest of money continued 6 per cent.
per annum, while it was 3 per cent. in Holland and Italy—a decisive
proof, in addition to historical examples of the bad faith of the times,
that in this case, as in nearly all others, the excess in the rate of
interest over 3 per cent. is no more than covers the risk of the class of
securities on which the high rate of interest is charged. The average
duration of human life, and its modifications by age, were then unknown.
In such a state of things life insurance on any solid rational principles
was impossible; nor is there any proof that the social condition of the
people of the 17th or any previous century, was such as would induce
them to insure their lives extensively for the benefit of their families.
After the revolution, and the establishment of the Bank of England, the
financial state of the country became settled; and the Government
borrowed money on life annuities but on very disadvantageous terms.
Men began to have confidence in each other, and the way was opened
to investments for long terms. Halley constructed a life table, and
inserted it in the Transactions of the early and glorious days of the
Royal Society. Demoivre, Simpson, and Dodson, in their works, showed
its practical application to all questions in which money payments are
dependent upon human life; and the doctrines of life insurance were
extended by the financiers of Holland, Germany, and France. Sweden
contributed its national tables. Dr. Price, Mr. Morgan, and the
directors of the Equitable Society, in various ways, gave a great impulse
to life insurance at the close of the 18th century. Mr. Pitt mitigated
the injustice of his income tax by exempting from taxation that part of
the income which was paid as premium for insurance; a modification in
favour, he said, ‘of those who have recourse to that easy, certain, and
“ advantageous mode of providing for their families by insuring their
“ lives.”* The fire offices commenced insuring lives. The Equitable
advanced rapidly, and new offices were established. Baily enumerated
15 life insurance companies in 1813; Mr. Babbage analysed 32 in
1825, thirty of which engaged the attention of 528 directors. The
science received considerable accessions by the writings of W. Morgan
and Baily. In 1815 Mr. Milne’s admirable work appeared, containing
asystematic and original digest of the science of life contingencies, which
has been extended, modified, and enriched by the analyses and contribu-
tions of Barrett, Griffith Davies, De Morgan, Gompertz, Edmonds,
Galloway, A. Morgan, Ansell, Neison, Jones, Sang, and other English
as well as foreign writers. The number of offices which now exist
exceeds 150; and the knowledge of insurance is extending in every
direction.

The whole of the commerce of the country turns on contingencies
which demand the application of scientific observation and calculation ;
and as English agriculture has ‘its chemists, English commerce must—
to keep pace with it—ultimately employ actuaries, to calculate the risks,
which are now only roughly guessed at; and thus extend the useful
sphere of an important scientific class of men at present almost peculiar
to this country.

Her Majesty’s Government, by facilitating that part of their
undertaking which life offices have hitherto found to be attended with
most. difficulty, namely, the exhibiting of such accurate, clear, and
frequent statements of their financial condition and progress as may

 

* Speech in the House of Commons on 14th December 1798.
LIFE TABLES. | 485

inspire the public with entire confidence in the success of their arduous
engagements—will contribute to their prosperity, and will tend to make
England, what it has already partly become, a great emporium for the
highest class of securities—policies on lives.

The families of the classes living on wages are still in nearly the same
condition, as respects life insurance and a provision against infirmity
and age, as the professional and middle classes in the last century ; but
the stimulus which the facilities and security that the Government could
afford, would undoubtedly induce them, in the course of time, to make
such a provision for the future as would be satisfactory to their own
minds through life, preserve them from humiliation in old age, and in
the event of untimely death secure as an inheritance for their widows
and fatherless children a decent livelihood, instead of a life of anguish,
infamy, or crime. (12th Annual Report, pp. 1-li.)

Construction of the English Life Table No. 3.—The English Life
Table No. 3 was calculated in the General Register Office with the help
of the Scheutz calculating machine, and was based upon the Census
enumerations of 1841 and 1851, and upon the 6,470,720 deaths registered
inthe 17 years 1838-54. It consists of three parts, or three Life Tables,
each of seven columns; the first part for Persons, consisting of such pro-
portions at each age of the two sexes as are produced by the births; the
second part for Males; and the third part for Females. The base of
the Table for Persons is 1,000,000 children born alive; and as boys
and girls’ were born in England during the period of observation in the
proportions of 511,745 boys to 488,255 girls, these numbers were made
respectively the bases of the Male Life Table and of the Female Life
Table.

In the Synoptical Table the numbers of the males and females living
and dying at each year of age are given as they would exist in a popula-
tion under the law of birth and mortality, found by direct observation
to prevail in England and Wales, undisturbed by emigration, by excess
of births over deaths, or by any other element of that kind.

The males, we find, if there is no emigration, exceed the females in
number in infancy, in childhood, and in manhood up to the age of 53,
when the women after the age of childbearing enjoy a firmer hold on
life, and die at a lowerrate than the men ; so that the number of women
of 53 and upwards exceeds the number of men of the corresponding
ages. The males are to the females of all ages as 20,426,138 to
20,432,046 ; thus proving decisively that the disparity in the numbers
of the two sexes of the English population is due exclusively to
emigration.

The Male and Female Life Tables were constructed independently :
that of the Persons was obtained by combining the other two in one.

The Life Table is based upon the observed rates of mortality at
different ages in England and Wales.

The rate of mortality-—or, in a technical sense, the mortality-—
expresses the ratio between three elements: (1) men living ; (2) time;
and (3) men dying.

The men living, and the t2me expressed in years, multiplied into each
other, produce the years of life with which the deaths are compared. A
year of life is the lifetime unit. It is represented by one person living
through a year. Any number of persons living, one at a time, in
continuous succession through a year, yield also one year of life. There
are 525,949 minutes in a year ; and 525,949 persons living through one
minute also enjoy one year of life,
486 [PART Vv.

The years of life are determined by enumerating the population at
certain points of time, and thence deducing the numbers living through
the time.

The following four cases may be distinguished :—

1. The population is known or is assumed to be stationary. Thus a
population of ten thousand living through two years, yields twenty
thousand years of life. Let the population be P, and the years of life y ;
then in x years, y= xP in all these cases. Here a may be an integer or
a fraction.

2. The population increases by equal numbers in equal times; that is,
it increases in arithmetical progression. If the population is 4,000 at
the beginning and 6,000 at the end of a period, the mean population
will be the sum of these numbers divided by 2, that is, 5,000; which
wili also be the population in the middle of the period. 5,000 multiplied
by the intervening years gives the years of life. Thus if P,is the
population at the beginning, and P, the population at the end of x years;

0 * 7 < *
pS —— annual increase; for the increase (7) is equal in equal

times by hypothesis. The population at the end of any time is
P,= P, + rx. And dy = P, dx + radx is the differential of the

j : x
lifetime, from which we have by integration y, = # Py + 7 z= the

years of life = the population in the middle of the period (B, +r 5)

multiplied by the years (x) over which the observation extends,

3. If the population fluctuates much, and frequent enumerations are
made, the mean of each successive couple of enumerations, multiplied by
the time, expressed in years and fractions of a year, will give nearly the
years of life. When the numbers at the beginning and at » equal
intervals of time are ascertained, the half of the extremes added to the
intermediate terms makes a sum which, divided by one less than the
number (zx + 1) of enumeraticns, gives the mean population.

4. The population of a country naturally increases in equal proportions
in equal times, or in geometrical progression; for this is a necessary
result if the increase also increases. Thus, let a population represented
by 1 become 1 + 2 in the first year; then :—

Lil+errl+2:( 42) x4) =14 2742.
Thus the increment of (1+7) is ¢ + 2; the ¢ growing out of the
population represented by 1, and 2? growing out of the population repre-
sented by 7. The population in two successive equal intervals of time
will be in the ratio 1: 1 +2:1+4+22¢+2?; and the arithmetical mean

of the first term and the third tem =1-+47 +4 53 which in a short

time, or when 7 is a small fraction, differs inappreciably from the middle

2
term (1 + 2), for the 5 may be neglected. And so it is if the mean

of several terms is taken. The result, therefore, in such cases, differs
little from the result which is obtained under the second head.

The division of the average annual deaths by the arithmetical mean

population of the extremes, understates the mortality ( . =m), which

varies inversely as the population. For the same reason the division
by the population living in the middle of the period overstates the
mortality. The shorter the period the less is the error; indeed the
two values approximate indefinitely as the period is shortened, and as
LIFE TABLES. | 487

the ratio (7) recedes to unity. Either divisor may be employed where
great precision is unattainable, or is not required.

The mean population existing at the two points equidistant from the
two extremes—in 1841 and in 1851—is near the true mean population
living through the 17 years 1838-54. By taking these years the
error in the years of life is reduced to a minimum.

Thus the mean population of the age 15-25 was by the different
methods :—

MALEs :—

ots 1,591,550 = true mean population, on the hypothesis
that the population increased in geo-
; metrical progression at a uniform rate.
Pa + Pa — 1,591,618 = arithmetical mean of the population living
= 7 ‘3 in 1841 and 18651. |
Se 1,595,424 = arithmetical mean of the population living

2 at the beginning and end of the 17
ears.

rt P, = 1,589,606 = population living in the middle of the
period.

The annual rate of mortality is determined for the several periods of
life by dividing the deaths at each age by the contemporaneous years
of life out of which they occur. If P represents the years of life enjoyed
by men of the age of 20 and under 380, and d the corresponding deaths,

d
then P

100 » = the annual rate per cent.

= m = the annual rate of mortality among the men of that age.

AverRAGE ANNUAL Rate of Mortatity in ENGLAND and WALES
in the 17 years 1838-54.

 

 

 

 

Acus. PERSONS. Mates. FusAys,
All Ages *02245 *02328 *02165
0- *06738 *07250 “06228
5- “00916 *00920 “00911
10- *00527 “00517 *00538
15- *00838 *00822 *00853
25- *01028 *00999 *01055
35- *01277 *01283 *01270
45- °01715 °01851 °01587
55- *02992 °03183 *02816
65- 06319 *06689 *05999
75- *14027 *14758 *13437
85- *28820 *30136 °27915
95 and upwards *43501 *44031 *43223

 

 

 

 

 

 

The rate of mortality at each age is thus deduced from the deaths
registered at that age, and from the population of the corresponding age
enumerated at the Censuses. Now it is generally admitted that the
ages of a ceriain number of women are understated; and I had to
consider what correction was necessary upon this ground.

The probable extent of the error in the statements of women’s ages,
it was shown in the Census Report for 1851, is not considerable; but
as the effect of the error is not always understood, some explanation is
necessary.
488 [PART Vv.

The English Life Table is not deduced from the population or from
the deaths alone, but from the ratio the one bears to the other at
different ages ; and to display the effect of transfers from one age to
the other, assume that the following numbers represent the exact
numbers living and dying at the three ages 25, 35, and 45.

 

 

 

 

FEMALES.

A Annual Rate of

ge.

. oe Mortality.
oe Dying ina 3
Living. Year,

(2) Ps. d,. Mas

25 313,095 3,024 00966

35 281,506 8,279 *01165

45 247,434 8,555 *01437

 

 

 

 

 

 

The mortality, it will be observed, increases as age advances; so that
if all the women of 385 were returned as ten years younger than they
are, the mortality at the age 25 would be overstated; the excess being
*00199. But there is less chance of women of 35 being returned at
death as 25 than there is of their being so returned at the Census; and
the corrective effect of this excess in the proportion of women at the
Census transferred to the earlier ages is apparent, on inspection of
the formulas below. d represents the deaths, P the population, mm the
mortality, and r” the increase of the rate of mortality between the ages
25 and 85. Thus—

de; ds, d,

P, = Hig s P,, = 7 Mes ap, = Dy
It is evident that an increase in the population and a decrease in the
relative deaths transferred from 35 to 25 might reduce the error to
insignificance. From the numbers living at several periods of age a
series representing the numbers living at each year of age was obtained
by the method of finite differences; and from these numbers again
the living at the ages 25-35, 35-45. . . . . were obtained.
The residuary errors affecting the values m, are, it is believed,
inconsiderable.

Upon comparing the female rates of moriality with those of males,
and the rates of progression in the mortality of the two sexes, I have
come to the conclusion, after carefully weighing the facts, that this
correction is adequate ; that the rates of mortality represent very nearly
the mortality of the female population; and that the probabilities of
female life, deducible from the mortality, are substantively true,

The rates of female mortality are in singular accordance with those
deducible from observations on males; the mortality of females being
slightly higher at the ages 10 to 35 than the mortality of males at
home in Mngland.—(Introduction to English Life Table, No. 3

. se >
pp. xiv-xxii. )

Constitution of a Life Table, or Normal Population—The con-
stituent individuals of a population are its elements ; and the population
is normal when its elements, arranged in corresponding groups, are in
LIFE TABLES. | 489

the same proportions as the elements of the Life Table. The births
= deaths in the same time; to a given number born, the living at each
year of age are in the same proportion as P, to é,; the rates of mortality
are the same ; the population lives a number of years after each age,
represented by the calculated lifetime.

In a normal population there is an indissoluble connexion between
(1) the numbers living, (2) the mean lifetime, (3) the births, (4) the
deaths, (5) the rate of mortality, (6) the probable duration of life.
Thus by the Life Table of Persons 1,000,000 annual births imply
1,000,000 annual deaths; sustaining a population of 40,858,184, of
whom 20,426,138 are males, 20,432,046 are females ; half of the persons
living 45 years = the probable lifetime; and the mean lifetime being
40° 858184 or nearly 41 years; that is = the mean age at death = the
number of years of life falling to the share of the children born. To
41 persons living there is one birth, one death, annually ; the rate of
mortality is 1 in 41; and 41 is the mean duration of life.

It has been shown that the rate of mortality involves three elements,
—time, numbers living, numbers dying; thus, if out of 102 living
men of a given age 4 die at equal intervals in the year, 98 will live

9
to the end of the year; so Be = the probability of living a year ;

102
iad = the probability of dying in the same time; and by hypothesis

102 + 98
——

the 102 men in the year enjoy among them = 100 years of

life; now the years of life to be passed by the survivors in the next
year will, if 4 diein the year, be 96, and thus the years of life will
accumulate year by year, until the last life shall expire. All the years
of life belong to the 102 men; and dividing the said years of lite by
102 the mean afterlifetime is determined. ‘Thus the units of the
numbers that express living men, men dying, and years of life, are
produced by men living a definite number of years and then dying.

By retaining one unit of time, and one living, in all cases, the varia-
tions of the numbers dying express the variations in the rate of mortality.
By fixing the numbers living, and taking the death as a unit, the mean
interval of time—which varies—between each death, will express the
velocity of dying in the scale of time, under different conditions ; and by
making the living man a unit, the death becomes a unit, and the
variations in the years of lifetime express the different degrees of
longevity. By making the time a unit (one year), and the death a
unit, the variations in the numbers living, out of which 1 death occurs
annually—or the relative amount of resistance to death by life is
expressed—under the given conditions. One death in one year to 41
living implies a mean lifetime of 41 years. It was shown before that
41 persons living through one year enjoy the same number of years of
life as one person living forty-one years. :

In a population which is disturbed by emigration, by immigration, by
varying excesses of births over deaths or of deaths over births, or by
pestilence, the mean age of the dying (Gy) can be determined from the
registers by arranging the deaths consecutively in a column (d,) at
the various ages, and drawing up from this column the columns
corresponding to é, and L,, or even to Q,. But people are born in one
place, die in another, and moreover the number of births is scarcely
ever the same us the number of deaths. So there is no necessary
connexion between the ages of these persons at death, the rate of
mortality, the probability of living, or the mean duration of the lives
of children born and living in precisely the same circumstances. The
490 [PART V.

results nearly coincide sometimes with those deduced, on correct
principles, from a life table; and the early life tables of Halley,
Simpson, Dr. Price, and others, were constructed from the burial
registers of Breslau, London, and Northampton, without any reference
to the living. The errors of such tables are illustrated in the Appendix
to the 8th Report of the Registrar General, where the old incorrect
Northampton Table is compared with a new table for Northampton
constructed on nearly the same plan as the English Table.*

The mean age of those who died in England in the 17 years 1838-54
was 29°4; whereas the mean lifetime of children born in England
during the same period is 40°9 years by the life table. This reduc-
tion of the age at death, 11°5 years below the mean lifetime, is the
result of the introduction of an excess of young lives; as in addition to
the 880,631 births to balance the 380,631 deaths, 191,068, making
571,699 children in the whole were born aunually and thrown into the
population. The mean age of the dying = the mean age to which
people live, in a normal population; but as our population is increasing,
the mean age of the dying in a limited time is 11°5 years less than the
mean lifetime. The mean age of the population of England was 26°4
years in 1851, instead of 82'1 years; so the excess of young people
reduces the age of the nation by 5°7 years, or by half the difference
(= >) between the age at death (29°4) and the mean lifetime
(40:9). Instead of living as long as they have lived (26:4 years),
they will live about 35°6 years (= E,.,.)—(Introduction to English
Life Table, No. 3, pp. xxxi-xxxvii).

The Rate of Mortality and the probability of Dying.—If on an
average of years out of 1,000 children born simultaneously, 149 die
in the twelve months following the date of birth, the probability of
dying is expressed by the fraction 0-149: that is the death-chance
of a new-born infant under the given law of mortality. As 851 of them
survive, 0°851 is the fraction to express the probability of living ; it is
the life-chance. Now ‘851 + °149 = 1=life-chance + death-chance.

This probability is often expressed thus: the chances are 851 to 149
that a new-born child will live a year. The value of £1 payable if the
child should live a year is 17s. (£°851); the value of £1 payable on
the death of the child is 3s. (£°149); the chances in favour of life
being greater than the chances in favour of death.

The lives may be looked at with a view to determine the persistency
of the life-force; which is such in the present case, that 851 live out
of 1,000 during one revolution of the earth; at the age of 20 it is such
that 992 out of 1,000 men live a year. The proportions vary under
varying conditions, but these variations do not accurately denote the
vital force, which is only correctly measured on the scale of mortality.

The mortality is determined by the ratio which the deaths bear to
the years of life. ‘The men living, and the time expressed in years,
“‘ multiplied into each other, produce the years of life with which the
“ deaths are compared. A year of life is the lifetime unit’ It is
represented by one person living through a year; or by two persons
living through half a year. A regiment of an average strength of
1,000 men during three years represents 3,000 years of life; and if the
deaths in the three years are 60, the rate of mortality is thus expressed ;

60
m= 3000
* See Extract on pp. 480- 2.
}. See Introduction to English Life Table, pp. xiv-xx; and extract on pp. 485-8,

= ‘02; or the mortality is said to be at the rate of 2 per cent.

 
LIFE TABLES. | 491

per annum. The 100 years of life are a fixed quantity; and as it is
found that under various circumstances, and at different ages, the rate
varies from 1 to 2, 3, 4, 5 up to 50, this scale serves to measure the
life-force, or the complementary death-force, in the same way as
the centigrade scale of the thermometer serves to measure heat.

A thermometer is not a convenient measure of heat unless at all
temperatures it contains the same quantity of mercury, and unless each
degree measures equal expansions of the mercury. If the mercury
escapes, a correction is required to give the expansion of equal quantities
of mercury at every degree of temperature. In observing with the
barometer, the measure is adjusted at both ends, so as to give the exact
height of the column above the mercury in its well.

So, to determine the rate of mortality on a strength of 1,000 men
joined by no recruits, it is necessary to take their mean strength during
the whole period of observation; for if one man dies at the end of a
week, 999 only remain afterwards exposed to risk, and if the numbers
are reduced at variable intervals to 990, to 985, to 911, to 700, to 600,
and so on, it is evident that the years of life in the same time will be
less than the years of life in a regiment which obtains a recruit for
every casualty. All that is required in such cases is to take the obser-
vations so as to give the true years of life; and the ratio which these
years of life bear to the deaths is the exact measure of the mortality.
It is evident, on the other hand, that such a measure is not supplied by
a comparison of the deaths in a year, for example, to the living at the
beginning of that year. The results by this method are only strictly
comparable when the deaths are in the same proportion and occur in
the same periods of the year.

By the English Life Table 1,000 infants followed through their first
year of age yield nearly 903 years of life; and the mortality is at the
rate of aed or, more correctly, en = 116559. Itis 16559 per cent.
per annum. The probability of dying is +149493; and upon the
erroneous assumption that this is the rate of mortality it would be
14°949 per cent. per annum; less by 1°610 than the true rate, with
which it should never be confounded.

At other ages than the first year the rate of mortality serves to give
the probability of living a year, and thus supplies the fundamental
elements of a life table. The difference between the rate of mortality
(m}, and the probability of dying (1—p), becomes less in proportion as
the two fractions diminish; for upon the hypothesis that the deaths in a
year occur at equal intervals in the year, the relation of p and m is
thus expressed :

_il-—jtm_ 2-—m.
P=T+4m—~ 24m.
' (Supplement to 25th Annual Report, pp. iv-v.)

General Description of a Life Table; Healthy Districts..—The
Transactions of the Royal Society contain the first life table. It was
constructed by Halley, who discovered its remarkable properties, and
illustrated some of its applications. The Breslau observations did not
supply Halley with the data to frame an accurate table, for reasons
which will be immediately apparent; but the conception is full of
ingenuity, and the form is one of the great inventions which adorn the
annals of the Royal Society.

Tables have since been made correctly representing the vitality of
certain classes of the population; and the form has been extended so as
to facilitate the solution of various questions.

 
492 [PART V,

In deducing the English Life Tables from the national returns,
I have bad occasion to try various methods of construction; and I now
propose to describe briefly the nature of the life table, to lay down
a simple method of construction, to describe an extension of its form,
and to illustrate this by a uew table representing the vitality of the
healthiest part of the population of England.

The life table is an instrument of investigation; it may be called
a brometer, for it gives the exact measure of the duration of life under
given circumstances. Such a table has to be constructed for each
district and for each profession, to determine their degrees of salubrity.
To multiply these constructions, then, it is necessary to lay down rules,
which, while they involve a minimum amount of arithmetical labour,
will yield results as correct as can be obtained iu the present state of
our observations.

A life table represents a generation of men passing through teme ;
and time under this aspect, dating from birth, is called age. In the
first column of a life table age is expressed in years, commencing at 0
(birth), and proceeding to 100 or 110 years, the extreme limit of
observed lifetime.

If we could trace a given number of children, say 100,000, from the
date of birth, and write the numbers down that die in the first year,
living therefore less than one year against 0 in the table, and on
succeeding lines the numbers that die in the second, third, and every
subsequent year of age until the whole generation had passed away,
these numbers would form a Table of Mortality, showing at what ages
100,000 lives become extinct.

Again, if the 100,000 children were followed, and the numbers living
on the first, on the second, and on every subsequent birthday until none
was left, the column of numbers would constitute a Table of Survivor-
ship. So if of 100,000 children born at a given point of time, the
numbers dying (d,) in each subsequent year were written in one column,
and the numbers surviving (¢,) at the end of each year in another
column, the two primary columns of the life table would be formed.

It is evident that if one of these columns is known the other may be
immediately deduced from it; for if of 100,000 children born 10,295
die in the first year of age, 3,005 in the second year of age, it follows
that the numbers living at the end of one year must be 89,705, at the
end of two years 86,700. Upon adding the column (d,) from the bottom
up to the number against any age (x), the sum will represent the whole
of the numbers dying after that age; and consequently the numbers
living at that age, as shown in the collateral column (/,).

The 100,000 children born at the same moment, and counted annually
to determine the numbers living at the end of every year, would by
our table completely pass away in less than 107 years. If another
generation of 100,000, born a year afterwards, were followed, the
numbers dying in the various years of age would not be very different,
the circumstances remaining the same; and the numbers of those
entering each year of age would vary inconsiderably from those of the
first series. If 100,000 children again were born at annual intervals,
and were subject to an invariable law of mortality, they would form a
community of which the numbers living at each age would be repre-
sented by the successive numbers (é,) in the life table. The sum of
these numbers, by the new Table of Healthy Districts, would be
4,951,908. The births are here assumed to take place simultaneously
at annual intervals; immediately before the births, therefore, in such
a community its population would be 4,851,908, to which it would fall
progressively from 4,951,908 by 100,000 successive deaths in the year.
LIFE TABLES. | 493

The average number constantly living would be some number between
4,951,908 and 4,851,908; and it would be very nearly the mean of
these limiting numbers.

In the ordinary course of nature, the births in a community take
place in remittent succession; and if it is assumed that the 100,000
births occur at equal intervals over every year, it is evident that at any
given date a certain number will be found living at all the intermediate
points of age between 0 to 1 year, 1 to 2, 2 to 3, and all the remaining
years of age. The population in the above instance would be found by
enumeration to be nearly 4,899,665.

The annual births would be 100,000 in such w community. The
annual deaths wonld also be 100,000; and by taking out the deaths at
each year of age, from the parish registers of a single year, the second
column (d,) of the life table would be found. By adding this column
of deaths up and entering the sum of the numbers year by year against
every year of age (x), the third column (J,) of the life table would be
obtained; for it has been already shown that the numbers attaining any
age x are equal to the numbers dying at that age, and all the subsequent
ages. From the registers of the deaths, a table of the numbers of the
population living in a parish so constituted could be immediately deter-
mined without any enumeration. Its deviations from the truth would
be accidental; and they would be set right by taking the mean of many
years. So also from a simultaneous enumeration of the numbers living
in each year of age, the two columns d, and /, of the life table could
be constructed without reference to any registry of the deaths at
different ages.

The mean age at death in such a community would express the mean
lifetime, or the expectation of life at birth; and the product of the
number expressing the annual births multiplied into the mean age at
death would give the numbers of the population.

The deaths in each year of age are called the decrements of life.
The decrement in the first year is large; in the first five years the
decrements of life are considerable; at the age of 10 to 15 they fall to
their minimum ; slowly increase to the age of 56; increase more rapidly
until the maximum is attained at the age of 75; then decline gradually
to 85, and after that more rapidly until every life is extinct at the age
107 by this table. (‘On the Construction of Life Tables, illustrated
by a new Life Tuble of the Healthy Districts of England,’ in the
Transactions of the Royal Society, 1859, pp. 838—41.)

Basis and uses of the Healthy District Life Table——Halley first
pointed out the financial applications of the life table, and first caleu-
lated the values of life annuities. ‘That branch of science, in the various
forms of life insurance, has since received great developments. The
new table shows that the duration of life, among large classes of the popu-
lation by no means in unexceptionable sanitary conditions, exceeds the
term of the ordinary tables, and proves that life annuities cannot be sold
advantageously by offices, or by the Government, to large classes of
lives for less than the values deducible from the new table.

A new branch of science has been developed since Halley’s day,—it
is the Science of Public Health. And here a new application of the
life table is found.

It is probable, upon physiological grounds, that man goes through all
the phases of his natural development in a hundred years; and that the
period of active life seldom extends beyond eighty years. But this is a
very indefinite measure, as the rates of mortality, in all the intermediate
ages, are left undetermined after it has been ascertained in what
proportions men attain the extreme limits.
494 [PART Vv.

Generations of men, under all circumstances, die at all ages; but the
proportions vary indefinitely under different conditions from a slight
tribute to death each year, down to the point of extermination by
pestilence. If we ascertain at what rate a generation of men dies away
under the least unfavourable existing circumstances, we obtain a
standard by which the loss of life, under other circumstances, is
measured; and this I have endeavoured to determine in the Life Table
of Healthy English Districts. And recollecting that the science of
public health was almost inaugurated in England by a former president
of this society (Sir John Pringle), who encouraged and crowned the
sanitary discoveries of Captain Cook, I feel assured that it will receive
with favour this imperfect attempt to supply sanitary inquirers with a
scientific instrument.

Heattuy Districts.—Population, 1851. Deaths in the Five Years
1849 to 1853. Average Annual Mortality per cent.

 

 

 

 

 

Average Annual Mortality
Population. Deaths. to 160 living (m).
Ages.
Persons.| Males. | Females. Persons.) Males. | Females.] Persons.| Males. | Females,
1. 2. 3. 4, 5. 6. is 8. 9. 10.
Allages - | 996,773 | 493,525 | 503,248 87,345 | 43,736 43,609 1°753 | 1°72 1°733
Under 5 - | 130,635 | 65,700 64,935 26,361 | 14,282 12,079 4°036 | 4°348 3°720
5 > | 122,406 | 61,733 60,673 4,209 2,080 2,129 “688 674 702
10— - | 110,412 | 56,651 53,761 2,377 1,087 1,290 °431 "384 “480
15— - | 181,339 | 90,066 91,273 6,603 3,113 3,490 *728 “691 765
25— - | 136,892 } 65,422 71,470 5,869 2,675 3,194 857 "818 “894
35— - | 108,056 | 52,734 55,322 5,208 2,447 2,761 “964 °928 “998
45— - 85,244 | 42,383 42,861 5,252, 2,698 2,554 1°232 | 1°273 1°192
55— 7 62,857 | 31,105 31,752 7,001 3,568 3,433 2°228 | 2°294 2°162
65— - 39,453 | 18,860 20,593 10,313 5,173 5,140 57228 | 5°486 4°999
i5— - 16,737 7,718 9,019 10,297 4,946 5,351 | 12°304 | 12°817 | 11°866
85— - 2,614 1,097 1,517 3,581 1,555 2,026 | 27°399 | 28°350 | 26°711
oe Ue 128 56 72 274) 112] 162} 42-813 | 40°000 | 45-000

 

 

 

 

 

 

 

 

 

 

 

The Healthy District Life Table was constructed in 1859 from the
Census enumeration of 1851 and from mortality observations extending
over the five years 1849 to 1853 in 63 districts of Kngland and Wales
which showed during the ten years 1841-50 a mean annual death-rate
not exceeding 17 per 1,000 persons living. It has been found by
experience that this Healthy District Life Table expresses very
accurately the actual duration of life among the clergy and other classes
of the community living under favourable circumstances—(“ On the
“© Construction of Life Tables, illustrated by a new Life Table of the
“ Healthy Districts of England,” in the Transactions of the Royal
Society, 1859, pp, 838-41.)

 
495

CONTENTS

OF

PART VI.—MISCELLANEOUS.

INTRODUCTION.

1. Sickness, anD Heatrn Insurancy.—Relation of Sickness to Mortality.--

- Sickness and Mortality, at various ages and from different diseases.—Early

Sickness Tables.—Definition of Sickness.—Sickness and Friendly Societies.—

Sickness among Dockyard Labourers.-—Sickness among Labourers employed

by the East India Company in London, 1823-34.--Sickness in the Metro-

politan Police Force.—Sick-time increases with Age in Geometrical’
Progression.-—Health Insurance.

2, ELementary Epucation.-—-Education and Signatures in the Marriage Register.
—-Elementary Education and Crime.—Signatures at Marriage as an Educa-
tional Test.--Intermarriage of Persons who can write with those who sign by
mark.——Elementary Education in England and in Scotland, 1862-4.--Progress
of Elementary Education.

8. Crvin ReEGistRATION OF Marriaces, Brrtus, anp Deatus.—Defective
Registration of Births and of Deaths, 1837-75.——Results of Civil Registration
and Improvements in Civil Registration Law effected by the Act of 1874.--
Registration Sub-districts of England and Wales, 1872.—Delay in the
Publication of the Registrar General’s Annual Reports.

4. Cost, AND THE PRESENT AND FuturE EconoMIc VALUE OF Man.

5. Risk or Fatat Raitway AccipENTs, AND INSURANCE AGAINST DEATH OR
Ingury THROUGH RaiLway ACCIDENTS.

6. Famity NoMENCLATURE IN ENGLAND AND WALES.
497

PART VIL—MISCELLANEOUS.

INTRODUCTION.

Tue selections embraced by the Parts devoted to Population,
Marriages, Births, Deaths, and Life Tables have occupied so large a
portion of the available space in this volume that the selection from
Dr. Farr’s writings in other branches of statistics has necessarily been
very restricted.

The first section of this Miscellaneous Part deals with sickness and
health insurance. The social and public-health aspects of sickness
invest with unquestionable interest and importance all trustworthy
statistics bearing upon this subject. The scarcity of such statistics, and
the difficulties of even defining practically and satisfactorily the term
sickness, are discussed, in the extracts given in this section. As there
is no national system of registration of sickness, Dr. Farr had to content
himself with the best available information from independent sources for
that portion of his article on Vital Statistics in MceCulloch’s British
Empire dealing with this subject, from which several extracts are
printed in the following pages. These independent sources included
friendly society returns, and returns of sickness among dockyard
labourers, labourers in the East India Company’s service, and in the
metropolitan police force. Sickness returns, apart from their value as
a complement to returns of mortality, supply the only trustworthy basis
for the calculation of tables for health insurance, or rather for sick-pay
allowances. The national importance of health insurance, both from a
social und political standpoint, was fully appreciated by Dr. Farr, who
strongly advocated the advisability of establishing a government system
of health insurance; partly on the ground that the financial condition
of so many friendly societies was far from satisfactory, thus tending to
check this form of thrift in the working classes, which, if fully
developed, would materially reduce the expense of poor-law relief.
Recent legislation has given a more healthy financial tone to friendly
societies, but the condition of many of them is still far from satisfactory,
and the position of not a few borders on bankruptcy, threatening disastrous
loss to members whose contributions have been paid out of hardly-earned
wages.

The Registrar General’s educational statistics, based upon the steadily
declining proportions of signatures by mark in the marriage Register,
afford trustworthy and thoroughly impartial evidence of the improve-
ment of elementary education during the past half century. Dr. Farr
initiated this branch of statistics in the early days of civil registration,
and there are few of the first 40 Annual Reports of the Registrar General
that do not contain pertinent comments on this subject. A selection
from these comments appears in the following pages ; and for the benefit
of those whose interest in the subject may lead them to wish for further
acquaintance with these statistics, it may be worth noting that in the
31st Annual Report, on pp. xxxvi-xliv, will be found a reprint of
a larger selection of these comments than could be provided for in this

Il
498 [PART VI.

volume. It was not unreasonably claimed for these statistics, and the
repeated deductions therefrom, that they “incidentally helped to
“ strengthen the movement in favour of State education for the poor,”
which bore fruit in the Education Act of 1870.

The third section of this Part contains «a few extracts bearing
upon the history and defects of civil registration of marriages, births,
and deaths, and upon the improvements and changes therein effected by
the Births and Deaths Registration Act of 1874.

The remaining sections contain selections from contributions upon the
“ Cost and Economic Value of Man,” on “ Risk of Fatal. Railway
“ Accidents, and Insurance against Death or Injury through Railway
“ Accidents,” and on “ Family Nomenclature in England.”

A reference to the biographical sketch of Dr. Farr at the commence-
ment of this volume will show that froma considerable proportion of
his work no extracts have been selected for these pages. The intention
of those who initiated and carried out the proposal to publish this
memorial volume was to make it as far as possible a storehouse of the
facts and principles concerning Vital Statistics deduced and enunciated
by Dr. Farr in the course of his laborious and useful career. With this
object in view it was inevitably necessary to confine the selection as far
as possible to those workg which most intimately and directly dealt with
that subject. This, and no want of appreciation for other work of
Dr. Farr’s pen, has led to the exclusion of much matter of undoubted
interest and value, although not distinctly bearing upon pure Vital
Statistics.

Epviror.

1. Sickness, AND Hrattu INSURANCE.

Relation of Sickness to Mortality.—It appears that in manhood, when
1 person in 100 dies annually, 2 at the least are constantly sick; and
although this exact relation is, perhaps, not preserved in infancy and old
age, or where the rate of mortality deviates much from the standard, it
may be safely assumed as an approximation to the truth. Admitting,
then, that the annual mortality is 2°19 per cent., after the corrected
returns, and that the population of England and Wales is at present
(1846) 17,000,000, the total number constantly disabled by sickness will
amount to 744,600 persons ; and if the same proportions be extended to
Scotland and Ireland, to 1,247,000. This reduces the efficient popula-
tion of the empire 1-23rd part ; and the productive power, as far as it
depends on human labour, 1-15th part, if the maintenance and attend:nce
of the sick cost half the preduce of their labour in health :* an example
will show how it would be erroneous to suppose that two populations,
in which the same absolute proportion of sick existed, suffered con-
sequently to an equal extent. ‘Two-fifths of the registered deaths occur
below 5 years of age, yet the mortality in England has latterly (1841)
not been more than 63°5 per 1,000 at this early age : in Sweden it was
(1755-75) 90°1 per 1,000; and it is probable that at the same period
the mortality of infants in England was not a great deal lower than in
Sweden; so that, if sickness have diminished at the same rate, the
proportion of infants constantly ill is not by one-third so great as it was

 

* In the English provincial hospitals the maintenance and the drugs administered
to each patient cost Is. 5d. daily ; in Paris, 1s. 5$d.; in London considerably more,
—(British Medical Almanac, p. 118.)
MISCELLANEOUS. | 499

a century ago. But children being entirely helpless, and in no way
contributing to the nation’s actual strength, a diminution of sickness
among them, however desirable, adds little immediately to national
power and happiness, compared with an improvement in the health of
adults, between the ages of 15 and 60 years, such as has been observed
in London since the 16th century, when the destructive epidemics
ceased.

The magnitude of the subject, and the fact that a million and quarter
of the inhabitants of the United Kingdom are disabled by disease and
suffering, is of less importance than the consideration that their con-
dition may be vastly ameliorated. In one class of districts the mor-
tality of boys below 5 years of age, is 145 in 1,000, in another 48 in
1,000 : between the ages of 15 and 55 it varies from 18 to 11, imply-
ing a difference of 14 men constantly sick in 1,000 living. In the
former districts about 36, in the latter 22, are constantly suffering from
disease, and absolutely disabled from labour. If the population of the
United Kingdom, and the adjacent islands (28,487,000), were as un-
healthy as that of Liverpool and Manchester, 1,937,000 would be ill,
and 968,500 would die annually; whereas if the whole people enjoyed
as good health as the inhabitants of other parts of England, only
1,026,000 would be constantly ill, and only 518,000 would die annually
on an average. In the former case, the mean duration of life would be
25 years, in the latter 45 years. Whether it be possible or not to raise
the standard of health to the height enjoyed in the healthiest counties,
or to one still higher, the importance of the subject recommends it to a
careful experimental investigation; because, when the character and
causes of our diseases are known, some provision may be made for their
alleviation ; the extent of the injuries which they inflict upon the public
will be determined ; and the standard of salubrity, indicating an increase
or diminution of physical strength, will afford the best index of the
prosperity of the nation, and of the extent to which it is affected by
atmospherical, political, or economical influences. (McCulloch’s Account
of the British Empire, Article “ Vital Statistics,” Vol. IL., pp. 542-3.)

Sickness and Mortality at various Ages, and from different Diseases.
—The rate of mortality declines as age advances from birth to puberty,
and then increases according to certain determinable laws. The mor-
tality decreases to the age of puberty, and then increases somewhat
slowly to between 50 and 60. After the age 55 the mortality increases
at such a rate that it is doubled for females every 8°24 years in the
healthy districts, and every 8°95 years in England and Wales. At the
ages 20-50 the mortality of females increases one sixth part for every 10
years of age in the healthy districts, and so would not be doubled at that
rate in less than 47 yeats. In England the mortality of females (20-50)
increases nearly one fourth part every 10 years of age; the mortality of
males (20-40) increases somewhat faster, and from 40 to 50 the increase
is intermediate between that of the previous age and the future, which
may be called the final age increase-rate.

It may now be shown that there is a certain relation between the
number of deaths by any disease and the number of attacks by that
disease. Some diseases are fatal to nearly every one they attack, and so
they can occur but once in a lifetime: such are hydrophobia, glanders,
cancer, tetanus, tabes mesenterica, phthisis, hydrocephalus, softening of
brain, some heart diseases, aneurism of aorta, angina pectoris, ascites,
ileus, perforation of intestine, ischuria, Bright’s disease, Addison’s
disease, diabetes, ovarian dropsy (without operation), cyanosis, fractures

Ir 2
500 [PART VI.

of base of skull, wounds of vital parts; extensive burns; poisoning by
high doses of prussic acid, strychnia, and other poisons, solid, liquid, and
gaseous; submersion under water for a few minutes ; suffocation. Every
death here represents one case of disease or injury. As medicine affords
alleviation but cannot cure, their prevention is the great end to be
aimed at.

Apoplexy and paralysis are fatal generally after two or three attacks.

Then there are two other great classes of diseases; (a) one is fatal to
a certain number of the attacked, and (b) the other causes inconvenience,
but is not fatal.

Of the first class, certain diseases, as a general rule, attack a patient
only once, and that in early life; such are small-pox, measles, scarlet
fever, whooping-cough, enteric fever. The deaths imply a number of
attacks varying with age: thus it has been shown that the mortality was
such in the London Small-pox Hospital, that there was 1 death to 2:44
cases in children under 5 years of age; 1 in 2°93 at the ages 20-30;
and in the two next decenniads 1 in 2°15 and 1in1°71.* According
to a report of the Committee of the Metropolitan Asylum District, 1872,
the mortality from small-pox after the age of five was half as high, but
increased in the three decenniads of age 20-50 ; it increased at the same
rate, the deaths being | in 5°98, 1 in 4°22, and 1 in 3°40 among the
vaccinated and unvaccinated taken indiscriminately ; the mortality of the
unvaccinated being much higher than the mortality of the vaccinated.
So the mortality from cases of fever has been shown to increase with
age,

“When the cases to one death at the respective ages have been de-
termined, the attacks from each disease can be calculated from the deaths
by that disease in the expanded life table (pp. xciv-v of this Report).

The mortality of the cases of cholera in London, 1854, was such, that
to one death there were only 2 cases; but the death-rate ranged with
age from 1 in 1°86 to 1 in 2°86.f Then the contemporaneous epidemic
of diarrhoea was not by a thirtieth part so fatal; there was, taking all
ages, one death in'61 cases: in children under 5 one death in 17 cases;
in adults of 35-45 only one death in 199 cases; the mortality in old age
increasing rapidly. By applying the proper factors the attacks of
cholera or diarrhoea are calculated from the deaths.

There is a peculiar class of the sometimes fatal diseases that are re-
current; such are intermittent fever, remittent fever, neuralgia, rheuma-
tism, gout, epilepsy, asthma; one attack, far from precluding, facilities
another apparently, so that one death may represent several attacks by
the same disease of the same person.

Among the diseases to which the deaths give little or no clue, because
theh are rarely or ever fatal, may be reckoned chicken-pox, cow-pox,
febricula, mumps, gonorrhea, primary syphilis, epistaxis, varicose veins,
nevus, toothache, tonsillitis, dyspepsia, worms, hemorrhoids, gastrodynia,
hydrocele, orchitis, paramenia, flat feet, obesity, corns, skin diseases of
various kinds, slight wounds and injuries.

A vast amount of incapacity in the army arises from these causes ; and
the necessity of recording the cases of diseases, both fatal and not fatal,
is evident. But it is to be borne in mind that a death is a much more
evident thing than attacks of disease varying indefinitely in intensity.
The death returns are the basis of all sanitary statistics. (Supplement
to 35th Annual Report, pp. xxxv-vi.)

 

* M‘Culloch’s Account of the British Empire, vol. 2. Article, “ Vital Statistics,”
p. 594.

t+ Report of General Board of Health, Committee of Medical Council on Cholera
Epidemic of 1854,
MISCELLANEOUS. | 501

Early Sickness Tables.—A. Bill, embodying a plan for enabling the
labouring poor to provide support for themselves in sickness and old
age, by small weekly savings from their wages, was introduced by
Mr. Dowdeswell, and approved by the House of Commons, in 1773; but
it met with the same fate as another Bill framed by the Commons in
1789, and founded on tables computed, at the request of a committee, by
Dr. Price. The Lords rejected both Bills; and thus deprived the
labouring poor of the guidance of a legislative Act in the formation of
friendly societies for half a century. The tables of sickness, computed
for the first Bill, were published by Baron Maseres in the second volume
of his Treatise on the Doctrine of Life Annuities : Dr. Price’s tables,
which have till latterly been in general use, were published, in the edition
of his work on Annuities, by Mr. Morgan. These tables were founded
partly on observations and partly on an ingenious hypothesis: no exten-
sive observations were ever made to determine the average time of inca-
pacitation from labour produced by sickness, till the subject was taken
up and investigated by the Highland Society (1824). Since then two
committees of the House of Commons have sat on benefit societies, and
the subject has obtained more attention. (McCulloch’s Account of the
British Empire, Vol. II., Article “ Vital Statistics,” pp. 570-1.)

Definition of Sickness.—Sickness, in practical statistics, is employed
in a general sense. If we consider man as a material body, acting intelli-
gently, anything in the condition of the body itself, which interrupts or
impedes that action, is sickness. Any disturbance in the functions of
the body, or alteration in the organs by which they are executed—from
the skin to the brain and spinal marrow—from the time the food enters
the mouth, till it exhales from the skin and lungs in vapour and gas—is
a disease : and the sum of sick-time, produced by all diseases, constitutes
the sickness of which statisticians speak. It is of various kinds. In
acute or severe diseases, such as fever, inflammation of an important
part, or malignant ulcer, a man is often able to think and move, just as
he can digest a small quantity of food; but not with any energy, or at
least with the energy required by an ordinary occupation. Any attempt
at exertion aggravates and prolongs the sickness. This, we believe, is
called bedfast sickness by the friendly societies. In other chronic
diseases, slow inflammations of internal organs, reduced dislocations,
rheumatisms, ulcerations, the patient. can attend partially to his business :
he is in possession of half his faculties; whether he can make them in
any way available depends on circumstances. This is walking sickness.
The infirm, the crippled, the maimed, may either be entirely helpless and
bedridden, or capable of some of the duties of life: their sickness differs
from the bedfast, and from the walking, in being beyond the pale of
recovery. The Highland Society calculated that of ten weeks’ sickness,
among persons of all ages under 70, two may be assumed as bedfast
sickness, five as walking, and three as permanent.* (McCulloch’s
Account of the British Empire, Vol. IL, Article “ Vital Statistics,”
pp. 571-2.)

Sickness in Friendly Societies.—The following table of sickness, from
the British Medical Almanac, presents a comparative view of the mean
proportion of sickness incidental to members of English and Scotch
benefit societies; according to (1.) the observations of the Highland
Society; (2.) returns obtained by Mr. Ansell, and published in his work
by the Society for Promoting Useful Knowledge ; and (8.) a table of

 

- * Report of Friendly Societies, by a Committee of the Highland Society, p. 108.
502 [PART VI.

Mr. Edmonds’s, agreeing very nearly with Dr. Price’s, at one time in
general use :-—

Proportion of Sick out of 100 Living at different Ages in Friendly

 

 

 

 

 

Societies.
Sick Time in 100 of Life Time. Sick Time in 100 of Life Time.
Between . Theroetical || Between . Theoretical
Scotch | English Scotch | English
Ase’. | Benefit | Benctit | S2bleby | Ages. | Benotit | Benefit | T7ble by
Societies.} Societies.) Gnas Societies.) Societies.) ‘7 onds.
20 to 30 1°14 1°54 was 70 to 80 32°50
30 — 40 1°32 1°83 2°30 80 — 90 favre 40°00
40 — 50 1°97 2°56 3°10 90 — 93 67°00
50 — 60 3°60 4°32 4°51
60 — 70 10°80 11°26 9°36
All Ages 2°45 2°76

 

 

 

 

 

 

These observations show, that, in the different circumstances, 1°32,
1°83, and 2°30 men in 100, between the ages of 30 and 40, were con-
stantly ill: the sick-time increasing regularly with age. It is easy to
deduce from this table the average days of sickness to each individual.

These Scotch and English observations represent, so far as limited
numbers can, the sickness to which men, who are healthy at the time of
entering benefit societies, are subsequently liable : the general proportion
of sickness is higher. Tables of sickness for the entire population
would be formed by taking 100,000 persons, of given ages, indiscrimi-
nately, and observing them for one, two, three, &c., years, they would
consequently comprehend 4,000 and 45,000 individuals sick when the
observation commenced expressly excluded by the rules of benefit
societies, as well as those suffering from syphilitic diseases and accidents
incurred through drunkenness or brawls. In the parish of Methven,
Perthshire, it was ascertained that 35 out of 743, or 4:7 per cent. of the
male population above 15, would, from bodily or mental infirmity, not
have been admitted as members of the friendly societies.* Medical
men are well aware that labourers often go about their work with
diseases of the heart, tubercles in the lungs, and disorders of considera-
ble severity. Dr. Forbes ascertained, by the personal examination of
120 Cornish miners, in actual employment, that only 63 had good health ;
of the remaining half, 26 had diffictlty of breathing, 14 pain of chest, 10
pain of stomach and bowels, 5 lumbago, pain of shoulder, palpitation,
scrofula, or fits.f Out of 115 children below 18 years of age, Dr. Bisset
Hawkins states, that 84 had good health ; 25 middling health; 6 bad
health. Of the miners at work only 53, of the factory children only 73
per cent., enjoyed good health. How much sickness exists among the
actual labourers of this country, independently of those definitely inca-
pacitated by disease, and who are either discharged on this account or
set aside as inefficient, there are no satisfactory statistics for determining.
(McCulloch’s Account of the British Empire, Article “ Vital Statistics,”
pp. 571-2.)

We are indebted to Mr. Neison for a most important contribution to
vital statistics, in the shape of an inquiry into the sickness and mortality
experienced among the members of friendly societies. The data,
published in detail by Mr. Neison, have been derived from two sources.
One portion, relating to the friendly societies of England, was obtained

 

* Report of Friendly Societies, by a Committee of the Highland Society, p. 280.
} Medical Topography of Penwith, Cornwall, by J. Forbes, M.D.; Trans. of the
Medical Association, vol. iv. p. 187.
MISCELLANEOUS. | 503

through Mr, Tidd Pratt; and consists of the quinquennial returns for
1836-40, made under the Friendly Societies Act, 10 Geo. IV., c. 56.
s. 84, as amended by 4 and 5 Will. IV., c. 40, s.6. The other portion
was procured by Mr. Neison himself from the friendly societies of
Scotland. The abstracts, made under his supervision, and at his own
expense, have been liberally communicated to the public. They are the
most extensive returns of the kind extant; and the results are of
the greatest practical importance.

The returns of sickness and mortality are separately given for the
rural, town, and city districts of England and Scotland. They will be
found in a condensed form in the annexed tables.

The sickness returned in these tables is much higher than that given
in the previous returns of the Highland Society, and of Mr. Ansell.
Thus the amount of sickness experienced in the 30 years of age, from
20 to 50, is by the Highland Society’s returns 22 weeks, Ansell’s
31 weeks, Neison’s 33 weeks; from the age of 30 to 60 it is 24 weeks,
45 weeks, and 52 wecks in the respective returns. From 20 to 60 the
sickness does not differ materially from that experienced by the Hast
India Company’s labourers.*

Sroxyess in Frienpiy Socretiss according to various Returns.

 

 

 

 

Average Number constantly Sick to 100 living at each Age.
Friendly Societies,
Ages. East India
mpany’s
Ges England. Scotland. England. Labourers.
§ Be; ot ) (Ansell.) (Neison.) (Neison.)
20-30 114 1°54 1°65 1°69 1°62
30-40 1°32 1°83 1°66 1°91 2°06
40-50 1°97 2°56 2°44 2°89 2°69
50-60 3°60 4°32 5°17 5°21 6°58

 

 

 

 

 

 

The Society of Odd Fellows had, in the year 1844, nearly a quarter
of a million of members. The Board of Directors, at Manchester, pro-
cured a return in 1845, of which Mr. Neison gives the following
analysis :—

Anatysis of Returns made to the Mancuester Unity or Opp
Frttows for the Year 1844.

 

No. of Members out | Average

Average of which Sickness

No.of | Deaths Deans NowOt | | ay

District. | Members of Members’! Weeks’ to each
during | Members, ‘Wives Sickness, One One Member
1844. : Member | Member’s | expressed

died. Wife died. | in Weeks.

 

 

Rural - -| 66,208 608 434 57,795 108°89 152°55 0°873
Town - -| 77,070 700 554 70,435 110°10 139°01 0°913
City < - | 99,818 978 662 98,687 102°09 150°83 0°988
Whole Unity- | 243,126 2,286 1,650 226,917 106°35 147°34 0°933,

 

 

 

 

 

 

 

 

 

 

 

 

* See extract on pp. 508-11.
504 [PART VI.

In explanation of the above table, it may be stated that the rural
district is composed of those places the population of which is under
5000, the town district of those places the population of which is 5000
and under 30,000, and the city district of such places -as have a
population of 30,000 and upwards.

During the year 1844, it will be seen that the mortality for the
whole Unity was, as already stated, about 1 to every 106 members ;
while for the rural districts it was 1 in 109, for the town districts it
was 1 in 110, and for the city districts it was 1 in 102. The average
amount of sickness to each member is 63 days*.

The contributions in the Odd Fellows Society appear to be inade-
quate to secure a member the advantages which they promise for any
length of time, under an economical management ; and it would appear,
that the expenses are at present extravagant. The income in 1844 was
325,2001.; the expenditure 241,604/.; the sum paid to sick members
was 107,440/.; for funerals, district, and widow and orphans’ funds,
62,7432.; and sundries 71,4211! ‘The average age of the members is
32 years; and to secure 10s. a-week in sickness, 102. at the death of a
member, and 5/. at the death of a member’s wife, the annual payment
should, according to Mr. Neison’s computation be 1/. 14s. 5d. The
actual sum demanded according to the new scale, No. 1, is 10. 2s. 9d.
This is irrespective of 5s. or 6s. a-year in “‘ Sundries” to each member.
‘The premiums of those societies are not graduated according to age.
Upon the whole they exhibit, amidst much good feeling, a want of
knowledge, calculation, and foresight—which must involve the managers
in discredit and the members in deep distress, unless an immediate and
effective reform be carried out in all the lodges. The contributions
must be raised and graduated, the expenses cut down to the narrowest
limits.

In 1834 the number of members in the order was about 60,000, at
the beginning of 1846 the number was 251,727. The entrance fees
in 1844 amounted to 49,3822, so that upwards of 40,000 members
were initiated in the year; and as the increase of members was only
21,461 in that year, “upwards of 20,000,” say the directors, “must
“ have left the order after paying their initiation money and contribu-
“tions for a length of time.” This, although it neither denotes
stability nor confidence in the order, is a large source of revenue ; which
may be taken into account in estimating the resources, and fixing the
premiums.

Reverting to the tables of returns from other socicties, it will be
observed, that nearly one-third of the members are between the ages of
30 and 40; the greatest number appear to enter between the ages of 20
and 30; but new members come in at 380 and 40 and greater ages. The
returns for England are from an average number of 229,449 members
observed 5 years (1836-40), those for Scotland only from an average
of 5,879 members for 12 years (1831-42). Nearly six-tenths of the
English, and seven-tenths of the Scotch members belonged to “rural”
societies ; the remainder to societies in towns and cities. The mortality
in all the societies was comparatively low ; in the Scotch higher than
in the English ; and in the whole not higher than in Surrey, one of the
healthiest English counties. The mortality under 30 in England and
under 20 in Scotland, was somewhat higher in the rural than in the
town societies ; after those ages the mortality was considerably higher
in the towns and cities than in the country ; thus, in England, of
149,210 members of the age 40-50 only 1,378 died, while 1,520

 

* Observations on Odd Fellow and Friendly Societies, by F. G. P. Neison, F.LS.,
and Actuary to the Medical and Invalid Life Office. ,
MISCELLANEOUS. | 505

members died in the town and city societies out of 107,286 members.
The mortality in the country was °924, in the towns 1°417 per cent.
annually. The mortality in Scotland at the same age, 40-50, was
*997 per cent. in the rural, 2-097 in the city and town societies. The
higher mortality in the towns, Mr. Neison appears disposed io ascribe
to occupation, and the different “physical exercises” to which the
several “classes of society” are “habituated.”* We cannot agree
with him. That “physical exercise” and occupation have an effect
on the mortality is admitted on all hands; but Mr. Neison should not
have forgotten at the moment he was writing, that the excess of
mortality in towns among children under 5 years of age, and among
women is as'great or greater than any he has discovered among the
artizans and labourers belonging to friendly societies. From the age cf
10 to 60 there were in England to every annual death from 2°3 to 2°7
members constantly on the sick fund. The mean of the 5 decennial
periods is 2°5 years of sickness to every death; or in other words
2-5 members constantly sick to one death in a year. The ratio of the
numbers receiving relief to a death is least at the age of 30-40; when
the earnings of a man are greatest, and the calls on him from a
dependent family are most urgent; at a period, therefore, when the
difference between “wages” and “ sick-pay,” and his indisposition to
forego this difference, are at a maximum. We have seen that many
artizans are constantly at work while labouring under severe—to say
nothing of slight illness; and it is evident, that the illness, lameness,
or infirmity, which incapacitates a policeman from doing duty, or from
walking 20 miles a-day, would scarcely prevent a tailor and weaver,
from plying the need!e and shuttle. Instead of inferring from the
facts, as Mr. Neison.appears disposed to do, that sickness and mortality
are not connected together ‘as cause and effect ;” we should Jay it down
as a principle, not true, but somewhat the less paradoxical of the two,
that there is no connexion between the time men of different trades in
friendly societies are in the receipt of sick-pay and the actual
sickness which they experience. The variable extent to which equal
degrees of sickness are likely to throw artizans of different trades on
the sick fund, should be borne in mind, in advising societies, consisting
of two or three prevailing professions. The mortality is greater, the
sick-time less in the Scotch than'in the English societies; we do not,
know whether this is connected in any way with the cholera, which was
epidemic in the period over which Mr. Neison’s Scotch returns, and
not in that over which his English returns, extend. An epidemic like
cholera, in which the cases are of short duration and fatal, would
account for the anomaly in the Scotch returns, which are little more
than four-tenths in extent of those returned by English societies. At
the age of 60 and 70, when the earnings are inconsiderable, and
infirmities gain ground on the strength, there are four or five constantly
on the sick and pension fund to one annual death ; the whole of the
illness experienced probably appears in the returns; and much that in
earlier life would be shaken off, or not be called illness.

The members of friendly societies are selected men, and do not
exhibit either the mortality or sickness of the classes from which they
aretaken. Yet we are inclined to think the mortality of the members
still understated ; and that like the sick-time, it will be found to increase
with the successive returns. This may be put to the test by analysing
the returns for the 5 years 1841-5; which are probably, in conformity
with the Act of Parliament, now at the Home Office or the House of

 

* Con. to Vital Stat., pp. 109, 110.
506 [PART VI.,

Commons. The numbers who enter and leave the societies at each
age should also be ascertained. ‘The following are interesting tables,
showing the mortality and sickness rates in friendly societies, and tho
average duration of attacks of sickness.

 

Rurat. Town, AND CITY Ciry anp Town

RURAL Socirrizs.

 

 

SociETIEs. SOCIETIES.
Age. zeoa Sickness. | Popula- Sickness.| Popula- Sickness.
ion or tion or tion or pabieneeees,
Years of Deaths. ta Years of Deaths. a Years of Deaths. a
Life, Weeks. Life. Weeks. Life. Weeks.
9 65 = 30 50 - i 15 = 19
16 34,367 217 28,243 23,145 163 19,283 11.222 54 8,955

20 276,984 } 1,972 244,885 181,595 1,310 158,566 95,389 662 86,319
30 365,471 3,067 364,074 213,994 1,586 194,842 151,477 1,481 169,232
40 256,496 2,898 | 387,336 149,210 1,378 188,302 107,286 1,520 199,034
50 138,257 2,635 375,705 84,687 1,400 199,421 53,570 1,235 176,284

60 55,828 | 1,972 | 428,870 39,458 | 1,249 301,075 16,370 723 127,795

70 17,046 | 1,289 | 356,791] 12,805] 884] 261,343 4,241 | 405 | 95,448
80 2611 | 335 | 76,378 1,832 | 213 | 47,423 779 | 122. | 28,955
90 115 5 2,120 107 2 1,770 8 3 350
100 3/ — - 3] — = - _ -

 

 

Total] 1,147,243 | 14,890 | 2,264,432 706,886 8,185 | 1,372,041 440,357 6,205 892,391

 

 

 

 

 

 

 

 

The constantly Sick, and
the Years of Sickness
to one Annual Death.

Constantly Sick in

Annual Mortality per Cent. 100 Members.

 

 

Age.
ae Rural | City and ao Rural | City and nals Rural | City and
and City So- Town | and City |. 5° Town | and City | 3° Town
Societies. cieties. | Societies. Societies. cieties. | Societies. Societies. cieties. | Societies.
9 — _— —_— —_— _— _— — —_— _~
10 *631 “704 *481 1°575 1°597 1°529 2°494 27268 3°178
20 “712 “721 “694 1°694 1°673 1°734 2.°380 27320 2°499
30 *839 “741. “978 1°909 1°745 2°14. 2°275 2°354 2°190
40 1°130 “924 1°417 2°894 2°419 37555, 2°561 2°619 2°509
50 17906 1°653 2°305 5°208 4° 513 6°307 2°733 2°730 2°736
60 51532 3°165 4° 417 14°722 | 14°623 | 14°961 4°168 4° 620 3°388
70 7°562 6°904 9°550 407114 | 39°114 | 43°132 5°305 5° 666 NSIT
80 12°830 | 11°627 | 15°661 56°061 | 49°609 | 71°234 4°369 4° 267 4°548
90 = == = = = = = = _

 

 

 

 

 

 

 

 

 

ENGLISH FRIENDLY SOCIETIES. Scotcy FRIENDLY SOCIETIES.
Days of Sickness in a Year to One Days of Sickness in a Year to Ono
A Member. ember.
ge,
Rural, City, City Rural, City, i
and Town s ene and Town andTown: g Bae gin oh
Societies. : Societies. Societies. oclebles: Societies.
10 6 6 6 6 6 5
20 6 6 6 6 6 7
30 7 6 8 '6 6 %
40 11 9 13 9 8 11
50 19 16 23 19 18 21
60 Bd 53 55 50 50 49
70 147 143 158 150 147 165
80 205 181 260 216 208 264
90 = = = 236 — 268

 

 

 

 

 

 

Members of the age of 20 and under 30 had, on an average, six days of sickness —
they received pay for six days of every year that they were entitled to pay. aa
MISCELLANEOUS. |

x

507

AvrerAGE Duration or ATTACKS or SICKNESS.
Scotch Friendly Societies, framed by G. P. Neison, Esq.)

(From Returns of

 

 

 

 

 

Total Number of Total Amount of meee pas ae e
Attacks, including | Sickness, including ‘et al Si ay gee
"Age those ending in that ending in ineludi hae pe tea
eee: Recovery and Recovery and me oer nae
those ending in that ending in “that andine in
Death. Death. Death:
Weeks. Weeks.
10-15 ~ - 12 39°428 3°286
15-20 - 117 749°571 6°407
20-25 - - 637 2830°285 4°443
25-380 - 985 5483-000 5*566
30-35 - - 1,074 5014°143 4°668
35-40 s 872 4524°714 5°188
40-45 - - 758 4158°714 5°486
45-50 - 519 3445°714 6°639
50-55 - 5387 6634°285 12°354
55-60 - 491 7171°571 14°606
60-65 - » 850 9102*286 26°004
65-70 - 135 5984°714 43°960
70-75 - 116 8867°999 76°448
75-80 - 29 4588°857 158° 236
80-85 - 19 4027:000 211°947
85-90 - —_ —_— —_—

90-95 - - 1 353° 000 353°000
6,652 72925+281 10°957

 

 

 

 

(McCulloch’s Account of the British Empire, Article “Vital
Statistics,” Vol. II., pp. 581-6.)

Sickness among Dockyard Labourers——The following tables are
based upon returns relating to the labourers employed in Portsmouth
Dockyard during the three ‘years 1830-1-2, showing the numbers
employed, and the cases and causes of absence from work.

 

 

 

 

 

 

 

 

 

 

; Total
Average Number of Cases. Days of Days of Cage of
Sickness | Sickness
Years. Number 4 f Absence
of Men. : oer cae voce from
Diseases. | Injuries. | Disease. | Injuries.
Work.
1830) - 2,079 697 357 9,188 5,884 15,072
1831 -| 2,002 888 325 9,605 4,620 14,225
1832 - 1,867 665 329 8,617 5,086 13,703
Total in 5,948 2,250 1,011 27,410 | 15,590 | 43,000
3 years |

 

This table furnishes, as the mean of the three years, the following

interesting results.

In the year, 1 man in 6 is seriously hurt; 2 in

5 fall ill. Each man, on an average, has an attack of illness, either
spontaneous or caused by external injury, every 2 years; and, at an
average, each disease lasts 14 days.

 
508 [PART VI.

So far as the returns from the other dockyards can be understood
and admit of comparison, they confirm these results; and between
Woolwich and Portsmouth, where hurts and sickness are distinguished,
there is a remarkable coincidence in the time lost by sickness, although
that from injuries is very different.

Tie Lost by Stcxness from Disease or Injury among LaBoureErs
in Portsmours and Woortwicn DockyasRrps,

 

 

Mean Constantly |\Constantly
‘Number Days Days | Constantly) suffering | Ill from
—_—_ of Lost by | Lost by Sick, from both
Sickness. |Accidents.] per Cent. | Accidents,| Causes.
‘Woolmer per Cent. | per Cent.
Portsmouth 5,939 27,410 15,590 1°26 0°73 1°99
Woolwich - 2,243 10,593 8,594 1:29 1°05 2°34

 

 

 

 

 

 

 

 

It may be safely assumed that of the labourers employed in the
dockyards 2 per cent. are constantly kept at home by diseases or
injury; and that diseases, independent of external mechanical injury,
constitute almost two-thirds of the entire sickness. No details or
explanations accompany the original returns; but it may be presumed
that the sickness only of the men who recovered, and returned to the
dockyards, is intended in the tables, and this, with’ the selection on
entering, excludes the greater proportion of sickness prevailing in a
population, although it expresses that experienced by the actually
working class. The sickness of the working labourers in the Kast
India Company’s service was, we shall show, 1°65 per cent.; and this
is little more than a fourth part of the entire sick-time experienced by
the whole number employed, including those pensioned. This propor-
tion would make the sick-time of the dockyard labourers 7°8 per cent.
of the lifetime.—(McCulloch’s Account of the British Empire, Article
“ Vital Statistics,’ pp. 572-4.)

Sickness among Labourers employed by the East India Company in
London, 1823-34.—A return of the state of health among the men
employed by the East India Company in London deserves especial
attention, as no observations so accurate or extensive have before been
published, relative to the sickness and mortality among labourers in
large cities, ‘This return was obtained ‘‘in the form of a large volume,
‘* containing a list of 2,461 labourers, employed in the month of April,
“ 1823, with a statement of the number of days’ illness experienced by
“ these labourers, one by one, year by year, for the 10 succeeding years ;
* also the date of every death, and the date when any labourer ceased to
“ be employed, by being superannuated and pensioned, dismissed, or by
« voluntarily leaving the service of the Company.”*

Every labourer put upon the sick list is allowed 1s. 6d. a day, Sundays
included ; he is also seen every day by the surgeon, and therefore remains
no longer absent than the case requires.

During the 10 years, 496 died, 248 were pensioned, and 208 left the
service, or were dismissed. The reporter, Dr. Mitchell, has calculated

 

* Factories Inquiry ; Supplementary Report by Dr. Mitchell, vol. i. p. 48,
MISCELLANEOUS. |

509

a table of the duration of sickness per annum for every age, from 16 to
81, which we subjoin:

 

 

Average Duration si . Average Duration .
Age. | of Sickness per |ATPREC Totton || age. | gt Sickness per |UPSES nose for
* | Annum for every every Man sick. Be. Annum for every every Man sick.
Man employed. v 7 Man employed. y ¥
Days. Days. Days. Days.
Under 21 4°02 13°96 51 to61 7°00 28°60
21 to 81 4°94 18°70 61—71 10°08 29°07
ey oe 22°63 71—81 11°63 31°77
—61 5° 23°21

 

 

 

 

 

 

 

Dr. Mitchell has unfortunately withheld the data from which these
results were derived. He has not stated the total days’ sickness, and
attacks at each age, nor arranged the observations so as to exhibit
the complete years of life. But the report contains tables showing the
number of the men at every year of age, from 16 to 78, in the beginning
of April 1823; the ages at which the 248 pensioners were put upon
the list; and the ages at which the 496 men died whilst classed as
workmen, as well as the ages at which 161 of the pensioners died. It
appears that the deaths of the pensioners were obtained in a separate
return, extending from April 1823 to January 1834, nine months
over the ten years in which the other deaths happened. From these
facts we first deduced the number living at each decennial period of
life, on the supposition that the 2,461 individuals alive in 1823 remained
in the service ten years; and thence subtracted the years of life lost
by deaths and dismissals. Dr. Mitchell having omitted to state when
or at what age the 208 men left the service, it has been assumed that
the younger men left in rather greater proportion than the aged, but
that all remained in the service five full years; which is the same
as supposing the dismissals were equally distributed over the ten years.
A similar correction was made for the deaths : 1-14th part was deducted
from the deaths of pensioners for the nine additional months in which
they were observed.

Noumeper of Lasourers in the Hast India Company’s Service, April
1823; from Ten Years’ Observations, the NumBrr living complete
Years between 16 and 90 years of age; the Dratus among the
WorkMEN and Pensioners; the Mortality compared with the
Mortality among Mates in London.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Labourers. Deaths. Annual Deaths per Cent, among
nah an Workmen.
Age. n the| 7... uring Males,
S| Books, | f'Gne| One | work. | Pon- Pen- |faboure) 00>
April | "Year. | ©2@> | men, |sioners.| E2tire] ag. |sioners.|"or" || don,
1823. ye Aa tacked. 1813-30.
er.
16—20 31 33 te me se ne a8 as 5
20—30 437 2,301 | 2,066 16 1 “78 2°79 12 6 f 0°82 1°22
30-40 779 6.671 | 5,939 S6 2 1°46 65 |S 1°48 1°69
40—50 599 6,749 | 5,764 136 8 2°38 10°4 i w7t 2°43, 2°54
50—60 451 5,365 | 4,255 147 40 3°52 14°2 40°27 4°04
60—70 137 2,739 | 1,819 95 75 5°88 15°7 |? 16°5{ 9°24 8°12
70—80 27 675 426°5| 16 30 5°66 17 ys 10°71 15°97
80—90 oe 56 35°5 a 5 Br oe. 23'2 | 13°90 30°91
33°84
2,461 24,610 | 20,343 496 161 2°50 10°6 | 16°5 3°13 |

 

 

These observations are equivalent to observations on 20,843 men
during one complete year, and between the ages of 30 and 70 are
sufficiently extensive to furnish a near approximation to the mortality
510 [PART VI.

in four decennial periods: earlier or later they are of little separate
value. The annual rate of mortality was 3°13 per cent.; and, notwith-
standing the selection, it agrees, between 40 and 60, very nearly with
the general mortality of males in London (1813-30).

The mortality under 40 is not so high among the labourers, because
the greater part of them are selected healthy men, received into the
service between the age of 20 and 35; after 50 it is higher than the
general mortality in London. These men were well supplied with.
food and clothing; their work, without being hard, insured regular
muscular exercise; in sickness they had rest and proper medical
attendance ; yet, between 40 and 50, the mortality was 67 per cent.,
between 50 and 60, as much as 82 per cent. higher than the mortality
at the same ages in all England. Such facts as these annihilate the
supposition that the increased mortality in cities is due to want of food,
and greater misery; nor, although these men drank freely, can we
admit that their moral habits differed so greatly from those of country
labourers as to account for their greater mortality.

Of thé 2,461 labourers, 10 per cent. were pensioned in the course of
ten years; 8 per cent. were discharged, or quitted the service; 1 man
in 81 working a year was pensioned; 1 in 4 had an attack of sickness ;
1 in 60 was constantly on the sick list; 1 in 21 (4°79 per cent.) of the
labourers was a pensioner; and 1 in 6 of the pensioners died annually.
The mean duration of life, after being pensioned, would therefore be
six years; five years and a half less than the mean duration of life
among the general class of men in cities at the same ages.* This, and
the evidence of the medical attendant, Mr. Lewis Leese, prove clearly
that the greater part of the pension-time must come under any compre-
hensive definition of sickness; the pensioners were declared by a
special report of the surgeon, permanently disqualified for labour; and
that not by age alone, for the majority were pensioned between the
ages of 50 and 70, but by the mechanical injury of a limb, some
infirmity, or a slow but fatal discase. Half the pension-time may
therefore be safely viewed as sick-time.

Sickness, &c. Sraristics of LanourEers employed by the East India
Company in London, 1823-34.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On the | Out of 100 Men Of 100 Living.
Labour- Pen- | Working One
ersEm-| At- sion Year. Sick i
Ages, | Ployed | tacks of Days of | Pen. ) List. |—————|"7))'" Sick,
SeS- | ncom-| Sick- | Sick- |sioned.| one Cases Labour-|.On the | and on
plete ness. ness. com- | op Si ole Pen- eae + Pension] the
Year, lete A685 sioned. e List. |Pension
year. ‘i List.
16—20 33 10°9 152 nee on 28°5 oe 1°10 a 1°10
20-30 | 2065 546°5 | 10,203 4 5°5 | 26°4 “20: |) 1°86) °27 1°62
30—40 | 590775) 1820°5 | 29,891 13 41 22°4 22) 1°38 “69 2°06
40—50 | 5703°5] 1805°5 | 30,286 | 13, 2 229 23 2°46 | 1°95 | 2°69
50—GO | 4169 | 1020°4 | 29,183 76 199 24°5 1°82 1°91 4°70 6°58
60—70 | 1615°5} 560 16,284 | 105 433°5 | 3847 6°50 | 2°76 | 23°85 | 20°50
70—S0 316°5) 116 3,681 35 201 36°6 11°06 | 3°20 | 46°49 | 48°78
80—90 23 1? 359) 2 DISS ae 870 | 2 69°65 a
19,838 | 4880°S | 119,715 | 248 973°5 | 24°6 123) 1e5 | 4°79 | 64k
Lin4 | lin 81 /1in 60 |1in 21 pee

 

 

 

* The expectation of life at the mean age when the 248 men were pensioned was
11-4 years, according to the city table of Mr. Edmonds,

+ Obtained by multiplying the mean number working by the days of sickness experienced by
one person: this sickness is a fraction higher than that given by Dr. Mitchell, as the days
opposite 21-31, &c. in his table were applied to the numbers 20-30, &c. in this. He has
improperly compared the 9th instead of the last column with the sickness of the Highlund
Societies, which comprehended every kind of incapacitation for labour,
MISCELLANEOUS. | oll

Thé proportion attacked by sickness out of 100 men, at each age,
working one year, differed inconsiderably between 20 and 60: the
number pensioned between 20 and 50 was also the same (*0022); from
6 to 11 per cent. of the workmen were placed on the pension-list
between the ages of 60 and 90; of the actually working class the sick-
time increased with age from 1:1 to 3°2 per cent.; the pensioners,
at the ages 60-70, formed 24, -at 70-80 more than 46 per cent. of the
living. The total sick-time (including pension-time) increased up to
50, in geometrical progression, at the rate of nearly one-third every
ten years; and if half the pension-time after 60 be counted as sickness,
it rather more than doubled in the subsequent decennial periods. The
rate of sickness, including all the pension-time under 50 years of age,
is much higher than that found by the Highland Society: it lies between
the rate assumed by Dr. Price and the observations by Ansell on the
English benefit societies.* There were rather more than two years of
incapacitation for labour to each death. The deaths were to the sick
and pension-time as 3°13 to 6°44.

Friendly societies, and companies who, like the Kast India Company,
may deem it prudent to make their men subscribe to a sick and pension
fund, will find these tables very valuable. They also throw great light
upon the state of health prevailing in the metropolis: the mortality and
other considerations show that these men, labouring in warehouses in.
the heart of the city, yet well provided for, occupy, as regards health,
a middle point between the worst classes and the inhabitants of the
cleaner and less crowded districts. (McCulloch’s Account of the
British Empire, Article ‘‘ Vital Statistics,” Vol. IL. pp. 574-7.)

Sickness in the Metropolitan Police Force.—This was embodied in
the year 1830, and had subsisted eight entire years at the end of the year
1838. The average strength of the force during the eight years was
3,314, the numbers being very nearly stationary throughout the whole
period. In order to maintain the average strength of 3,314 men, it was
found necessary to recruit annually as many as 1,100 new members, the
vacancies being created by 1,068, who are removed or retire from the force,
and 32 who die every year. The average duration of the service of each
policeman is, consequently, three years. Theaverage at which the men
enter, is 284 years; about two-thirds enter between the ages of 20 to
31, and the remainder, with a very few exceptions, enter between the
ages of 31 and 85 years. The annual mortality was °97 per cent. or
very nearly 1 per cent. The average number constantly sick during
the eight years was 2°81; or the days of sickness in a year to each man,
were 10°3. For every annual death 2°90 were constantly sick, conse-
quently there were nearly three years of sickness to every death. Out
of 100 living, 3:78 were constantly sick in the month of January, and
2°38 in the month of July; the months of the year in which sickness
was respectively at a maximum and minimum. The men are first
chosen as being of sound and vigorous health, and the force is afterwards
kept select by frequent discharges of men showing symptoms of impaired
health or strength.

Each individual has to walk 20 miles every day in going his rounds,
besides being obliged to attend charges at the police offices, the labour
of which may be estimated as equal to walking five miles more, in all 25
miles a day. During two months out of every three, each police
constable is on night duty, for nine hours each night, from 9 o’clock in
the evening till 6 in the morning.

 

* See Extract on pp. 501-7.
512 [PART VI.

We have been favoured by the Commissioners of Police for the
Metropolis with the following return in continuation of that communi-
cated by them to the Committee of the Statistical Society. The return
of the average force for each year is an additional column. Our calcu-
lations based upon this column differ slightly from those of the Committee.

Return of Sickness and Morrarity in the METROPOLITAN POLICE.

 

 

; Removed) Average Days Annual | _ Days of
Years. Admitted. and ree Died. | 0° Sickness | Mortality] Sickness to
Retired. ‘ Suffered. | per Cent.| each Man.
8 Years, 1831-38 8,868 8,494 3,395, 256, 272,391 “94 10°0
7 Years, 1839-45 8,057 6,431 4,157 224 222,913 “17 7

 

 

 

 

 

 

 

Ours are we believe correct. It will be observed that in the last seven
years the dismissals, the deaths, and the sick-time have been less—
though the average force was 800 greater than in the preceding period.
—(McCulloch’s Account of the British LEmpire, ‘Article “ Vital
“ Statistics,” Vol. IL, pp. 580-1.)

Sich-time increases with Age in Geometrical Progression.—If the
number of attacks at each age be the same, the duration of each attack
and the sick-time will increase in the same ratio ; and conversely if the
duration of the cases and the sick-time augment at the same rate, the
number of attacks at every age wili be equal. Any two of the elements
being given, the third may always be deduced from them. Again, if the
mortality of the attacked increase at the same rate as the mortality of
the entire population, the proportion attacked at every age will be the
same. Among the London labourers the mortality between 30-40,
40-50 was 1°48 and 2°43 in 100 living; the mortality among 100
attacked was 6°5 and 10°4. Now 1°48 is to 2°48 very nearly as 6°5 is
to 10°4; and it results from this, that the attacks, whatever their
absolute number may be, whether 22 or 52, were the same in both
periods. The deaths below apply equally to the attacks and to the

|
Annual Attacks. |Annual Deaths.

 

Mean Number

 

Ages.

 

Living.
|
30-40 100 22 1°48 :
|
40-50 100 22 2°43

 

living: they apply however high the absolute number of attacks be
raised, provided it be raised to the same degree in both periods; but
cease to apply if the number of attacks in each period be different.—
(McCulloch’s Account of the British Empire, Article “ Vital Statistics,”
Vol. IL, p. 594.)

Health Insurance.—Sickness is not easily defined. It varies very
much in degree ; but for practical purposes the line is drawn by friendly
societies, police, army, navy, and by patients in civil life with sufficient
accuracy. Such sickness as confines 2 member to bed, called bedfast
sickness, or at home from work, a policeman from duty, a soldier or
sailor to hospital, figures as sickness in the respective returns. Enthetic
disease is not recognised by the friendly societies or the police; but it
swells the sickness of the army and navy returns. In civil life men
MISCELLANEOUS. | 513

work and take physic when their ailments are slight, whereas in the
public service they are sent to hospital. Women oftener return them-
selves sick than men. The sickness of very young and very old people
has not been accurately determined.

But it has been found by experience that in England io one annual
death in a body of men two are on an average constantly suffering from
sickness of some severity. There are two years of severe sickness on
an average to one death. In the police and in some friendly societies
the constantly sick to one annual death are 2°8 ; in the army (1873) at
home 4°2; enthetic disease will account for the difference.

As there are now 700,000 annual deaths in the United Kingdom it
may be inferred that there are 1,400,000 constant sufferers from severe
sickness; and 2,000,000 sufferers from such sickness as requires medical
relief, or throws the members of friendly societies on their funds.
That would give 100 patients each to 14,000 hospitals and 6,000 dis-
pensaries. ‘The sickness is of every shade, from the darkest mortal
ailments to the lighter pains and muscular weaknesses, and is so related
to the mortality that the deaths and sickness within certain limits rise
and fall together; thus, if the constantly sick in the population could be
reduced from 1,400,000 to 1,050,000 the deaths could be reduced from
700,000 to 525,000; or the annual mortality would be reduced to the
desired rate of 17 in 1,000. The diminution of human suffering keeps
pace with the diminution of the death-rate; so do the ineffectives of the
working population and the claims on the funds of friendly societies.

Sickness occurs irregularly through a man’s life in attacks as they are ©
called ; still under such a law that there is an average amount of sick-
time to every death; men are also subject to an average number of
attacks during their lifetime under the same sanitary conditions; the
liability of adults to attacks of one kind or other being the same at
different ages, but the fatality and the duration of the illnesses from
those attacks rising with the advance of age according to the same
Jaws.*

It is evident that these societies are most useful adjuncts in sustaining
health; when the head of the family is disabled, they supply him with
medical attendance and a sum sufficient to meet his most urgent wants.
And as there is a law of average sickness while every man’s life or health
is uncertain, they are indeed Friendly Societies, and with good manage-
ment and proper tables will confer all the benefits they promise. The
ordinary premiums are often inadequate to provide sick-pay—that is,
really annuities—after the age of 65} ; and the societies do not profess to
support the members through chronic diseases of more than 12 or 18
months duration, Here the aid of the fortunate steps in to help the
artizan and labourer in misfortune. Under the English Poor Law the
sick man in need is provided with medical relief and sustenance ; every
man’s life is insured against death by starvation, provided that, if able,
he is willing to work.

Unhappily no community can, in our present state, undertake to
supply all its members with all they want; and if we express in money
the price of drink, food, heat, physic, clothing, lodging, cleansing,
including sewerage required for the enjoyment of the longest mean
lifetime (L) we shall have this equation, putting I for income:

I

di ftheppepias

 

* McCulloch’s Account of British Empire, Vol. II., Articie “ Vital Statistics,”
pp. 570-96.

ft See Extract from Registrar General’s 12th Report, pp. 514-17.
514 [PART VI.

where wis a fraction approaching wnity as the full cost of the com-
modities of life approaches the income. Galen justly remarks that
there is one hygiene for those who can command all the necessaries of life,
another for those whose means are limited. To decide on the comfort
to be sacrificed with least lost by the poor is an important life problem
for the hygienic student.

The deaths in England in the year 1871 were 514,879; implying
1,029,758 persons constantly sick from diseases of some severity; that
is equal to a number sufficient to fill 10,298 hospitals, each containing
100 beds always oceupied. And it may be assumed that the numbers
are sustained by an annual influx of 12,357,096 patients, ill a month on
an average, of whom 11,842,217 recover, 514,879 die.

46,556 persons died in the year in public institutions—in hospitals
13,706, lunatic asylums 4,097, workhouses 28,753; and 468,323 died
in their own homes or elsewhere. Whether the patient in hospital or
home shall recover or die often depends upon the medical attendant.

Under the new and judicious Friendly Societies Act the sickness and
mortality returns will no doubt be so organised as to throw much light
on the health of different occupations as well as on the finance
of sickness insurance.* (Supplement to 35th Annual Report,
pp. Ixxvii-viii.)

Health insurance may be effected on the same convenient plan for
servants and artizans as life insurance. Thus a man servant, aged 20,
who pays °650/. or 13s. at the beginning of every quarter (1s. a week)
for 5 years would, without the payment of any further premium from
the fifth year inclusive, be entitled to °454/. or 9s. ld. a week,—for
every week of sickness, that he experienced during the next 40 years ;
or until the age of 65, when the payment of his deferred annuity should
commence. He would be entitled to 1s. 10d. a week during sickness
in the first year, 3s. 8d. in the second, 5s. 6d. in the third, 7s. 3d. in
the fourth, and 9s. ld. a week during sickness in the fifth year, at the
end of which it is assumed that the payment of his premiums ceases.
A young artizan of the age of 16, by continuing the payment of 1s. a
week for 11 years, insures 1/. a week in sickness from the age of 27 to
the age of 65; anda sum rising every year from 1s, 11d. a week to 1d.
in the intermediate years of age 16 to 27. ,

For a guarantee fund some addition should be made to the net
premium ; the rate of pay in sickness should be less than the wages,
and the usual proofs of sickness should be demanded.

Clerks, artizans, and all the labouring classes obtain salaries and
wages—incomes—much earlier in life than the higher professional
classes, and it is a fortunate circumstance—of which they are apparently
unaware—that by setting aside every year a small sum for the 8 or 10
years after their earnings commence, they can INSURE THEIR LIVES,
purchase a PENSION in OLD AGE, and insure a PROVISION in SICKNESS,
before they ARE MARRIED, and thus leave the whole of their income
after marriage free to meet the increased expenses of housekeeping.

The two following tables have been framed, and will be found: the
first, applicable to the class of artizans who earn wages ranging from
25s. to 42s. a week; the second to the class of labourers on wages
ranging from 8s. to 15s. a week. The premiums should be deducted
every week from the wages; and if the employers contribute a sum
annually, equivalent to one third, one fourth, or one fifth of the

 

* Friendly Societies Act, 38th & 89th Vict, c. 60., 1875,
MISCELLANEOUS. | 515

premiums, it will form a guarantee fund, and there will in all healthy
trades and places be a surplus which may be distributed among the
members, either as a deposit available like money in a savings bank,—
or a sum insured and payable at the death of the member to his widow,
children, relatives, or friends.

WEEKLY Premium to insure Pay in Sickness at the rate of £1

 

 

a week.
Weekly Premium | Weekly Premium
Age. from this Age to the Age. from this Age to the
Age following. Age following.

d. s. d.
15— 3 56— 1 0
17— 4 57— 1, LE
22— 5 58— E 2
33— 6 59-- 1 3
40— 7 60-- 1 4
45-- 8 61— 1 5
48— 9 62-- 1 6
51— 10 63— 1L. 3
54— 11 64— 1

 

 

 

 

 

 

The table may be read thus :—A person of the age of 17, or of any
age under that following (22), insures, for a premium of 4d. a week,
sick pay at the rate of 12. for every week of sickness, or of 3s. 4d. for
every day of sickness, except Sunday.

WEEKLY Premium to insure Pay in Sickness at the rate of 7s. 6d.

 

 

a week.
Weekly Premium Weekly Premium
Age. from this Age to the Age. from this Age to the
Age following. Age following.

d. d.
15— LB 58— 5
22— 2 59-— 54
36— gh 60— 6
44—— 3 61— 63
49— 3h 62— 7
53—- 4 63— 73
57— 4 64— 8

|

 

 

 

 

 

The table may be read thus:—A person of the age of 22, 23, or of
any age under 36, insures, for a premium of 2d. a week, sick pay at the
rate of 7s. 6d. for every week of sickness, or of 1s. 3d. for every day of
sickness, except Sunday.

The table is graduated on this principle: 2d. a week insures 7s. 7d.
a week at the age 35-36, and at the age 22-23 it insures a larger sum,
as the sickness is then less; these larger variable sums, which the
premiums cover may be paid if the contribution of the employer is
liberal, and the persons who keep and audit the accounts are ready
calculators who have time to spare. The annexed table will enable
such persons to determine the sick pay that every penny a week of
premium will provide, at every age from 20 to 64, among workmen of
average health.

KK 2
516 (PART VI.

The Numser of Pence which for every Week of SICKNESS 4 Premium
of a Penny a Week will provide.

 

 

 

Weekly Premium, a Penny.

Weekly Sick Weekly Sick Weekly Sick

ane Pay in Be. | Age. Pay in Ponte, Age. Pay in Pence.
d, d. d.
20 61 35 45 50 ae
21 60 36 44 51 26
22 59 37 43 52 25
23 58 38 41 53 24
24 57 39 40 54 23
25 56 40 39 55 a2
26 55 41 38 56 21
27 54 42 36 57 19
28 53 43 35 58 17
29 52 44 34 59 16
30 51 45 33 60 15
31 50 46 32 61 14
32 48 47 30 62 13
33 47 48 29 63 12
34 46 49 28 64 11

 

 

 

 

 

 

 

 

 

Resuirs in reference to Heatran Insurance, deduced from Returns
procured by Mr. Neison and Mr. Thomas Cleghorn, Registrar of
Friendly Societies in Scotland; compared with the results deduced
from the English Life Table, No. 2.

 

 

 

 

 

 

 

 

Number of Pounds, Shillings, or Pence which a
Premium of 1/., or 1s., or 1d. a Week, will provide
over a single Year.
Age.
By 67 Ss oe ee English
Scotch Societies ae oclelies Life Table,
1846-50. pe eta No. 2.
(Neison).
18 69:648 61°920 65° 674
23 71-607 59°390 58°345
28 70°390 61°38] 53° 236
33 58-010 63°712 47°763
38 54°269 57°127 41°829
43 46°226 48-689 35°712
48 29°073 34°543 29°820
53 17°692 22°007 24-503
58 14° 836 16°658 17°922
63 8°519 10°118 12-281
Col. 1 mo fe 3

 

 

The table may be read thus :—A man aged 23, who for the year after
that age pays a premium of a penny per week, would be entitled to pay,
during sickness, of 71°607 pence weekly by column 1, 59°390 pence by
column 2, and 58°345 pence by column 38, deduced from the English
Life Table.
MISCELLANEOUS. | 517

It will be observed that the sum that can safely be insured is larger
at the earlier ages by the Scotch returns than it is by the column
deduced from the English Life Table.

In conformity with the existing practice of friendly societies, the
members of the fund should contribute for ¢hree or for siz months before
they are admittted as free members to receive pay in sickness.

After the age of sixty-five the line of demarcation between health and
infirmity or sickness becomes indistinct, and for the practical purposes of
health insurance can be drawn with neither certainty nor uniformity.
What under one set of circumstances is considered health is under
another paid for as sick-time. The provision for the age of infirmity
and non-production should therefore be of the nature of a deferred
annuity ; the premium commencing early, and ceasing about the age of

25 or 35; the annuity opening at 65.—(Appendix tc 12th Annual
Report, pp. xxxvii-xli.)

2. ELEMENTARY EDUCATION.

Education, and Signatures in the Marriage Register.—In considering
in what manner the records deposited in this office may be rendered
useful in illustrating the condition of the people, I have found the
registers of marriages calculated to throw much light upon the state
of education, with respect to writing, among the adult population of
England and Wales.

Almost every marriage is duly registered, and every register of
marriage is signed by the parties married; those who are able writing
their names, and those who are unable, or who write very imperfectly,
making their marks. Therefore, an enumeration of the instances in
which the mark has been made will show the proportion among those
married, who either cannot write at all, or write very imperfectly.

It may be said in recommendation of this criterion that it is free
from the disadvantage of selection, including alike every class and
condition, and every age, except children and very old persons. It
must at the same time be remembered, that although a fair average
is thus afforded, the portion of the whole population exhibited in the
yearly returns of marriages is small. It appears that there are usually
about 7 or 8 marriages to every 1,000 of the population. If, therefore,
if be assumed that persons between the ages of 18 and 65 constitute
half the population (which the enumeration of ages in 1821 shows to
be very nearly the case), it will follow that of those who may be con-
sidered the marriageable portion of the community about 30 in every
1,000 (or 3 per cent.) are married yearly. The portion, therefore,
- whose signatures appear on the marriage registers of a single year is

sufficiently small to be easily affected by accidental circumstances; and
it cannot safely be asserted that the 30 in 1,000, from whose signatures
we would draw an inference respecting the other 970, may not happen
to consist of more than the proportionate number of uneducated persons.
It must not therefore be hastily assumed upon the evidence afforded by
the returns of a single year, that the inhabitants of any particular
county or district are less educated than their neighbours. The experi-
ment must be repeated often, and be attended with similar results,
before this inference can be drawn with safety; and it is only when
returns of the same description, given for several successive years, shall
have exhibited similar facts, that it will be perfectly justifiable to arrive
at any unfavourable conclusion with respect to any particular district.

It is obvious that this criterion gives no insight into the amount and
nature of the education now afforded. It can be applicable only to the
518 [PART VI.

past, and particularly to such as existed between 10 and 20 years ago.
Tt is confined to the signatures of persons married, and is not extended
to those of witnesses in the marriage registers, or of informants in the
registers of births or of deaths; and for this reason, that the signatures
of persons married are entirely free from the objection of being selected
instances, and that it is almost impossible that the same person should
have signed twice in the same year; whereas the informants are in
some degree selected persons, and the signature of the same informant
is liable to occur many times.

Inability to write is, without doubt, indicative of considerable deficiency
in other kinds of elementary education. Opinions will differ as to the
extent to which such deficiency may from thence be inferred; and this
is a question the solution of which I will not now attempt.—(2nd Annual .
Report, pp. 7-8.)

Elementary Education and Crime.—The proportion of those who
wrote their names in 1845 was rather less than in 1844: but there
was a great increase of marriages in 1845, and it is probable that the
increase was greater among the ignorant than among other classes of
the population, which will account for the change without implying
that the population at a marriageable age in 1845 were less able to
write than the population at the corresponding age in previous years.
The serious fact remains, that there is no evidence that any improve-
ment in the mere elementary education of the people took place in the
period when the men and women married in the seven years, 1839-45,
were educated; and that the state of education was such that 4 in 10
English men and women could not write their own names. The state
of education differs in different counties. And it has recently been
shown, in an analysis of the criminal returns, compared with the facts
published in previous Reports, that crime is most prevalent in the
districts where in proportion to the whole the fewest numbers can
write. “It is found, that out of 22 different combinations formed of
‘** the various districts of England and Wales, in every instance there
“ is an excess of crime where there is the least education or instruction ;
“and, comparing the respective sections of each group of counties, it
“‘ will be seen that there is an average excess of 25 per cent. of crime
“in the sections of inferior education over that of higher education ;
“ and in some districts the excess is as much as 44 per cent.”*—(8th
Annual Report, pp. 32-3.)

Signatures at Marriage as an Educational Test—It may be here
useful to inquire, of what value is this test ? as by some it has beeu
misunderstood, and by others mis-stated.

Men to the number of 164,520, of whom about five-sevenths were of
the age 20-80, and the same number of women, of whom jfive-sevenths
were also of the same age, and the rest younger or older, went through
the various marriage ceremonies in the established churches, in the
chapels of Protestant dissenters, in the Roman Catholic chapels, in
the meeting houses of various kinds, and in the register offices in 1858.
At the end of the ceremony the husband and wife are invited in all
cases to sign the register book, in the presence of the officiating minister
or the registrar; they having the option, if they cannot write, to sign
by making a mark against their names.

The parties are not asked whether in their own opinion they can or
cannot write, but are asked to write their names on an important
occasion, when on many accounts it is desirable that they should append

 

* Statistics of Crime in England and Wales 1834-44, by F. G. P. Neison;
Journal of Statistical Society, Vol. xi., Part IL, p. 140.
MISCELLANEOUS. | 519

their names, in their own handwriting, to a public register. The
abstracts which have appeared in my Reports show how many men and
how many women under these circumstances do sign with marks.

Two questions are raised on these signatures: Is the man or the
woman who signs with a mark unable to write? Are the men er
the women who write their names, able to write anything else? Some
men and women who can write imperfectly, do undoubtedly sign with
marks. Upon the other hand, some persons can write their names
who cannot write a letter or keep an account in writing. The fermer
class is perhaps the most numerous. Some of the 30 men, some of the
44 women, who sign with marks can write their names. Some ot
the 70 men and the 56 women who write their names, write little
else; and are evidently unpractised writers, as their signatures are
often almost illegible ; not the flourishes of penmanship in which some
men concenl the letters of their name, nor the undecipherable scrawl in
which others write, but the uncouth, ill-formed, letters of men and
women who have never advanced at school beyond the first rudiments.

Looking at both sides of the question, the obvious inference is, I
believe, correct; and we have practically 49,983 young men, and 72,204
young women unable to write, out of 164,520 of each sex who married,
and will be the fathers and mothers of the next generation of English
men and English women.

Of these persons unable to write, it is known that large numbers are
unable to read.

On the hypothesis that the numbers who can write in the ordinary
sense of the word are understated or are overstated, the test is still
available for purposes of comparison; as the timidity which prevents
some men and women from writing their names, or the vanity which
prompts others to try who can scarcely put letters together, must he
almost equally powerful in the several counties of England. These
disturbing causes leave the important fact unexplained, that in ¢en
counties from 15 to 28 men, and in ten other counties from 39 to 50
men, in 100, sign with marks when they are required to write their
names.

The value of this test is also questioned upon the ground that it is,
in itself, no proof of education; and it must be at once admitted that
at the utmost it shows only how many out of a given number can or
cannot write. Many of the men and women who cannot now write,
as in the days of old when barons and knights signed with marks,
possess great intelligence and have acquired many useful arts; so
thousands, on the other hand, who read and write, are ill educated,
and know nothing of those liberal arts and sciences which enlarge,
refresh, and invigorate the mind as the sunshine and showers fertilize
and adorn the soil of England.

In fine, the arguments that the marriage registers supply in favour of
the extension of education cannot be set aside by a few stories about
young girls, terrified in the presence of the clergyman, making marks
when they are able to write their names. The-marks of the men alone
are conclusive. (16th Annual Report, pp. iv—viii.)

Intermarriage of Persons who can write, with those who sign by
mark,—Each marriage constitutes a family ; and to the family the fact
that one of its members can read and write, is of more importance
than the fact that both can read and write. Now as 107,267 men and
89,441 women wrote their names in 1855, it is evident that the 196,708
may have been so distributed in pairs, as to leave no pairs in which
neither the husband nor the wife could write.
520 [PART VI.

Such a combination, however, does not take place. But if it is
assumed that the men and women who can write, and that the men and
women who cannot write, have no tendency to intermarry greater than
that which disposes them to marry those who are not ‘in the same class
as themselves, it follows from a well-known mathematical formula* in
the calculus of probabilities that the 152,113 married couples would
have been distributed as they are in the second column of the annexed
table.

 

 

 

 

Numbers if no | Numbers as
— selection had | given in the Difference.
existed. registers.
Husband anv wife write - 63,072 76,734 + 13,662
Husband on wife writes 70,564 43,940 — 27,324
(mixed marriages) -

Husband anv wife do not write 18,477 32,139 + 13,662

a) (2) (3) (4)

 

 

 

 

 

Here the indisposition to mixed marriages is evinced in the fact that
instead of 70,564, there were only 43,240 couples in which one or other
of the two could write; half the difference of those numbers or 13,662
being added to the 63,072 couples in which both husband and wife write,
and the other 13,662 to the 18,477, in which neither the husband nor
the wife writes. As the poor intermarry, and the wealthy intermarry,
so naturally the classes who cannot write intermarry ; and thus, instead
of having the greatest number possible of cases in which at least one
writes, there is not the due mathematical proportion of such cases, but
in 32,139 of the new families, neither the father nor the mother will be
able to write.

The number of married couples in England was about 3,150,470 in
the year 1855. It is certain that at the date of their murriages,
elementary education was less diffused even than it is in the present
day, consequently the proportion of the cases in which neither the man
nor the woman writes will be greater among these 3,150,470, than it was
among the couples married in 1855, or even in 1847; but upon applying
the proportions deduced from the facts of 1847, it is found that in 1855
there must have been nearly 1,488,000 families in which the husband
and wife could both write their names; 905,912 families in which one
could write the other could not write; and 756,558 families in which
neither the husband nor wife, the father nor mother, could write their
names. How defective the rest of their elementary education must
have been is self-evident. (18th Annual Report, pp. v—viii.)

Elementary Education in England and in Scotland, 1862-4.—It
should be recollected that the marriageable women of a country are a
selected class, and include very few of the infirm, deformed, idiotic, or

 

* Let m denote the number of men who are able to write their names, and m’ the
number of men unable to write their names ; also let f denote the number of women

able, and /’ the number not able to write ; then putting { ee } and multiplying

the terms of the two equations into each other, we havemf a: + mf’ + mf’ =MF
«mf. (nif smf) mip
“MEF MY MF
The first term gives the proportion of combinations in which both write, the
second in which the man or the woman writes, the third the proportion in which
neither writes.

 
MISCELLANEOUS. | 421

others incapable of learning. They can nearly all learn to write if they
have the opportunity. And upon turning to the Report of Dr. Stark,
addressed to the Registrar General of Scotland,* I find that all the
women of the county of Kinross who married wrote their names in the
registers; the proportions per cent. were also 98 in Peebles, 98 in
Kincardine, 96 in Roxburgh, 96 in Kircudbright, 94 in Perth, 92 in Fife,
91 in Edinburgh, and 93 in the far off Orkneys. Under these circum-
stances he must be an extreme optimist who can contend that the state
of education of the women of England is the best possible, when it is
found that by the same test in 100 of the marrying women of the
county of Bedford only 55 write their names, in Cornwall only 60, in
Stafford only 52, in Lancashire 53, in the West Riding only 57, in
Durham only 62, in Monmouthshire only 48, in North Wales only 61,
and in South Wales only 44.

The women of London come as immigrants in large proportions from
every county ; 83 in 100 of the brides wrote their names. Middlesex,
Surrey, Sussex, Hants, Rutland, deserve to be mentioned as counties in
which 80 or more of 100 brides wrote their names in the register. In
Westmorland 79 women wrote their names; but it is in the education
of the men that the Northern Counties approach and even excel, several
of the Scotch counties.

In Scotland we discover a state of things highly creditable to ihe
people of that part of the United Kingdom ; and it is difficult to explain
the difference in any other way than that in the general struggle for the
church property at the Reformation the people had the good sense to
endow the schoolmasters with small stipends, and not to give the whole
revenue of the land either to the clergy or to the nobility. Between the
minister and the lord stood the schoolmaster in the presence of the
people. The advantages of the Scotch system of education became so
apparent that it was expanded in the period of the civil wars (1646),
anh firmly established after the Revolution by the celebrated statute of
William and Mary iu 1696. The endowment was small, and stimulated
instead of slackening the exertions of the schoolmaster, who had to
depend largely on his own industry, zeal, and popularity for support.
M‘Cullech estimated the average fixed stipend at 252. 10s., exclusive of
house and garden; the school fees at 22/. 10s.; the income from all
sources at about 632.

It is impossible to say how much Scotland owes to this system of
schools, and to the universities, which are accessible to the youth of the
kingdom. ‘There was probably as much revenue proportionally devoted
to education in England as in Scotland, but the money was in various
ways misappropriated, so that before the Reform Bill passed, and even
in 1837, when the registration of marriages commenced, the working
classes, entirely ousted from the educational charities and universities,
were in the most deplorable state of ignorance. One in three of the
young men, and one in two of the young women, of England could not
write their names in the matriage register even in 1841, after some efforts
had been made in the cause of popular education.

Happily a considerable improvement is visible in the registers ; one in
four of the men, and one in three of the women, now sign with marks,
In twenty-three years the marks-men have fallen from 33 to 23; the
marks-women from 49 to 32 in 100.

Still in common education the great body of the people of England
are many degrees below the people of Scotland, and it is impossible to

* Wighth Detailed Aunual Report of the Registrar-General of Scotland—Abstracts
of 1862, p. xxiii.
+ Statistics of British Empire, vol. II., p. 373.
3522 [PART VI.

calculate the advantage this superiority gives the Scotchman over the
Englishman at home and abroad. The superior education of the people
of Scotland is a benefit to the world ; without it Watt could not have
invented, Burns could not have written. The brightest boy in a village
without a school has no chance of distinction, except by accident. (27th
Annual Report, pp. xvii-xix.)

Progress of Elementary Education.—The legislature has now (by the
Education Act of 1870) decreed that every child in the country shall be
brought under educational influences, and the effect of this wise provision
should ultimately be seen in the decline of the proportion of marks in
the marriage registers, until all the marriageable people of the pre-
educational period have given place to generations of men and women
capable not merely of writing their names, but instructed in other
essential branches of knowledge, the possession of which can hardly fail
to raise the national standard of mortality as well as of intelligence.

As the year 1871 will form a new point of departure in educational
matters, it may be useful to show here the extent of the improvement
which has taken place as regard the substitution of signatures for marks
in the marriage registers since 1841.

Proportion per Cent. of Mren and Women who sienep the MARRIAGE
Reeister with Marks, 1841-80. ;

 

 

 

To every 100 Marriages Quinquennial Decrease

PuRiOns the annual proportion who signed per cent. of signatures
‘ f the Marriage Register with Marks. by Marks.
of Five Years.

Men. Women. Men. Women.
1841-45 32°6 48°9 —_ —
1846-50 314 46°2 3°7 5°75
1851-55 30°2 43°5 3°8 5°8
1856-60 2371 38°1 10°3 12°4
1861-65 23°6 32°9 12°9 13°6
1866-70 20°5 28°3 13°1 14°0
1871-75* 18°5 25°2 oS 11°0
1876-80* 14°8 20°0 20°0 20°6

 

 

 

 

 

* The figures for years since 1871 have been added to the Table to bring the
information down to a more recent date.—Ep.

And the best proof that the marriage returns do yield approximately
reliable evidence of educational deficiencies is the fact that year after
year the same localities preserve a uniform character whether of high or
low proportions of signatures.. If the question of signature or mark
were one of timidity, or of mere caprice with the men and women who
marry, it is inconceivable that whole counties should maintain for years
the same position relatively to one another as they are foundtodo. (34th
Annual Report, p. xiii.)

3.—Crvit ReGistRaATION oF Marnriaces, Brrras, anp Drarus,

Defective Registration of Births, and of Deaths, 1837-75.—The Act
of 1836+ lays it down in clause 19, that the parent of a child, or the
occupier of the house in which a child was born, “ sAy within forty days

 

+6&7 Will. 4. ¢. 86, clauses 19, 20.
MISCELLANEOUS. | 523

“ give notice of the birth to the Registrar ;” and in clause 20 enacts,
that the parent or occupier shall give the required information, on being
requested so to do by the Registrar. It was not enacted that the persons
who best know shall give the information; and there is no punishment
for the neglect; no penalty for refusal. Any one who has adminis-
trative experience will see the difficulty of working such an enactment.
How can a Registrar, who is paid a shilling a case for every birth
registered, ascertain the occurrence of every birth, legitimate or
illegitimate, in every house, in every street of London? In other large
towns, or in wide districts, the Registrars encounter similar, or equal
difficulties. The Registrars have been urged, through the Inspectors,
to adopt the most effective means for getting information from all
sources, and it is gratifying to me to state that through their exertions,
with the assistance of the enlightened part of the public, the number of
births that escape registration has constantly declined. The precise
extent of the deficiency cannot be determined; but there is reason
to believe that the annual deficiency in the last ten years docs not
exceed the estimate in the last Census Report,* and that was 13,614 out
of 763,623. The probable annual deficiency in the ten years 1841-50
was 38,036, in the next ten years 19,323, and in the last ten years, as
has been already shown, 13,614. The deficiency thus rapidly declined :
calculated on 1,000 births occurring, it was in the three decades, 65 in
the first, 29 in the second, and 18 in the third. There is little hope of
effecting the registration of all the births until the Legislature enacts
the carrying out of the intentions of the Act under the pressure of a
penalty clause, which in practice would rarely or ever after the first
year have to be enforced. If every parent of a child were directed to
give early information of its birth to the Registrar, and subjected to a
penalty for neglecting this duty to the child and to the State, few births
would escape registration. The record would be complete ; the missing
links in pedigrees would be reduced to a minimum ; children would be
under the protection of the law, and they would no longer be under the
many disadvantages arising from inability to prove their age and
parentage, by a birth certificate.

There is reason to believe that a certain number of children born
alive are buried as still-born, and that of deaths buried without a
Registrar’s certificate a few are never registered. The officiating
clergyman is bound in every such case to give notice of the burial to
the Registrar of the sub-district in which the death occurred; but this
is not, for various causes, invariably done.

The causes of death are certified on forms supplied, in the great
majority of cases, by the medical attendants of the deceased or by the
coroners ; but in 1871 in about 8 per cent. of the deaths the cause was
not certified by a qualified practitioner. A certain small number of
medical practitioners refuse to fill up the certificates for various reasons ;
in about 2 per cent. of the cases there was no medical attendant; and
in the residue of the cases the sick children and adults were attended
by chemists and druggists, by herbalists, by bone-setters, by quacks, and
by various orders of unqualified people. In a considerable number of
sub-districts every death is certified ; in a few sub-districts, especially
of Wales and Cornwall, the certificates fall to a very low proportion.

The grant of the certificate, which is now voluntarily given by the
great majority of practitioners, should be rendered compulsory to meet
the exceptional cases, and some means should be adopted to secure the
best returns of the cause of death procurable in every case. While

 

* Vol, 4., Appendix A., p. 55,
524 [PART VI.

asking power to meet exceptional cases thanks are due to the College
of Physicans and to the medical profession generally for their friendly
co-operation in carrying out the Act. (35th Annual Report, pp. v, vi.)

Results of Civil Registration, and Improvements in Civil Registra-
tion Law effected by the Act of 1874.— Births, deaths, and marriages
have been partially registered in the parishes of England since the days
of Queen Elizabeth ; and the names of the great mass of the people of
all classes, ranks, and ages who have lived since that date have been
inscribed in one or other of these national records. But many of the
Church register books have perished. And through the development
of religious dissent and other causes they every year grew more
defective until the Legislature passed the Act which carne into
operation in’ 1837: and not only relieved many consciences, but
provided a better machinery for the record, not indeeed of important
religious rites, but of the facts of birth, death, and marriage, with such
particulars as might be of use not only in connexion with the history
of families and with property, but with the social life and health of the
nation. One notable column was added to the register, which has
turned out to be of great importance. Inquests into violent and sudden
deaths have been held for centuries in England; but now the opinions
—the verdicts—of the medical men of England on the causes of all their
patients’ deaths are certified ; and undoubtedly these recorded opinions
have been already of great use, and will be of still further use to
science in future times. The Legislature of England has thus taken the
lead in advancing the health of Hurope.

The following passage occurs in the last work of Dr. E. A. Parkes,
F.R.S., the author of the best work on Hygiene that has appeared in
any country: “ The attention now paid to public health is in a large
“ degree owing to the careful collection of the statistics of births
and deaths, and of the causes of death, which have been collected in
England for the last thirty-eight years. It may truly be said indeed,
that not only all Europe, but gradually the entire world, has been
influenced by the work of the Registrar-General of England. We
are now able to determine the limits of mortality and its causes with
“ some precision, and are being lel up to the consideration of the
“ causes which bring about a too high death-rate.’ Public Health, by
the late E. A. Parkes, M.D., F.R.S., p. 61.

The following pages contain some account of the improvements which
have, after thirty-seven years experience, been made by the new Act in
the system of registration. Emigration and immigration affect the
population of England more perhaps than that of any other State in
Europe ; and the subject has been discussed at some length, particularly
noticing the influx of returning emigrants which was first noticed in the
last Census report, and accounts for a certain proportion of the 24,093,767
of people in England at the end of 1875, during which year the popula-
tion increased by 297,695. The English emigrants were much less
numerous than in the previous six years. The seasons made their
influence felt; the winter was excessively severe, and the rainfalls of the
summer flooded the lands, and raised the raintall of the year above the
average. The prices of bread were low, of meat high. Indeed, in the
last 20 years the price of beef rose 50, of mutton 29 per cent. How
much the cattle diseases and quarantine, interrupting the freedom of
trade, have contributed to this result IT do not discuss; but the scarcity
or abundance of food affects the registers sensibly, and so does the state
of trade, which was still depressed throughout the year; yet fewer
out-door paupers were relieved than in previous years. Marriage is u

6

‘6

rf

‘

‘“

a

PS
MISCELLANEOUS. | 525

civil contract, and is always registered in England; as we may trust will
also be soon as effectually done in the other divisions of the United
Kingdom. Three in four marriages are celebrated according to the rites
of the Established Church ; and the fashion of marrying by banns rather
than by license has sensibly increased during recent years. The most
important change is in the greater frequency of early marriages since
civil registration was established ; and this is discussed at some length.
‘The spinsters married were on an average 24 years of age; and instead
of 43 in 100, as in 1841-5, no less than 22 were under age (of 21). The
effect of this important fact requires investigation. One of the most
gratifying circumstances is the diminution of the numbers both of men
and women who sign the marriage registers with marks, thereby pro-
fessing inability to write their own names. The proportion signing with
marks in 1841 was 33 men, 49 women, out of 100; in the year 1875 the
proportions fell to 17 and 23. Thus in 30 years the proportion of
ignorant husbands fell from 33 to 17; of ignorant wives from 49 to 23.
The ranks of writers increased every year ; those of women more rapidly
than those of men; so that if the same rate of increase be maintained in
the next as in the last 34 years, nearly all the men and women who
marry will be educated at least to this extent—they will be able to write
their names. It is gratifying to find that the disparity between men
and women is diminishing; and that in 22 years at the same rate of
approximation as has prevailed for ten years the numbers of husbands
and wives who write will be nearly equal. The buildings registered
for public worship and for the celebration of marriages still increase.
While the births went ou at the average rate it is satisfactory to find
that the proportion of children born out of wedlock decisively decreased.
In the 10 years preceding sia children were boru out of, to a hundred
born in—wedlock ; in the year 1875 only five were born out of, to
100 born in—wedlock. For 30 years the proportion of children born
out of wedlock has progressively declined; it fell 30 per cent. Eleveu
years ago, out of a much smaller number ot’ children born, 47,448 were
bastards ; in the year 1875 the number fell to 40,813; thus 6,635
children have now fathers and mothers who instead of repudiating
recognize their duties to their offspring. It is premature to attempt to
assign the cause of the change; but data are supplied which will assist.
the investigation. At the rate of illegitimacy that prevailed 30 years
ago seven, at the present rate fire, in every 100 of the people we meet
would be illegitimate, if the mortality of this unfovtunate class did not
exceed the average; but that, as is well known, is far from being the
ease. Of 1,000 infants born in 1875 no less than 158 died in the first
year of life ; while in certain selected districts, of 1,000 infants born
out of wedlock nearly double that number died in the same time. Tn
some country districts the difference in the mortality is much greater ;
in Stratford-on-Avon out of 1,000 of each class born 69 legitimate, 2938
illegitimate children perish; in Kendal the proportions of the two
classes are 91 and 329. The assigned causes is given of infant deaths
in Driffield and Preston where the mortality of the children born out of
wedlock is among the highest. The deaths in excess are not due to
violence, but to the want, so well shown by Dr. Russell of Glasgow of
the mother’s milk and care. The general result is that as the unfor-
tunate children are.cut down prematurely by thousands, the proportion
surviving in the population bears nosort of relation to the numbers
born. The multiplication of the breed of men aud women who
abandon their children is checked by an inexorable law.

The mortality year by year in the urban districts is shown in juxta-
position with the mortality of the rural districts, which will enable
526 [Pant VI.

the inquirer to trace the relative fatality of disease in the two classes
of population; thus, for 29 years the deaths in the town districts were
to the deaths in the country districts as 25 to 20; but while in the
first four years 1847-50 the deaths in the towns were to those in
the country as 27 to 21, they were in the last five (1871-5) as 24 to 19.
Then it is shown that the excess of the aggregate mortality in 1875 was
due to the excess of the mortality of both males and females at the ages
above 35; the excess due to the cold weather increased rapidly as age
advanced after that term.

The death registers serve the purpose of self-registering inspection.
Sometimes great sums are expended on works without any apparent
results; time has not ripened their fruits; or they are left imperfect ;
pure water is supplied without sewers, or main drainage is created
without branches to connect the great trunks with every dwelling ; the
dwellings remain sordid and crowded; sanitary regulation is neglected.
All this is revealed by the death-rate. Death cannot be deceived by
sham defences. In the last and' in this present Report is shown
the mortality of several districts, with a summary view of the sanitary
work achieved by sanitary organization.

The registers at the end of 1875 contained 54,078,314 names;
25,241,938 of children born, 12,298,886 of men and women married,
and 16,537,490 of persons deceased at all ages. The birth registers
are not quite complete, as a certain number of births were never
registered ; but on account of the excess of births over deaths in an
increasing population and emigration they exceeded the deaths, which
again exceed the number of persons of both sexes married. The
certified copies are at Somerset House; the original registers are in
the several registration districts in the custody of the registrars and
superintendent registrars who are empowered to grant certificates on
the same terms as the central office. In addition to the large number
of searches and certificates so granted, 25,407 searches were made in
the year 1875 at Somerset House and 19,639 certificates were granted,
for which 38,8791, 15s. 6d. were duly handed over to Her Majesty’s
Exchequer.

The births, deaths, and marriages for the United Kingdom are given ;
and the several rates which differ somewhat from the rates of England,
chiefly in consequence of the defects of the marriage registers of Ireland
and Scotland, where the registration of marriage is not enforced as it is
in England. Dr. Burke, the Registrar-General of Ireland, has shown
that the births in Ireland are depressed by the emigration of women at
the child-bearing age, so that the low birth-rate of 26-1 per 1,000 in
Ireland to 35°5 in England, and to 35:4 in Scotland, is not entirely due
to defaults of the Irish registration officers. Dr. Burke points out how
by more judicious arrangements the registration of deaths might be
rendered more complete in Iveland; and, no doubt, under his energetic
administration the registration of marriages and births will ere long be
as complete in Ireland as it is in England. ‘The defect of the records
of the most important events in the lives of the people is remedied in
France, Belgium, and Italy by recording every marriage as a civil act
without interfering at all with the solemnities of religious ceremonial.
In the meantime the English rates may be accepted as representing
pretty accurately the corrected returns for the United Kingdom; with
which the returns procured from the most advanced States of Europe
may be compared.

The members of the International Statistical Congress have undertaken
to draw up under different categories a series of reports based on official
returns from the different States. The first on the population of Europe
MISCELLANEOUS. | 527

has been issued by Dr. Berg, the delegate for Sweden, and is worthy
of that eminent statist and of his country, which enjoys the renown of
having taken the first Census in modern times—1751. Dr. Berg
returns the population up to 1870 or 1872 ; and a careful estimate has
been framed of the area and population of the several States in 1875
and 1876 by Herr Behm and Dr. Wagner. By this estimate the
population of Italy expressed in millions is 27}, England (U.K.) 334,
France (1872) 36. Austro-Hungary 373, Germany 423, Russia in
Europe 734 millions. The population of the great States with
their colonies and dependencies is, by the latest estimates: British
empire 236 millions, Russian empire 87 millions, Turkish empire
48 millions, German empire 43 millions, France 42 millions, Austro-
Hungary 38 millions, Italy 27 millions. The area of the British empire
-is 20 million square kilometers, of the Russian empire 22 million square
kilometers.

Since 1st of January 1875, the Act which amends the previous
statutes regulating registration of births and deaths has been in
force ; it compels, under a penalty, parents to record births, and nearest
relatives to record deaths, in the civil register books.

This amending Act was considered necessary with a view to making
more complete than formerly the record of births, and in the hope of
obtaining increased accuracy with respect to each particular registered
concerning deaths.

Formerly many births annually escaped being recorded in the civil
registers, more particularly illegitimate births in large towns. It may
be hoped that this compulsory clause may reduce the number omitted,
although the birth register is not as yet quite complete.

With respect to deaths, very few escaped civil representation, and
the chief defect was the want of accuracy in the information supplied
for record by persons “ present at death,” and “in attendance ” during
fatal illness.

Many mistakes were consequently made as to the exact number of
Christian names, the precise spelling of surnames, the age, the occupa-
tion of the deceased, and the cause of death; occasioning necessarily
much trouble to the Bank of England, insurance offices, friendly
societies, clubs, &c., and to everybody who had occasion to use
certificates of death.

Now it has become the duty of the “ nearest relatives,” in addition to
burying the deceased, to record in the civil register, within five days
after death, the various particulars rendered necessary by statute; and
thus it is to be hoped that the original entries will be correct, requiring
no or few corrections—a change which I shall be glad to see, as
alterations in registers are not to be encouraged.

This compulsory system, under penalties, imposes new duties on the
public, and accordingly the Statute makes it imperative that the
registrar shall be at home at certain fixed hours on particular days in
each successive week, and thus be accessible to informants, who, on
repairing to his office at these times, which are announced and published,
will be certain not to have made a useless journey, and will be enabled
at once to make the entry.

Moreover, registrars have, in order to meet the convenience of the
public, to attend at “stations” on fixed days in distant parts of
their sub-districts, where the inhabitants may avail themselves of
the opportunity of meeting the registrar in their own immediate
neighbourhood.

Prompt registration, quickly effected after the occurrence of a birth
or death, is gratuitous; unless a householder prefers requiring the
528 [PART VI.

registrar to attend at his residence rather than go himself to the office ;
in such a case he can make that arrangement on paying the small fee
of one shilling.

When a death occurs, the nearest relative is permitted to send “ notice”’
of the event, accompanied with a medical certificate as to the fatal
disease, to the registrar, and if the death is recorded within 14 days no
penalty is incurred.

Formerly births could not be registered when more than six months
had elapsed; now, under special authority, they may be recorded even
within seven years.

An arrangement has been made for registering births when parents,
having omitted to perform that duty, having gone into a distant part of
the country ; which is very convenient for the migratory portion of the
community.

No name of a putative father can now be registered without his
consent, and unless he himself sign the entry in conjunction with the
mother.

Greater facilities are afforded for recording any name which, having
been given after registration to an infant in baptism or otherwise, it is
desirable to add to or to substitute for the named recorded in the first
instance.

Coroners are required to transmit to registrars verdicts of juries, to be
recorded in registers of deaths, more promptly than formerly.

An infant cannot legally be buried as_ still-born without the
production of a certificate or declaration ; which may be considered a
very great improvement on the former loose system. I trust that the
clergy and the cemetery authorities will strictly carry out this salutary
law.

Registered medical practitioners are now required, under a penalty,
to certify the causes of their patients’ deaths, which are registered
together with the names of the certifying practitioners. The number
of uncertified deaths has already been greatly diminished under the new
statute, and the inquiries which the registrars now make when no
medical certificate is produced cannot but tend to strengthen the
protection to human life which registration supplies.

Greater facilities are given for changing boundaries of districts.

Deputies must be nominated by all registration officers.

Offences against the Registration Acts may now be summarily
brought under the notice of magistrates in petty sessions, whereas
formerly in most cases of prosecution it was necessary to proceed by
the expensive process of indictment at assizes ; consequently many
escaped unpunished. When the offence is held to be serious, the
delinquent may still be prosecuted by indictment.

Returns are to be made ata very cheap rate to sanitary authorities
and school boards ; and so are certificates to friendly societies, as well
as to factory inspectors; and this, although convenient for the public,
is not perhaps unnaturally felt to be a grievance by registration
officers.

Persons registering births may now, on paying the small sum of 3d.,
receive a statement recording name and date of birth, which, although
not evidence in a court of law, may be useful in after days. ;

Parliament has sanctioned the payment to each registrar of 4/. 10s.
annually, in addition to his former small emoluments, in acknowledg-
nent of the trouble he takes, and has during many years gratuitously
and cheerfully taken, in sending extra periodical returns to be made
use of in the Weekly, Quarterly, and Annual Reports issued from this
office.
MISCELLANEOUS. | 529

An alteration has been made in the mode of correcting errors of fact
and substance incurred in the registers; and the method is a great
improvement upon the former system, which was much too lax.

Births and deaths at sea are recorded here more completely than
before, and certified copies of the same are obtained by the public
without difficulty.

Such are some of the new enactments, and it may be confidently
expected that they will be found to be conducive to the public benefit.

Steps have been taken to make the provisions of the new Act generally
known, and it is satisfactory to state that it has not been found neces-
sary to take proceedings to enforce the compulsory clauses, except in a
few instances, where a breach of the law had been aggravated by the
conduct of the offender.—(38th Annual Report, pp. v—x.)

Registration Sub-Districts of England and Wales, 1872.—The
registration of births and of deaths is performed either at the houses of
the people or at the offices of the 2,195 registrars. As each informant
has to go to the office of the registrar of his sub-district, or the registrar
has to go to the house in which the event occurred, it is evident that
the size of the sub-district is one important element in the administra-
tion of the Act. A second element is the population ; for the births
and deaths bear a certain though variable relation to the existing
numbers. A third element is also important, and that is the mode in
which the population is distributed over the area, as the population
may be dispersed pretty evenly in farms and cottages over a wide area
of country, or a dense ward of a city; again, it may be, and is often,
concentrated chiefly in a town, but with wide suburbs, and with open
country parishes associated with the town for registration purposes.
The original church registration of baptisms and burials, as well as
marriages, was parochial; it was performed at the church; so the
informents had to go to the registering clergyman, but had not to
travel further than the limits of the parish which, however, might be
great or small. That system of registration was, as is well known,
incomplete as regards both births and deaths,

The sub-district was substituted for the parish as the registration
administrative area; and containing a variable but an average number
of 7 parishes, it increased the distances to be travelled; with this
alleviation to the public, but aggravation to the labour of the registrar,
that the registration of birth or death might be performed in the house
where the event occurred.

There were countervailing advantages: where the registrars were
paid by a fee for each event registered, an extensive population might
supply them with sufficient employment, and such an income us would
command the services of educated men.

The division of the country into sub-districts in the first instance
was made by the Poor Law Commissioners and Guardians, apparently
without any very definite rule as to size or population; but the general
result is, that there are seven parishes on an average to each; that the
average area of a sub-district is 26} square miles, the average popula-
tion in 1871 ten thousand three hundred and forty-seven: while the
average number of persons married in a sub-district in that year was
178, of births 363, of deaths 285. Then the weekly number in an
average sub-district was 7 births, and 4 or 5 deaths; making about
11 births or deaths weekly. If the registrars visit every house to
register births and deaths, they cannot on an average travel more than
two wiles in each case, nor probably much less than one mile unless they
arrange to register the births periodically in beats. Their pay is at the

LL
530 [PART VI.

rate of a shilling an entry, and 1s. 6d. additional for the first 20 hirths
or deaths.

While the average area and population are as given above, the
extremes are very wide fromthe average. The sub-district of Berwick-
street, St. James’s, London, comprises only 24 acres (0:0375 mile),
while Bellingham in Northumberland, round the tributaries of the
North Tyne comprises 175,131 acres (274 square miles).

It appears that 11 sub-districts have less than 10U0 inhabitants; and
11 have populations ranging from 71,319 to 123,915. :

Thus it will be noted that 475 of the sub-districts had an area of 20
and under 80 square miles, equivalent in area to circles with radii
ranging from 2°82 to 3°34 miles; that 2 of them had a population
under 1000; 244 a population under 5000; 166 a population of
5-10,000, 54 a population of 10-20,000; and 11 a population of
20-30,000-

When a country has once been sub-divided for any administrative
purpose in which officers are appointed to distinct portions of territory,
any change is attended with some inconvenience, and some disturbance
of vested interests. But there can be no doubt that with the experience
that has been acquired, a better working division of the country could.
be made now; so as to retain or secure the services of able registrars,
and at the same time to offer the public greater facilities. Thus the
sub-districts of 80 square miles of territory, equal to a superficies of
8 by 10 miles are too large ; and this is still more the case with sub-
districts of 90, 100, and so on up to 274 square miles.

Upon the cther hand as regards area, the sub-districts of less than
a square mile are below the mark; though many of these very small
sub-districts are populous, and five have a population exceeding 50,000.

The large sub-districts of Croydon with 71,319 inhabitants, of
Preston* with 85,427 inhabitants, iucluding something more than the
towns, are conveniently served by one registrar ; and the same may be
said of the other 9 most populous sub-districts, one of which (Everton*
in West Derby district, near Liverpool) contained in 1871 one hundred
and twenty-three thousand nine hundred and fifteen inhabitants.

The advantages in towns attainable in ample sub-districts are various ;
good officers, with due care in the selection, can be obtained, as the
remuneration is sufficient to pay for the whole of their time, and a place
for the registry office can be found in some well known central public
building. In the continental cities it is in the Town Hall. As a
general rule the largest sub-districts are among those in which the
registration is by far the most efficiently performed. (35th Annual
Report, pp. xxiv--vii.) — :

Delay in the Publication of the Registrar General's Annual
feports.—Before closing this Report, it may be permitted to advert to
a circumstance which has sometimes been made the subject of observa-
tion, namely, the interval of time, which to some persons may appear to
be longer than is necessary, between the close of the year to which the
subjoined tables relate and the date at which they are ready for publi-
cation. In the present instance their preparation, and work which must
be done antecedently to that preparation, have occupied a period of
fifteen months. It has been asked: Why this delay? The question
may be put by some whose haste to gain knowledge is not immoderate,
but who have not become acquainted practically with the immense
labour involved in the construction of statistical tables, and in the cal-
culations based on them. It is put by others whose great desire will

 

* The sub-districts of Preston and Everton have since been sub-divided—Ep,
MISCELLANEOUS. | 531

not be satisfied till the statistics of the British empire for this current
year 1862 are laid with the morning journal on their breakfast tables on
New Year’s day 1863, ard who even then, because they live in an age
of mechanical invention, for which by some process of thought they
take credit to themselves, will not consider it their duty to be surprised at
so remarkable a result. In answer to the question it may be stated :—

1, That this office was established by Act of Parliament, primarily,
for the purpose of collecting, arranging, paging, examining, correcting,
binding, and indexing the certified copies of the English registers, aud
of supplying stamped certificates of births, deaths, and marriages to all
persons who may apply for them; that the certified copies are received
quarterly, but the returns are not completed till nearly three months
after the end of each quarter; and that the preparatory duties which have
been mentioned, and which occupy a majority of the clerks engaged in
the office during a period of eight months after the quarterly arrivals
have begun, must be performed in respect to each volume before it can
pass into the hands of the statistical clerks. As the work in the Record
Department advances, each quarterly volume is released for the pre-
paration of the statistical abstracts; but the entire number of volumes
of any registration year are not available for this purpose till the
September following the termination of the year.

2. That in conformity with a provision of the Registration Act, a
general abstract is prepared, in each year, of the number of births,
deaths, and marriages registered during the foregoing year, in order
that it may be laid before Parliament ; but the detailed abstracts that
constitute the “ Annual Reports” are works of much labour and skill,
and necessarily occupy considerable time in preparation. These reports
are not designed merely to answer a temporary purpose. They may be
regarded as storehouses of facts which have been arranged on methods
that are approved as the most useful and convenient, aud to which, both
now and in future years, students of vital statistics may resort for the
elucidation of questions bearing on the social condition of the people, on
national progress, on life, health, and disease. It is important that they
should be done well. It is desirable only in the next degree that they
should be done quickly.

It will be urged that the machinery of registration should be em-
ployed to give immediate warning of epidemic diseases, to trace in
contemporaneous reports their beginning, progress, and decline, and to
assist in investigating general and local conditions in which they are
developed. When the plague is at the door, the people will not wait
till its history can be written in a blue book. This is quite true, and it
will be sufficient to state in reference thereto, that a weekly report for
London and other large English towns is published on the Tuesday
following the termination of each week, and a quarterly report for
England and Wales within a month after the close of each quarter.
(28rd Annual Report, pp. xliii-iv.)

4, Cost, AND THE PResENT AND FutTurRE Economic VALUE
or Man.

The characteristic of life property in wages, and in incomes from
professions, commerce, trades, and manufactures, is that it is inherent
in man, and is the value of his services—of the direct produce of his
skill and industry. In slaves it is vendible and transferable ; in freemen
it is inalienable ; but is not the less on that account property, which in
the early states of society is assessed and taxed in the form of personal

LL 2
532 [PART VI.

services. It is combined with stock in all productions; and the
proportion of the elements varies in every kind of product.

The labour of the parents, and the expense of attendance, nurture,
clothing, lodging, education, apprenticeship, practice, are investments
of capital, at; risk extending over many years; and the return appears
in the form of the wages, salaries or incomes, of the survivors, com-
mencing at various ages, 12, 15, 18, 21, 24, 27, 30, 33, 36, 39, and ages
still greater ; for the incomes in the higher professions increase probably
up to the age of 50 or 55. The outgo increases from infancy up toa
certain age; the earnings then commence, and ere long equal the outgo ;
they are subsequently in excess throughout manhood, and at advanced
age decrease, until they are extinguished amidst the feebleuess and
infirmities of oldage. The present value of the person’s probable future
earnings, minus the necessary outgo in realizing those earnings, is the
present value of that person’s services. Like capital invested in the
soil, in the vintage, or in a commercial adventure, the capital invested
in the life of man returns, in happy natures, profit of a hundred-fold ;
in other cases fifty, twenty, tenfold; in others it is barely returned ; in
some it is entirely lost, either by death, sickness, vice, idleness, or
misfortune.

A large part of the profit of trade, and even of professions, is derived
from external capital. I leave this for the moment out of consideration.
And then, in large classes of cases, as well as in individuals, the incomes
differ ; but they will be found, on an average, to bear a very constant
relation to the amount of capital invested in preparation—to the risk
under which it is exposed—and to the time that it is under investment.
The latter element is of greater importance than is generally imagined ;
for the fact that the earnings commence at ages ranging from 15 to 46,
will account for much of the difference in the incomes of different
classes. This may be illustrated by cases of deferred annuities.
Thus, if interest is reckoned at 5 per cent., 1002. a year from birth to
the age of 15 is worth 1482. a-year from that aye to the end of life;
1002. a-year from birth to the age of 25 is worth 3620. a-year from that
age to the end of life; 1007. a-year from birth to the age of 30 is worth
5402. a year from that age to the end of life; 100/. a-year from birth to
the age of 40 is worth 1,180/. a-year from 40 to the end of life. Thus,
capital yielding the same profit in different professions may, durin
the age of return, yield average incomes respectively of 100J., 2004,
8002, 4002, 5002.,..... 1,0002.

The following table has been calculated by the formula miele

 

=-==the
deferred annuity which a premium of 1/. a-year from birth to the age
x will provide from that age to the oldest age in the Life Table.

The Dererrep Annuity which a Premium of 1004. a-year will purchase
if continued up to the Agus of 15, 25, 30, and 40 years respectively,
alluwing either 3 or 5 per cent. per annum interest.

(Results deduced from the new English Life Table.)

 

Age. 3 per Cent. 5 per Cent,
£ &
15 * - 91°42 148-36
25 - 202°75 362°10
30 287°12 589°72
40 563°36 1180°05

 

 

 
MISCELLANEOUS. | 533

Thus the premium of 1004. a year, allowing the rate of interest to
be 5 per cent. per annum, provides deferred annuities of 148° 361. ;
362° 102., 5389+ 721,, and 1,180°05/., according as the premium is continued
from birth to 15, 25, 30, or 40 years.

From the English Life Table we find the number of persons who
live from birth through every year of age to the end of a century.
Let the average wages, salary, or professional income, earned in the
year of age 2to z + 1 be represented by w,; then as P, represents
the numbers in the life table living through that year ; w, P, will be the
sum of the wages; in like manner w,,, P,4, will be the sum of
the wages in the year of age x+1 to x+2; and so on to the end of the
table, age ». Let this column be added up from the oldest age to
the age x, and the sum be represented by W,; then W, against the
age O = the sum of the wages of the generation. As the sum of
the column P, in the life table is Q, (= the total numbers living at all

 

WwW,
ages, to a given number of births, D,), it is evident that = the

average annual earnings per head of the whole generation; and Dd.
= the average earnings of each person from birth to the end of his life.

So if the average cost of maintenance of a child age 0-1 were
known to be y,; and ofa person through any year of age x tow + 1
were y,; then the cost of maintaining P, persons would be y, P,; and
the sum of a column of such numbers from the end of the table to the
age x would be Y,; the cost of the maintenance of the generation
would be Y,. The difference between the wages and the cost of
maintenance is W, —Y,; or the surplus of the earnings over the cost
of necessary subsistence. W,— Y, may be called the profit; as W,

o

represents the produce, and Y, the cost of production. Then a

=F
= the annual profit per head; and ee = the average aggregate

gain on the life of each individual.

If we assume for a moment that the profit W, — Y, is in the possession
of an individual A ; and is a transferable value; the price will depend
upon the rate of interest (¢) at which investments of the kind are made.
‘Thus, if the rate of interest is 5 per cent. per annum, the annual
revenue W, — Y, will be worth 20 years’ purchase. For in this case
Ww, ee Y, W, a YX, : ill
a ae 20 (W,—Y,). The produce or income wi
be at the rate of oo Wty Woe per cent. on the capital ; the

: 5 Y, 5W,—5Y, _
expenditure or outgo we cent.; the profit —W,-Y,
5 (W, — Y.)

(W, — ¥,)

If instead of the series P, in the life table, the series (1 +3)
vt! P, be employed; the present values at birth, and at any age
# (1) of the future wages, (2) of the future cost of maintenance, are
immediately obtained : the difference is the value of the future profit.
And on dividing by the column D, = v*/,, the present value of the
average wages, cost, and profit of a man of the age a is found.

= 5 per cent. on the capital invested.
534 [PART VI.

The value of w, and y, can only be learnt by observation. And
the actual wages of classes of men in different trades and professions,
as well as the actual cost of education and maintenance, are desiderata
in statistics.

The tables from which an extract is given at the end of this paper,
have been framed from returns of the wages of agricultural labourers,
with which I was some time ago favoured by Sir James Kay Shuttle-
worth, and from returns collected by witnesses before a committee of
the House of Commons.

The cost of maintenance is anestimate. Instead of the series P},* the
series D, has been used throughout (Table C.), which is equivalent to
assuming that the wages and cost in the several years of age were equal
in value to the sums in the columns w, and y,, paid down to or for
each person at the precise age a. The character of the results is thus
indicated with sufficient exactness for illustration and for all practical
purposes.

It will be seen that at the age 20, the value of an agricultural
labourer’s future wages is 482/.; that the value of the estimated cost of
necessary maintenance is 248/.; that the net value of his services is
therefore 2342.

Tartzr A.—Dicesr of Sir J. Kay Snvurrtewortn’s Return of the
Waces of the Best Crass of LAsourers in NorroLk.

 

 

 

: Earnings of
Age. Number of | Earnings of ae a f lewis,
Labourers. Man. Children, including
Gleaning.
£& £ £
17-20 - 4 47 — 7
20-25 - 14 374 7 381
25-30 - 27 813 39 852
30-35 - 37 1,160 137 1,297
35-40 37 1,140 175 1,315
40-45 - 37 1,164 237 1,401
45-50 - 29 924 274 1,198
50-55 - - 19 581 134 215
55-60 - 13 407 90 497
60-65 - 4 126 31 157
65-70 - 3 77 7 84
70-75 - 2 36 4 40
75-80 - A 16 _ a
80-85 - -_ —_ —~ =
85 and upwards - _ — -- —_
Total = - 3 227 6,895 1,135 8,014

 

 

 

 

 

 

 

 

* The above series, P}, is not in the life table, and is nly b Jeul:
3 per cent. interest for Table D. See p. 536. : ue cuca
MISCELLANEOUS, |

535

TasLe B.—Waces and Cost of Maryrenance of AGRICULTURAL
Lazourers in Enetanp. (Extract from a Complete Table.)

 

 

1. 2. 3. 4, 5.0 6. 7. 8. 9. 10.
Expense |Wages| Expense
Sum | Expense of Main- |Earned| of Main- Ww
_, [of the of Wages | tenance | by all| tenance ea Net Profit
Living |Living | Mainte- | Harned| for all | the | for the Li # = the
Age,| 2t_ Jat each] nance | per. the |Living| whole of re Difference
8°! each | Age per |Annum/) Living |in the} the . © | between
Age. | and | Annum | by one |the year| year |Living at ae 7 | the Income
up-~ | for one | Person. |following/follow--each age|" a and Outgo.
wards.| Person. the ‘ling the| x and | ¥@™°*
f Age x. |Age x | upwards.
a | le | Ne. Yo. Ws | Yole |Wele | Yu We. |(Wx—Yz).
& £ £& & & & &
0 | 513 | 20,961 7 -- 3,591 | — | 268,539] 420,488] 151,949
5 372 | 18,848 7 = 2,604 | — 253,741 | 420,488) 166,747
10 355 | 17,029 8 ne 2,840 | — | 241,008] 420,488) 179,480
15 346 | 15,272 12 12 4,152 | 4,152 | 224,501 | 415,249) 190,748
20 | 335 | 13,561 15 23 5,025 | 7,705 | 201,945 | 386,913} 184,968
25 321 | 11,914 15 29 4,815 | 9,309] 177,240 | 344,124] 166,884
30 | 307 | 10,337 15 31 4,605 | 9,517] 153,585) 297,143] 183,558
35 | 291 | 8,834) 15 31 4,365 | 9,021] 131,025 | 250,519] 119,494
40 275 | 7,410) 15 31 4,125 | 8,525] 109,665 | 206,375} 96,710
45} 257 | 6,071] 15 31 3,855 | 7,967| 89,580|164,866| 75,286
50 | 237 | 4,826 15 31 8,555 | 7,347] 70,9N5|126,271) 55,366
55 215 | 3,685 15 3] 3,225 | 6,665} 53,790] 90,900} 37,110
60 189 | 2,660 15) 31 2,835 | 5,859] 38,430] 59,156] 20,726
65 | 156] 1,780] 15 29 2,340 | 4,524] 25,215] 32,008] 6,787
70 118 | 1,074 15 21 1,770 | 2,478] 14,625] 13,807} — 818
751} 79] 560] 15 16 1,185 | 1,264] 6,915| 4,359) — 2,556
80 44 239 15 4 660 176 2,100 378} — 722

 

 

 

 

 

 

 

 

 

 

 

The Table B. should be read thus: of 513 males born annually,
335 attain the age of 20; and the sum of the numbers who attain that
and every subsequent birthday is 13,561: the expense of bare mainte-
nance in the year following is 15/. (rather less than 6s. a week); the
wages of one labourer in the same year are 23/.; the cost of maintaining
the 335 is 5,025/.; their wages amount in the same time to 7,705/.; the
cost of maintaining all at and above that age is 201,945/., while
their wages are 386,913/.; the difference or the net annual profit is
1849682.

 
536 [PART VI.

Taste C.—Monzy Vatur of a Man; or Vatur of the Future
Earnines and of the Cost of Marnrenance of an AGRICULTURAL
Lasourgr. (Interest 5 per Cent.)

 

 

 

 

Present Value of Annuity Equivalent in Value to

Cost Excess of Cost Excess of

Future | of Future | Earnings | Future | of Future | Harnings

Age. | Earnings, | Mainte- | over Cost | Earnings, | Mainte- | over Cost

nance, | of Mainte- nance, | of Mainte-
nance, nance,

We. Ya. W. — ¥z, W, Y,, We. — Yz,

De D: D, Ne N, N,

0 - 147°89 142°52 5°87 10°75 10°36 °39
5 260°32 204°38 55°94 14°81 11°63 3°18
10 -| 347°88 231-01 116-88 19°84 13°17 6°67
15 - | 488°85 247-30 191°55 25°73 14°50 11°23
20 482°06 248°47 233°59 29°10 15°00 14:10
25 487°90 241°55 246°35 30°31 15°01 15°31
30 - | 474°35 233°19 241°16 30°53 15°01 15°52
35 451°738 223°51 228°22 80°35 15°02 15°34
40 423°71 211°69 212-02 30°02 15°00 15°02
45 391°11 198 °35 192-76 29°59 15°01 14°58
50 * 350° 64 182°27 168°37 28°78 14°96 13°82
55 301°41 163°59 137° 82 27°46 14°91 12°56
60 238°29 141-08 97°22 24°76 14°66 10°10
65 165-20 119°20 46°00 19°93 14°38 5°55
70 - 97°09 96°32 “07 13°92 13°81 eLT
75 49°11] 73°66 — 24°55 8°55 12°82 —4:27
80 10°25 51°27 —41°01 2°20 11°00 —8:80

 

 

 

 

 

 

Taste D.—Va ue of the Future WaGEs of AGRICULTURAL LABOURERS,
and of Proressionat Incomzs. (Interest at 3 per Cent.)

 

 

 

 

 

Interest 3 per Cent. Without Interest.
Value of Future Wages and Salaries. | Amount of Future Wages and Salaries.
Age. Of Agricultural Of Persons Of Agricultural Of Persons
Labourers. in Pro- Labourers. in Pro-
—— | «fessions oan | ——-— | fessions on
On High | On Low Moderate On High | On Low Moderate
Wages. Wages. Incomes. Wages. Wages. Incomes.

£ £ x & £ &

11 542 —_ — 1,187 — mae

15 607 456 —_— 1,195 886 _—

20 637 487 — 1,151 859 —
25 627 481 5,829 1,068 796 10,462
30 597 459 5,700 965 718 10,240
35 556 424 5,951 856 629 9,844
40 509 373 6,038 746 530 9,250
45 456 312 5,932 636 427 8,451
50 397 253 5,584 527 335 7,424
55 330 201 4,933 416 256 6,140
60 255 157 3,979 306 191 4,641
65 172 116 2,718 198 135 2,961
70 100 72 600 112 80 609

75 49 32 _ 52 =, 34 —

80 8 5 _ 8 5 _

 

 

 

 

 

 

 

 

Norse.— The amount of the future income is the average amount received ae the
Ages in the first column,
MISCELLANEOUS. | 537

The table should be read thus.—The value of the future earnings of
(1) an agricultural labourer on good wages at the age of 25 is 627/.,
(2) of an agricultural labourer on low wages 481/., (3) of persons in a
profession returning a moderate income of about-288/. a year is 5,3291. ;
the average amount of wages after ‘that age is 1,068/., and 796/., and
10,4621. respectively.

Here Qi = (1+ §) (t+? P, $ut+? Ppa. + u"+'P,). And
P, the average number of persons living through the age x to z + 1 by
the life table.

W, is obtained from the series Q' by multiplying the several terms
by Wz We+1-

Ww
Then +~ = the present value of the wages.

The values in this table are given oa the extreme hypothesis that
the wages are as certain to be paid as Government Life Annuities at
3 per cent. interest. Compare these values with those in Table C.,
where the interest is 5 per cent.—-(Paper on the Equitable Taxation
of Property in Journal of the Statistical Society, Vol. XVI,
pp- 38-44.)

5. Risk or Farat Rartway ACCIDENTS, AND INSURANCE AGAINST
DeatH or INJURY THROUGH RaILway ACCIDENTS.

The persons killed on railways in 1868 amounted to 797, 714 being
males and 83 females; 34 of the persons (21 males and 13 females)
were returned as killed by manslaughter. Of the deaths, 24 (21 of
males and 3 of females) were suicides: the unhappy victims threw
themselves on the railways, and converted the trains into steam
Juggernauts.

This return differs largely from that made to the Board of Trade for
the same year, showing only 150 deaths in England and Wales.* The
companies speak with confidence of the accuracy of their returns of
passengers, 39.of whom they state were killed by causes beyond the
passengers’ own control, and 14 by causes referable to misconduct or
want of caution. In the two previous years, 24 and 28 passengers were
killed. The return of accidents to servants of companies and of con-
tractors is said to be incomplete, because many railway companies are
not required by law. to report accidents to such persons to the Board of
Trade. It is in this respect that the return to the Board of Trade is
most defective. It is probable that none of the railways return deaths
occurring some weeks after the injury. The numbers “injured” by
the English railways in 1867, as stated in the returns, was 660 to
138 deaths; in 1868, it was 528 to 150 deaths, or excluding the
Abergele accident, to 117 deaths.

Registration records only 13 deaths by collision in 1868. In the five
years 1863-7 only 82 persons were said to have been killed by collision,
31 by trains running off the line. That makes 23 deaths annually
including engineers and stokers. It is probable, therefore, that the
return by the companies of 105 passengers killed in three years (1866-8),
or 35 annually, though under-stated, may serve as a basis of computa-
tion ; and the number, as compared with the number of journeys, is
not considerable. Thus in the year 1867, besides 84,418 season ticket

 

+ Number of accidents of injury to life and limb which have been reported to the
Board of Trade during the year 1868. Parliamentary Paper 162, July 1, 1869.
The deaths for Scotland were 47, for Ireland 15.
538 [PART VI.

holders, 250,598,982 passengers travelled by rail; and as 35 were
killed on an average of the three years 1866-7-8 according to the
returns, the chance of this disaster on the way to any one is represented
by the fraction +000,000,12, after correcting for season ticket holders.
Hence it follows that a premium of l-eighth of a farthing, will insure
1,0002. on an average journey, and taking 600 journeys a year ‘0720.
= ls. 5d. will insure 1,000/. on any life killed during a year of average
journeys. Then, as about 23 passengers are injured to one killed, by
taking the duration of illness into account, we see how those ingenious
persons who undertake insurance against railway accidents make their
calculations and profits.*

The chances against being killed in any single journey vary with
the line, and perhaps with the distance; but if the return is
correct, the general chance is more than 8,000,000 to one that a
passenger will arrive at the end of the journey alive; and the chances
are more than 362,000 to one against his being either injured or
killed. It is probable that there is now no safer kind of locomotion
than railway travelling. It is safer than riding on horseback, or in a
carriage.

This degree of safety is only maintained by the laudable vigilance of
the companies, and of their officers: and the vigilance is kept up by
the heavy pecuniary fines to which they are liable for every injury or
death inflicted on a passenger by their default.

Seeing the small number of accidents to passengers, it has been too
readily assumed that there is no danger to passengers in railway
travelling ; and this saying has been quoted: “a person who wishes to
“ put himself in the safest place possible cannot do better than enter a
“ first-class railway carriage.”

This is based on a fallacy. The rate of mortality from all causes
is always given, like the rate of interest, so as to show the rate per
cent., or per 1,000 per annum; and at the age of 30 this is 10 per
1,000, at 50 it is 20 per 1,000 per annum. The railway mortality
has been calculated hitherto on the journey, which is on an average
of 9°6 miles and may be of half-an-hour’s duration, more or less. The
rate which has been given above is, therefore, per half hour ; and as
there are 17,520 half-hours in the common year, the rate per annum
is 17,520 times the rate per half-hour. When the multiplication is
performed it will be seen that the rate of mortality on a constant
average railway-travelling population is 2 per 1,000. This is an
appreciable addition to the ordinary mortality of men, which ranges
from 10 at the age of thirty, to 20 at the age of jifty, and to 40 at the
age of sixty-three.

Dangers can be numerically appreciated with great exactness on a
large scale, but in practice it is not customary to take into account
additions or diminutions of the rate of mortality not exceeding
one-10,000th part: and men every day encounter dangers of that
measured magnitude without hesitation. Unless they had this
sufficient amount of courage human affairs could not go on; the lion
in the path would bring everything to a standstill. But when the
annual rate igs raised under any exceptional conditions such as
railway travelling by one, and certainly when it is raised by two
in 1,000, the increase under those conditions cannot be entirely

 

* The railway companies return 68 killed to 1,557 injured by their default ; the
numbers injured by the passengers’ own defaults is evidently wrong. It is ‘only
16 injured to 37 killed in the three years 1866-7-8. I take the proportion from
those reported killed and injured by the companies.
MISCELLANEOUS. | 539

neglected. The railway carriage cannot be held up as a harbour of
perfect safety.

But taking the railway passengers’ rate of mortality at 20 in 10,000
for the whole year round it is evident that a season ticket-holder who
is on an average railway only an hour a day for 200 days adds less than
one-10,000th to his risk: it is, therefore, below the degree of commonly
appreciated danger. For double the time the risk may be doubled ; but
even this is only an addition of 2 to the ordinary risk of 150 in 10,000
from all other causes incurred by a life at the age of fifty. Insurance
offices constantly neglect such slight additional risks in dealing with
men living in different circumstances, in different professions. As the
assayer of gold cannot test its fineness from alloy with any certainty
beyond the 2 or 8 ten thousandth part, so it is in scientific assays of the
value of human life.

It is gratifying to find that the risk to the railway passenger has
continually decreased since the early observations of the year 1840-83,
when the passenger encountered a risk five times as great as our com-
putation gives; and this improvement may be in part fairly aseribed to
the laws under which railway companies are liable to heavy claims from
injured passengers for damages. The least want of vigilance, ineffi-
cient training of the staff, overwork, defaults in the construction of the
line, defects in the engines or the carriages, lead to most disastrous
consequences.* Against the divers elements of danger we have the
natural anxiety of the directors, and of a very skilful body of officers to
ensure the safety of the lives of their passengers. All their efforts
in this direction are sharpened by the heavy penalties of the law. And
it is easily conceivable that any relaxation of existing safeguards might
lead to an immediate increase of danger to passengers, so that the
deaths, injuries, and fears of travellers may become twice as great as
they are now.

The “servants of companies or contractors” do not appear practically
to enjoy the same legal protection as passengers, and they are killed in
considerable numbers: in the year 1868 the companies returned 53, and
“many companies” do not take the trouble to report such deaths to the
Board of Trade, “not being required to do so by law.” This is very
evident, for in 1868 while 150 deaths on the railways in England and
Wales are returned from all causes, to the Board of Trade, the total
of such deaths distinguished in the registration returns are, after
deducting 24 suicides, no less than 773! After the deduction of 53
passengers, and of 34 trespassers or persons killed at level crossings,
686 remain, who must have been chiefly “servants of the companies
“ and contractors.” No fines, we may presume, were inflicted in these
cases, as the relatives would have no means of bringing actions under
Lord Campbell’s or any other Act. The workmen have no remedy
when they are killed “‘ by causes beyond their own control;” and their
deaths in most instances are from causes under their control.

It must on these grounds and on others be admitted that the people
at large, and the railway companies, have reason to be dissatisfied with
the present state of the law. In the year 1867, when the railway
companies returned the deaths of 28 passengers, 15 were killed by
causes beyond the control of the said passengers; and 13 by “their

 

* See Neison’s Contributions to Vital Statistics, p. 247. His paper isan excellent
digest of results deducible from the Board of Trade Returns down to the year
1852. In 1840-3 sixty-one passengers were killed in 57,617,578 “ passages,” or one
in 944,550. 260 passengers were injured. But the average distances travelled then
were 18 miles for which allowance has to be made, as the distances are now less than
10 miles.
540 ‘ [PART VI.

“ own misconduct or want of caution,” if we adopt the judgment of
the companies in the matter. The persons injured in the two categories,
they state, were 578 and 6, the latter evidently wrong; for that year
the companies paid 322,985/. as “‘ compensation for personal injury, &c.”*
This is a large sum; it is 2°4 per cent. on the 13,534,28]1. of fare-
receipts from passengers. It does not include all the legal expenses
of the party injured; and we have no means of knowing the amounts
or the per-centage on the sums awarded by juries.

The companies have just grounds to complain of the costs of litigation,
which are probably included in the above sum, and of the uncertainty
of awards, which are based on appreciations of the extent of injuries
often obscure,t and of the value of men’s life incomes, scarcely within
the capacity of juries, or of the ordinary courts. The public have still
greater ground for dissatisfaction. The families of poor men can derive
little advantage from the law; and the result to the opulent is uncertain.
Some railways deal with sufferers in a liberal spirit; others are said
to oppose every claim by hostile litigation: here is another ground of
inequality under the laws.

In endeavouring to arrive at remedies, four things have to be especially
kept in view ; (1) the principle that to ensure the utmost care on the
part of the railway authorities loss of life or limb is to be compensated,
so far as this can be equitably done, by payments in money bearing
some reference tothe economic value of the person injured; that (2) the
railway should know beforehand the amount it may be called upon to
pay; that (3) both the railway company and the person injured should
be relieved from any unnecessary expense in obtaining an equitable
settlement ; and that (4) the tribunal for determining the extent of
injury, the value of the life, and the division of blame, should be skilful
and competent.

I have shown elsewhere that the economic value of men can be

estimated by deducting the present value of their necessary subsistence
from the present value of their future earnings. Thus, taking his
wages as the basis, the value of a Norfolk agricultural labourer, at
the age of 25, was found to be 246/.t; while the value of the income
of a professional man earning 300/. a year being 5,000/., the deduction
of his necessary professional subsistence may reduce the money value of
his life to something like 3,000/. By neglecting this element, the
values of a life are sometimes exaggerated. The compensation for
injury can never exceed the value of the life; and the injuries to body
and limb may be classified by a tariff, so as to bear definite proportions
to the value of the whole life. The tariff would be subject to modifi-
cation in singular cases which can be easily conceived; thus the loss of
a finger may deprive a great violinist of his fortune.

Objections may be raised to this principle of compensation. The
lives of the Queen’s subjects are all equal in the eyes of the law. And
no one admits that a railway company can be justified in neglecting any
precaution in the case of a single passenger, be he rich or poor. The
same vigilance and care are required and given in all cases. Why then
should the company pay more for the life of an officer than for the life
of a soldier, for the life of a judge than for the life of a solicitor, for

 

* Parliamentary Return, No. 484, 1868; what the “ &c.” means in the return is
not clear.

t The difficulty of the surgical questions will be at once seen on referring to the
Classic essay on “Railway and Street Injuries of the Nervous System, by J. E.
Erichsen, Professor of Surgery in University College.”

{ Journal of Statistical Society, March 1853, pp. 39-44. ‘The value of the wages
is 488/.; of the necessary subsistence 2427. (See Extracts on pp. 531-7.)
MISCELLANEOUS. | 541

the life of a bishop than for the life of a curate. Yet the loss or injury
on a carriage full of curates might not exceed 30,000/., while the loss
on the life of two bishops might raise claims for a larger sum. The
answer to this is that the compensation in money is to the individual,
or to his family, for the pecuniary loss, to which it must therefore bear
some defined proportion. Besides, as all classes are mixed up in a train,
the effect of the larger fines on the railway companies is to awaken a
vigilance calculated to prevent injury—and that is after all the main
object—to the lives of ali classes be they of small, or be they of exor-
bitant value. It is possible, however, and even desirable to save
disputes, expenses and uncertainty, to try and find some average mini-
mum amount, suitable to the majority of cases, and susceptible of
expansion to meet exceptional instances. This can be done on the
principle of insurance.

(1.) Thus to deal with the Cases of Death for which the railway
company is exclusively liable. Let a fixed sum be paid by the company
for each passenger killed by its default, and let the sum, varying for the
three classes of passengers, be fixed after careful inquiry. I assume
for the moment that the sums have been determined; and that they are
1,361. for first class, 1,0002. for second class, and 600. for third class
passengers.* Then the tariff of injury would be graduated on these
scales: assume for the moment that on the 23 annual deaths from the
companies fault the amount is 23,000/.; and that the rate for injuries
is so graduated as to amount to an average of 300/.; then 519 injuries
a year will cost 155,700/.; making with compensation for deaths
178,7002. ‘That is less by 144,285 than was paid by the English com-
panies in 1867 as compensation for personal injury “ &c.” in the latest
year for which we have returns. It leaves a reserve.

Where Parliament limits the fares to meet a special purpose it may
limit the compensation.

(2.) The passengers killed by what the return designates their own
“ misconduct or want of caution” appear at first sizht to have no claim;
but in each of these cases a small fine should be levied, in order to
enforce attention to provisions of prevention on the part of the company.
Here is an illustrative case :—A solicitor (J.), enjoying an income of
2,000/. a year is killed under these circumstances: he is startled from
sleep, and attempts to leave the carriage as the train starts ; he is stopped
by a servant of the company, who is an old soldier, and acts in strict
conformity with the regulations ; in the struggle, J., falling between the
platform and the iron wheels of the carriage, is crushed to death. He
is found stretched on the ground, with torn clothes, and a physician
has to communicate the sad intelligence to his wife, now a widow, who
was awaiting his return to dinner. He was killed, as the return would
say, “ by his own misconduct.” But it was held by the jury, that if
instead of a narrow step for the foot, the interval between the platform
and the carriage had been protected, as it is in some other cases, J.
could not have been crushed, his family could not have been deprived
of 2,0002 a year, Another solicitor was killed shortly after, not under
the same, but under similar circumstances. The structural alteration
suggested by the jury involved some expense; it was not carried out.
It may possibly be inexpedient on other grounds, but it is quite certain
that if in all such cases the company were subject to a fine on the old
principle of the deodand, no means would be neglected to prevent
passengers being killed by such ‘ misconduct” of their own, or by any
want of precaution on the part of the company.

 

* These sums are in proportion to the average fares of the three classes :—2° 11d, ;
1:55d.; and ‘93d.
542 [PART VI.

(3). The guards, engine-drivers, stokers, and other servants of the
company, who are killed by causes beyond their own control, are justly
entitled to compensation, at a settled rate. The workmen of the com-
pany or of contractors, often strong but dull, require drilling, training,
and instructing against the dangers of the line. The contractors and
companies could by discipline prevent many deaths, and would exert
themselves more diligently in this direction if they had in every case of
death or injury on the line to pay a definite fine. Some of the com-
panies liberally contribute to the friendly socicties of their servants,
which should be made the universal rule. The whole of the members
of such a fund, as well as the company, should be called upon to
contribute at every death on the line, to give every one an interest in
saving life.

(4). There is no provision to meet those extreme cases from which
the companies suffer, inasmuch as the claims upon them appear prac-
tically unlimited. How much has been demanded cannot be stated, but
18,0002. it is said were paid in one case; 7,000/., 5,000/., 4,000/.,
38,0002., 2,0002., and 1,000/. are apparently common claims. These
cases give rise to expensive litigation, and the scientific estimate of the
value of a life income, on which the amount hinges, is thrown into
the hands, and left to the decision, of an ordinary jury. What the
result may be is a matter of chance. A trial, for a family left destitute,
is a hazardous speculation. These cases will be met by the companies
insuring the lives up to 5,0002. The passenger will thus appraise his
own life, and will pay a premium partly recovering the risk, sufficient,
with some addition from the company’s reserve, to pay the sums insured
wherever the passenger is killed on the line, whether by accident to
the train or otherwise. Thus in three years (1866-8) 35 passengers
were killed annually : 12 by their own want of caution or misconduct,
23 otherwise. This is from the company’s return. The proposal is to
pay the insurance on the 12 deaths, as well as on the 23 deaths. These
sums are insured by special premiums paid by the passengers; and will
therefure be independent of the compensations covered by the tariff
under the first head.

I may here answer a preliminary objection: “There are Railway
“ Passengers Insurance Companies in existence, and any other insurance
‘“‘is unnecessary.” The answer is: these companies have no control
whatever over the causes of death and injury, and the principle here
upheld is that the losses on lives should be met by the parties who can
exercise a certain control over the events against which insurance is
effected. Besides, these insurance companies limit their insurances to
1,0002.; and if the returns of the companies are complete, the insurance
is curtailed of its fair proportion by a proviso, somewhat misleading,
that the insurance shall extend “to such injury only as shall be caused
“ by some injury or accident to the train.” They pay for nothing
beyond the above 23 deaths; so for a third of the deaths returned they
pay nothing; and the death of J. above cited under such a policy
would not have been by accident to the train; and had he held a
policy his family would have got nothing from a Railway Passengers
Insurance Company. Their general policy even apparently does not
cover all the deaths by accident on a railway, while it extends to other
accidents.

An action by law is now inaintainable against a person who by his
wrongful act, neglect, or default may have caused the death of any
person.* This action, under the Act, can now be brought “notwith-

 

* Preamble to 9 & 10 Vict. cap. 93. Lord Campbell’s Act is entitled, * An Act
“ for compensating the Familes of Persons killed by Accidents.” (26 Aug, 1846.)
MISCELLANEOUS. | 543

“* standing the death of the person injured.” Every such action shall
be for the benefit of the wife, husband, father, mother, grandfather,
grandmother, step-father, step-mother, son, daughter, grandson, grand-
daughter, step-son, and step-daughter of the person killed. The jury
may give such damages as they think proportioned to the injury resulting
from such death to the parties respectively for whose benefit the action
is brought.

By the Judicial Statistics, we learn that 203 actions were brought
under the Act in the year 1868; 122 of the verdicts were for the
plaintiff, 3 were subject. to special case or reference; 29 verdicts were
for defendant, in 6 jury was discharged without verdict, in 5 a juror
was withdrawn, 88 were cases of nonsuit, or were otherwise disposed
of. The total amount recovered was 68,092/.; which if equally divided
among the successful plaintiffs, taken at 124, gives an average of about
549/7.; in 9 of the cases the damages were 1,000/. to 2,0001.; 6 were
2,000/. to 3,000/.; 1 was 3,000/. to 5,000/.; and in 1 the damages
were 9,7501.* Actions were brought in 98 other cases of injury from
negligence ; of which 47 resulted in verdicts for plaintiff, + were subject
to special case, and 9 to reference; 7,202/. were recovered, we may
assume by 60 plaintiffs, or on an average 120/. each. The largest
damages in a single case are said to have been between 2,000/. and
38,0002.

The expenses of the 301 trials are not stated, but they would neces-
sarily be large; and the dread of expense necessarily deters many
executors from moving. To meet this difficulty to some extent, the
Act was, in 1864, amended by 27 & 28 Vict. cap. 95, which gave other
persons beneficially interested power to bring actions.

Many of these actions were brought against railway companies; but
the whole amonnt of 75,294/. recovered goes but a short way towards
the compensation for personal injury as shown in the returns to the
Board of Trade. There is a wide margin for Jaw expenses, and the
greater part of the residue must go to meet unlitigated claims.

(4). Any common tariff to compensate for deaths or injuries can only
provide for the cases of persons of moderate fortunes; and should
only be pitched to meet a part of the pecuniary damage sustained, as
the fine is not vindictive but preventive, and in mitigation of a family’s
losses. Railway Jife insurance by the companies ensures the con-
tinuance of vigilance on their part, substitutes definite for unlimited
claims, and gives families the fullest benefit free from the uncertainty
and expenses of litigation.

The insurance could be most conveniently effected by annual policy
tickets, to be issued by each company, but in such terms as to insure,
for a commensurate premium, any sum from 5002. up to 5,000/., payable
by the company owning any railway in the United Kingdom on which
the passenger insured was killed ; and in case of injury a sum propor-
tional to the extent of loss, always a fractional part of the sum insured,
sustained by the passenger.

The risk of death on a single journey being so slight we have no coin
small enough to pay a premium for 1,000/.; but taking 600 average
journeys, nearly 6,000 miles for the year’s travel, of an average person

 

* This was an action of “Howard v. The Great Indian Peninsular Railway
Company, tried at Lewes, Sussex, on 17th July 1868, before Mr. Justice Willes.
The jury found a verdict for the plaintiffs for 9,750/., which they distributed thus :—
to the widow 3,750/., and to each of three children 2,000/.”

{ Judicial Statistics, 1868. Part II., pp. 3-11.
544 [PART VI.

likely to insure, the exact premium calculated on the companies’ own
returns to the Board of Trade is 1s. 6d. (*072) for 1,0002. on each death

524
Take the injuries by the same returns at 15 to each death (35) ; and

let the damages for an injury be on an average 1|-third of the sum insured
at death ; they would necessarily have a large range as the injury was
slight or severe ; then the premium to insure against injury would be
7s. 3d., making 8s. 8d. in the aggregate. To settle the premium minute
preliminary inquiries would have to be made into all the results of c¢x-
perience attained, and into the circumstances affecting the loss of value
of the professional life by injuries, but for the purpose of illustration let
it be assumed that 8s. a year will henceforward insure the passenger’s
life to the extent of 1,000/. against death or injury by any railway
accident, without raising the question of default on his own or the
company’s part; and of this let 7s. be paid by the insurant, 1s. by the
company.

The insurance might be thus worked. The passenger would take out
an annual policy ; the premium being 7s. for 1,000/.; 35s. for 5,000/.
If he take out a season ticket he will take out the insurance ticket at the
same time ; and in all other cases he will take his insurance ticket at
the station nearest to his residence. Each railway in the United Kingdom
will issue insurance tickets, and the premiums will be paid into one fund
under separate accounts ; and the compensations for death or injury on
each railway will be written off the account of that railway which will
be called upon to make up its own deficiencies. There will be many
arrangements of detail necessary to insure the well-working of such a
system ; butit could all be brought in England under the railway clearing
house system. The premium should be subject to approval by a Govern-
ment office, and be so rated as to render it the interest of companies to
reduce the current mortality.

I have assumed for the moment that the insurances would not be taken
for more than 5,000/.; but as sometimes larger sums are awarded it may
be deemed right to insure for larger amounts ; at the above rates a man
of large professional income might insure 10,000/.for an annual premium
of 34. 10s. The actual compensations are paid by the passengers, whose
fares are fixed with due reference to the compensations as well as other
charges, and the premiums for the additional sums required to meet the
cases of lives of more than ordiuary value would relieve the companies
to a considerable extent.

Each man having appraised himself in his policy no further question
of the economic value of the whole life could be raised. ‘Chat would be
fixed by the tariff for all uninsured cases, and by the policy of insurance
in other instances. It is understood that the tariff price would be paid
on every person killed by the default of any railway company, as well as
the extra sum insured.

The cases of ¢njury ave so infinitely diversified, and so difficult to
measure, that to deal with them it may be necessary to establish a special
court of arbitration, consisting of a barrister, a surgeon, and an actuary,
who would soon acquire experience and be able to lay down general
rules for future guidance.

Under these arrangements, we might expect improved means for
the prevention of deaths in travelling on railways, and tewer deaths
among the servants of the companies and of the contractors. At the
present time a battalion is killed every year. (31st Annual Report,
pp. 203-8.)
MISCELLANEOUS. | 545

6. Famiry NomMenctature In ENGLAND AND WALES.

In former Reports* have been described the nature and important use
of the indexes prepared in this department, by means of which the entry
of any registered birth, death, or marriage can be generally refcrred to,
on the mere mention of the name, in a very short space of time. These
indexes, which are separately prepared for the births, deaths, and mar-
riages registered in each quarter, receive a yearly addition of upwards of
1,850,000 names; and at the end of the year 1854 they contained the
names of 4,828,464 persons married, of 9,598,276 children born, and of
6,622,108 persons who died during the period of 174 years from Ist July
1837, when the system of general registration commenced. More than
21,000,000 of the names of the immediate subjects of one or more of the
important events of birth, death, and marriage were thus inscribed in
the indexes to the registers, which thus form a nominal list of no
inconsiderable number of the people of England, living or deceased.

The personal or family nomenclature of the inhabitants of any country
is a subject of considerable interest. Much that is illustrative of their
early condition, customs, and employments is often discoverable in the
names which have been handed down to them from bygone generations,
and an investigation of the origin and character of these names will
always afford matter for curious speculation and usefulinquiry. English
surnames have already to some extent engaged the attention of anti--
quaries and others, who have brought to light many interesting facts on
the subject ; but several curious questions as to the number and extension
of particular surnames have never, owing doubtless to the want of a
sufficient collection of observations, been fully examined. Asa con-
tribution in aid of such inquiries, it may prove not uninteresting io
notice here a few of the more obvious facts derived from the indexes to
the registers, leaving the application of them to those whose tastes may
lead. them to follow up the subject.

The most striking circumstance presented by the indexes is the
extraordinary number and variety of the surnames of the English people.
Derived from almost every imaginable object,—from the names of places,
from trades and employments, from personal peculiarities, from the
Christian name of the father, from objects in the animal and vegetable
kingdoms, from things animate and inanimate,—their varied character
is as remarkable as their singularity is often striking. Some of the
terms which swell the list are so odd and even ridiculous that it is
difficult to assign any satisfactory reason for their assumption in the first
instance as family names, unless indeed, as has been conjectured, they
were nicknames or sobriquets, which neither the first bearers nor their
posterity could avoid.

In Wales, however, the surnames, if serames they can be called, do
not present the same variety, most of them having been formed in a
simple manner from the Christian or fore-name of the father in the
genitive case, son being understood. Thus, Evun’s son became Evans,
John’s son Jones, &c. Others were derived from the father’s name
coalesced with a form of the word ap or hab (son of), by which Hugh ap
Howell became Powell, Evan ap Hugh became Pugh, and in like manner
were formed nearly all the Welsh surnames beginning with the letters
BandP. Ilereditary surnames were not in use even amongst the gentry
of Wales until the time of Henry VIII, nor were they generally esta-
blished until a much later period; indeed, at the present day they can

 

x * First and Sixth Annual Reports of the Registrar General.
if
? MM
546 [PART VI.

scarceiy be said to be adopted amongst the lower classes in the wilder
districts, where, as the marriage registers show, the Christian name of
the father still frequently becomes the patronymic of the son in the
manner just described.*

The probable number of surnames in England and Wales has been the
subject of conjectural estimates based on a small collection of facts. By
the careful collation of all the registration indexes it could be approxi-
mately ascertained ; for during a period of more than seventeen years
it is probable that almost every resident family contributed to the re-
gisters an entry of birth, death, or marriage. The task of collating
upwards of two hundred immense quarterly indexes would, however,
involve a vast amount of labour without any commensurate result ; more-
over the number of names is constantly varying, owing, on the one hand,
to emigration, or to the extinction of families by death, and on the other,
to the introduction of fresh names by foreigners and immigrants, to the
corruption of existing names always going on amongst the illiterate, and
to various other circumstances. The numbers of different surnames
contained in one quarterly index of births, and in another of deaths
have been ascertained; the former selected with reference to the period
of the last Census, and the latter without premeditation. The following
are the results :-—~

 

 

Persons Different
registered. | surnames.
Bintns. Quarter ending 31st March 1851 157,286 25,028

Deatis. Quarter endiny 3lst March 1853) - 118,119 26,991

According to these numbers, there were for every 100 of the births
registered about 16 different surnames, and for every 100 of the deaths
about. 18, reckoning every surname with a distinctive spelling, however
slightly it may differ from others, as a separate surname. Taking the
two indexes together, and by a careful collation climinating all duplicates,
the numbers stand thus :—

 

Persons Different Different surnames to Persons to
registered. surnames, every 100 persons. one surname,
275,405 32,818 LRe9 8-4

An alphabetical list of 82,818 surnames, the largest collection yet
made, is thus obtained ; and as this result is furnished by two quarterly
indexes only, it may be assumed as a rough estimate that the whole
uumber in Kngland and Wales is between thirty-five and furty thousand.
It is important, however, to remember that the list includes a large
number derived from the same roots as others, commonly agreeing in
sound, but differing in orthography often only to the extent of a single
added or substituted letter. By these trifling variations the number is
immensely increased. ‘The name of Clerk, for instance, is also commonly
spelt Clark and Clarke, one and the same primary name (from elericzs)
being implied in the three forms; but three separate items necessarily
appear in the list, for practically as sarnames they represent different
and distinct persons and families. .Again, the widely spread name of
Smith appears in family nomenclature also as Smyth, Smythe, and even
us Smijth. It is not usual, however, to regard these diverse forms as

 

* So late as the time of the accession of the House of Hanover, the unabbreviated
prefix “ap”? was very commonly used, and, by employing it with the contracted
form, three generations could be expressed in one name ; thus Richard ap Pritchard
implied Richard the son of Pritchard the son of Richard.
MISCELLANEOUS. | 547 7

representing one name only, nor would all their bearers probably concur
in admitting the common origin of the several variations. Until a com-
paratively recent period, an entire disregard of uniformity and precision
in the mode of spelling family names prevailed, even amongst the
educated classes, and many family Bibles and writings might be
adduced as evidence that this was apparently less the result of care-
lessness than of affectation or design. While the sound was in a great
measure preserved, the number of different surnames became greatly
multiplied by these slight orthographical variations, as well as by other
corruptions ; and if, in reckoning the number, each original patronymic
with its modifications were counted as one, the list of 32,818 would be
considerably reduced.

The contribution of Wales to the number of surnames, as may be
inferred from what has been already stated, is very small in proportion
to its population. Perhaps nine tenths of our countrymen in the
Principality could be mustered under less than 100 different surnames* ;
and whiic in England there is no redundancy of surnames, there is
obviously a paucity of distinctive appellatives in Wales, where the
frequency of such names as Jones, Williams, Davies, Evans, and others,
almost defeats the primary object of a name, which is to distinguish an
individual from the mass. It is only by adding his occupation, place of
abode, or some other special designation, that a particular person can be
identified when spoken of, and confusion avoided in the ordinary affairs
of life. The name of John Jones is a perpetual incognito in Wales, and
being proclaimed at the cross of a market town would indicate no one in
particular.

From the circumstance of their common British origin it might be
supposed that the Welsh people and the inhabitants of Cornwall would
exhibit some analogous principles in the construction of their surnames ;
such, however, is not the case. ‘The Cornish surnames are mostly local,
derived from words of British root, and they are often strikingly
peculiar. A large number have the prefix Tre, a town ; the words
Pol, a pool; Pen, a head, Ros, a heath, and Lan, a church, are also of
frequent occurrence in surnames. The Cornish family nomenclature
differs materially from that of the rest of England.

The local distribution of surnames is not the least interesting branch
of this subject ; for most persons will have remarked that every district
of the country possesses some surnames rarely met with anywhere else,
the origin of which must be sought for in circumstances peculiar to the
locality. To trace out the connexion between the surnames and these
circumstances is a task which may be most advantageously undertaken
by local inquirers; and the indexes prepared by each superintendent.
registrar, and preserved with the registers in his custody, would prove
useful adjuncts in such investigations.

While it is obvious that the original adoption of a particular surname
was the result in most cases of arbitrary circumstances,—since John
Smith, instead of being called after his occupation, might equally have
chanced to become John Johnson from his father’s Christian name, or
John Wood from the situation of his abode, or John Brown trom his
complexion,—it is curious to remark the predominance of certain
names, which seem to have been adopted preferentially by large numbers

 

* Of the 328 registration officers and their deputies acting in the districts of
Wales, 207 are comprised under 17 surnames, in the following proportions; viz.,
Jones 46, Williams 26, Davies 16, Evans 16, Thomas 15, ltoberts 14, Lewis 11,
Hughes 10, Edwards 8, Lloyd 8, James 6, Griffith 6, Morgan 6, Rees 6, Owen 5,
Morris 4, and Ellis 4. There is only one officer of the name of Smith. The
districts referred to are numbered 581 to 623 in the Abstracts, and include some
portions of English Counties on the Welsh border.

MM 2
548 [PART VI.

of the people, or conferred upon them by others, and now prevail in
every county of England. Do these common names hold the same rank
in point of numbers which they had at first, or have some of them
spread and multiplied more rapidly than others? or instance, is the
present predominance of the Smiths amongst English surnames due to
the original numerical strength of that great family, or to some special
circumstances acting upon “the ordinary laws of increase, owing to
which the descendants of the hammer-men have multiplied at a oreater
rate than the bearers of any other name? Has the progency ‘of the
tawny Browns increased faster than that of the fair complexioned Whites,
relatively to the original numbers of each race, so as to account for the
excess of the former over the latter; or were the Browns in a majority
in the first instance? Various are the surmises and speculations to
which such questions may give rise. One point, however, the regis-
tration indexes enable us to determine; the particular names which
have ultimately attained the strongest hold on the people ; aud also,
with tolerable certainty, the relative numbers of the adherents of each.
The subjoined list of 50 of the most common surnames in England
and Wales is derived on 9 quarterly indexes of births, $ of deaths,

Firty of the most common Surnames in Encianp and Watns, with
the aggregate Number of each entered in the Indexes of Births,
Desths, end Marriages in the Year ending 30th June 1838, of
Births in the Quarter ending 8ist March 1851, and of Births,

Deaths, and Marriages in the Year | 1853.

 

 

 

 

 

 

 

 

 

 

 

 

Nuwnber Number
‘ 5 of Intries Bia tats of Entries
£ Suen aniee deck = Surnames. ateuch
Surname. Surname.
Smith BaL5o7 26 Iarris 7042
2 Jones 33,341 27 Clark 020
3 Williams 21,9236 28 Cooper 6,742
4 | Taylor 16,775 20 Harrison 6,309
5 | Davies 14,983 30 | Davis 6,205
6 Brown 14,346 31 Ward G,O84
2 Thomas 13,017 22 Beker G03
8 | Evans | T2,555 33 | Martin 5,898
9 Roberts | 10,617 34 | Morris a 88s
10 Johnson 9,468 35 James 5,750
ll Robinson 9,045 36 Morgan 5,691
12 Wilson S517 37 King 5,661
13 Wright 8,476 38 Allen 5,468
14 Wood 3,238 39 Clarke 5,309
id | Hall 8,188 tu | Cook 5,300
16 Walker 8,088 41 Moore 5,269
17. | Hughes 8,010 42 | Parker 5,230
18 Green 7,996 43 Price 5.219
19 | Lewis 7,959 44 | Phillips 5,124
20 | Edwards 7,916 45° | Watson 4,771
21 Thompson 7,839 46 Shaw 4,759
22 | White - 7,808 47 | Lee 4,731
23. Jackson 7,659 48 Bennett 4,671
24 ‘Turner 7g 49 Carter 4,648
25 Hill 7,192 50 Griffiths 4,639
Total 440,911
1

 
MISCELLANEOUS, | 549

and 8 of marriages; and although the inquiry might have been
extended over a more lengthened period, it was found that the results
were in general so constant as to render a further investigation unne-
cessary. When arranged according to the numbers in each index, the
names appeared almost always in the same order, and the variations,
when they occurred, rarely affected the position of a name beyond one
or two places. These 50 names embraced nearly 18 in every 100 of
the ‘persons registered. The 3 names at the head of the list, Smith,
Jones, and Williams, are, it will be observed, greatly in advance of the
others; and if the numbers may be taken as an index of the whole
population, it would appear that on an average one person in every 28
would answer to one or other of these 3 names.

Regarded with reference to their origin, it seems that of the 50 most
vommon Dames more than half are derived from the Christian or fore-
name of the father, and are thus literally stve-names or sirmames. This-
is the most primitive form of a second name, and it was extensively
used amongst the Anglo-Saxons as well as by other European nations.
Names derived from occupations are next in number, and contribute 13
to the list. Atter the Smiths come the Taylors, who are about half as
numerous as the Smiths; next the Wrights, amounting to about. half
the number of the Taylors; then the Walkers, Turners, Clarks,
Coopers, Wards, Bakers, and Clarkes. The Clarks and the Clarkes, if
taken collectively, would occupy the third place in the list of names
derived from employments ; a fact which points significantly to the
importance attached to the clerkly office, and to the possession of a
moderate amount of learning, in rude and unlettered times, when a king
received his characteristic epithet (Beau-clerc) from his scholarship.
This class of surnames is peculiarly instructive as illustrating the
pursuits and customs of our forefathers ; many of them furnish evidence
of astate of society impressed with the characteristics of feudal times ;
and not a few are derive from terms connected with the amusements
of the chase and other field sports to which our ancestors were so
ardently attached. Widely different would be a national nomenclature
derived from the leading occupations of the present day. The
thousands employed in connexion with the great textile manufactures
would take precedence even of the Smiths; while the Taylors would
give place to the shoemakers (now scarcely recognizable under the
not common surname of Suter with its variations, Soutter, Sowter, &c.),
as well as to the Colliers, the Carpenters, the Farmers, and others.
The Hawkers, Falconers, Bowyers, Fletchers, Arrowsmiths, Palmers,
Pilgrims, I'riars or Freres, and a host of other family names derived from
various callings which have become obsolete in this country, would
be wanting. Seven of the 50 surnames belong to the class of local
surnames, and are expressive of situation, as Wood, Hall, Green, &e. ;
and two (Brown and White) are derived from personal peculiarities.

The surname ef Smith is pre-eminently the most common in
England, as that of Jones is in Wales; and so great is the multitude
of the Welsh Joneses, that the latter name not only enters into com-
petition for priority in point of numbers with the Smiths, but in several
years shows uw majority over its rival. With a view to determine the
relative frequency of these two widely-spread surnames, the numbers
of each entered in the indexes during the years 1838-54 have been
ascertained. he result is that the births, deaths, and marriages of
the Smiths registered in this period were 286,037, and those of the
Joneses 282,900, the excess in favour of the former being 3,137 in
the 17 years. Smith is, therefore, unquestionably the most common
surname amongst us, though the Joneses are little less numerous, and
550 [parT VI.

in six of the years actually contributed to the registers larger numbers
than the Smiths. Together, the bearers of those two common names
amounted to 568,937, or 1 in 86 of the whole number registered,
during the period referred to.

Assuming that the persons of the surnames of Smith and Jones are
born, marry, and die in the same proportions as persons of all surnames,
it will follow that in England and Wales there are not less than half a
million of persons bearing one or other of those two surnames. The
Smiths, amount to rather more than a quarter of a million, and the
Joneses to little less; together forming no iuconsiderable portion of the
English population. ‘These numbers represent, un the assumption that
the average number of persons in a family is the same as in the whole
population at the Census, viz., 4°8 persons, about 53,000 families of
Smiths, and 51,000 families of Joneses; and to vive an illustration of
their numerical powers, it may be stated that tbese two great tribes
are probably sufficiently numerous to people the four towns of
Birmingham, Bristol, Leeds, and Hull, without any addition of persons
of other surnames.

Upon the facts derived from the indexes of the registers for the
year 1853, the probable number of persons in England and Wales
bearing each of the 50 most frequent surnames has been computed.
From this estimate it appears that the persons by whom these 50
surnames are borne amount to about 3,253,800; nearly one sixth of
the entire popuiation of England and Wales. On an average, it seems,
one person in 73 is a Smith, one in 76 a Jones, one in 115 a Williams,
one in 148 a Taylor, one in 162 a Davies, and one in 174 a Brown.

It is sometimes useful, in dealing with an extensive list of names, to
know the proportionate numbers commencing with each letter of the
alphabet. With such information, the names may be subdivided,
accordiug to the initial letters, in groups, large or small, so as to
secure tolerably equal numbers in each group. The experience of the
department in this respect, derived from the registration indexes, shows
that the letter Bis the most frequent initial of surnames amongst us,
comprising more than a tenth of the whole. Next in number are the
surnames ranked under the letter H (9°5 per cent.) ; then those under
S. and W. (8:9 and 8°7 per cent.) The vowels, which enter largely
into the words of the English language from their occurrence in
the prefixes ab, ac, ea, in, im, un, &c., are not extensively used as the
initial letters of surnames; and amongst the consonants N and K are
the first letters of the fewest surnames, except X and Z. As many
words in common use, chiefly of Anglo-Saxon origin, have been adopted
as surnames, the philologist may probably trace some relation between
the surnames and the words of the language beginning with the same
letters; but so large have been the additions made to the English
vocabulary in modern times, that such a connexion is by no means
obvious in reference to the words now found in our dictionaries.
(16th Annual Report, pp. xvii-xxiv.)

 
APPENDIX.

 
553

APPENDIX.

THE “FARR TESTIMONIAL FUND.’

As soon as it became known that Dr. Farr had resigned his appoint-
ment as Superintendent of the Statistical Department of the Registrar
General’s Office, a gencral feeling prevailed amoung those who fully
appreciated the value of his public services, especially with reference to
their influence upon the progress of public health in England, that some
cffort should be made to secure for them some public recognition. A
mecting of those interested in this project was held at Somerset House,
early in April 1880, at which the Earl of Derby had consented to take the
chair. It was decided to start a Farr Testimonial Fund, and an Executive
Committee was appointed to carry the proposal into effect. Mr. Richard B.
Martin, M.P., agreed to act as Honorary Treasurer, and Mr. Noel A.
Humphreys, of the Registrar General’s Office, as Honorary Secretary.
Measures were taken to bring the Farr Testimonial Fund under the
notice of the general body of the medical profession, and of the Members
of the Royal Society, Statistical Society, Institute of Actuaries, British
Association, and Social Science Association, with all of which Societies
Dr. Farr bad been more or less intimately connected. More than
20,000 circulars, setting forth the object of the movement, and asking for
subscriptions to the fund, were thus distributed. During more than
twelve months the efforts of the Executive Committee were directed to the
promotion of the fund, and resulted in the collection of 1,1321. 3s. 6d.
The following is a full list of the subscriptions :—

: LIST OF SUBSCRIPTIONS.

 

G ss ds Ss as
The Earl of Derby z 50 0 0 | Paget, Sir James, Bart., F.R.S. 5 5 0
De Cappelaine, J. 52.10 © | Bailey, A. H., Pres. Inst. Act. 55 0
Heywood, James, F.R.S. 25 0 0 | Spottiswoode, William, Pres. R.S.- 2 2 0
Proprietors of The Lancet 50 0 0 | Erichsen, Jobn Eric, F.R.C.S. 1010 0
Carpenter, Alfred, M.D. 20 0 © | ‘Henniker, Sir Brydges P., Bart. 5 00
Apothecaries’ Society 1010 0 | Clode, William 3.30
Graham, Major George 20 0 0 Fayrer, Sir Joseph, K.C.8.1, F.R.S. 2 2 0
Curling, T. B., F.R.S. 5 5 0 | Oakes, Thomas 220
Tuke, T. Harrington, M.D. 5 5 0 | Humphreys, Noel A. 220
May, George, F.R.C.S. 1 1 0 | Thomson, James 1010 0
Simon, John, C.B., F.R.S., D.C.L. 5 5 0 | Acland, Henry W., M.D. F.Rs.,
De Chaumont, F., M.D., F.R 8. 110 ee ae ss ‘ 2 BO. h

urrows, Sir George, Bart., M.D.,

Rigden, George, M.R.C.S. + Eek .0 E.R.S. 2 is i x ۤ & 6
Jevons, W. Stanley 1 0 0] Greenhill, W. A., M.D., Oxon 20 0
Hill, Alfred, M.D. 1 1 0] Carillon, Wilson, F.S.A. . 22 0
Westgarth,W. - 10 10 9 | The Earl of Shaftesbury, K,.G. 1 0 0
Westgarth, W. (2nd don.) 1010 0 J enner, Sir William, Bart., K.C.B., 5
Se ee 8 | ae nd Risdon, MD, LED.
Pitter, Joseph 220 E.R.S. : 2 BR EH
Hassall, Arthur Hill, M.D. 2 2 0] Frankland, Professor, F.R.S. 5 5 0
Logie, Cosmo Gordon, M.D.,¥.R.C.8. 2 2 0 | Fraser, Thomas R., M.D., FR. 220
Martin, R. Biddulph, M-P. - 1010 0 | Vacher, Francis, F.R.C.S. - 220
Grimshaw, T. W., M.A., MLD. 3.3 0} Gairdner, Professor W. T., ILD. 55 0
Druitt, Robert, M.D. 2 2 0] Rawlinson, Robert,C.B.  - 5 00
Clover, Joseph Thos., F.R.C.8. 220 Corfield, W.H., M.A., M.D. 220
Stevenson, Thos., M.D. 110 Mouat, Fred. John, M.D. 55 0
5o4 [ APPENDIX.

SEA reeSoere ceo eoc seo eeoest Se ese eo soso ootoe se eoeoacecs &

 

Ls. d. | Ess ae
Lewis, James 22 0 MeKewan, Wm. 3053~0
Balding, D. B., V.R.C.S. 3) 3.30) Gibbs, G.S. - . 220
Saunders, W. Sedgwick, M.D. 5 5 0 | Darwin, Charles, l’.R.s. 5500
Hamilton, Archibald 10 10 © | Bourne, Stephen, F.S.8. ted
Janson, I’. H. 5 5 0 | Jamison, Patrick - 05
Newmarch, William, F.R.S. 1010 0 | Swith, Colonel J.S. - 2 2
Philipson, G. H., M.A., M.D. 2 2 0) Hill, Frederic 10
Norman, George Ward 25 0 0 | Philip, George - - 5 5
Hart, Ernest - 56 5 0] Winch, W.R. ae
Brassey, Thos., M.P., Pres. Statis. Cleghorn, J. « 28
eee = iy = Copperthwaite, W. C. 22
Watson, Sir Thos, Bart. MLD. POM MtDG ds. =<
TE.R.S, - - 1010 0 | Russell, J. A., M.B. - 10
Lubbock, Sir John, Bart. 5 5 0 | Hodge, W.B. - 5 0
MacLaren, A. C. 5 5 0 | Mocattayr.D. - 5 3
The Earl Fortescue woo Albright, Arthur 2: 3
Lord Houghton, D.C.L., F.R.S. 5 5 0 | Willans, J. W. 11
Bristowe, John Syer, M.D. 3.3 0 | Beddoe, J., M.D., F.R.S. 1s
Bain, W. Pellew, M.D. 3.3°~«0 Thomas, C. J., J.P. 11
Ogle, William, M.D. 2 2 0 | Blower, Benjamin, M.R.C.S. 11
Rendle, William, F.R.C.S. - 2 2 0 Sanders, W. R. a 5
Rendle, George, M.R.C.S. 2 2 0 | Baines, Mrs. M..A. 300
Walter, John, M.P. - 20 0 0 | Armitage, T. R., M.D. Bisg
Gull, Sir William W., Bart., M.D. 10 0 0 | Clark, Sir John 2
Latham, B., C.E. 515 6 Lord Napier of Magdals. 338
Lord Ebury - 1010 0 | Bunyon,C. J. - 22
Eassie, W., C.E. 2 2 01 Bayley, J. 2 2
Watson, J. W. - 1 1 0! Windeatt, John 1a
North, 8. W., M.R.C.S. 1 1 04} Paget, Joseph 10
Richardson, B. W., M.D., F.R.s. 5 5 0 | Andrew, J., M.D. 2 3%
Field, Rogers, C.E. 565 0 Greig, J. A. - 11
Hubbard, Right Hon. J. G., M.P. 1010 0 | Balfow’, General Sir George, M.P. 55
Robinson, W. K., M.D. 2 2 0]! Brennan, A. - : y 2)
Pagliardini, Tito - 1 1 0 | Scott, Exors. of Russell 23 0
Ligertwood, Thomas, M.D. - 11 04 Brind, F. Ww. BF36
Buchanan, George, M.D. 3 3 0 | Duke of Devonshire 20 0
Montefiore, Nathaniel - 10 0 0 | Morley, Samuel - 1010
Ransome, Arthur, M.D. 2 2 0 | Williams, C. J.B. M.D, V.RS. - 5 5
Liddle, Jobn, M.R.C.S. 2 2 0) Barrett, T. B., M.R.C.S. 11
Vian, W. J. - 1 1 0] Nightingale, Florence 10 19
White, Joseph, F.R.C.S. 2 2 0 { Farmer, James Td
Guy, W.A., M.B., F.R.S. - 1010 0 | Darwin, G. H. - 2 0
Longstafl, G. B., M.B. 20 0 0 | Homersham, T. C. a5
Tyndall, John, F.R.8. 5.5 0 | Atkin, W., M.D., F.BS. Ld
De la Rue, Warren, F.R.S. 5 5 0 |- Baylis, C.O., M.D. 11
Harrison J. Thornhill 1 1 0] Palgrave, R.H.Inglis  - 55
Lord Mount-Temple 5 0 0 | Welsh, J. Kemp, J.P. 5D
Harcourt, A. V., F.RS. 1 0 0 | Bratton, J., F.R.C.S. lil
Taylor, John Edward 2 2 © | Anderson, Mrs. E. G., M.D. 2 2
Smith, Protheroc, M.D. 2 2 0} Macpherson, H. M. - a)
Kent, C. 1 0 0] Brodie, Sir B.C. 30300
Smith, Robert Mackay - 2 2 0] Tannyngton, Major-Gen. - 330
Wilkinson, Thomas Reed 2 2 0 | Singer, C. Douglas 5 5 (0
Sprague, Thomas Bond 5 5 0 | Buchanan, Andrew. M.D. 220
Spalding, Samucl 5 5 0 | Sanderson, J. Burdon, M.D., F.R.8. 2 2 0
Messent, John 2. BO Lawson, Inspector-General R. - 830
Lovegrove, Natalie - 5 5 0 | Prestwich, Joseph, F.R.S. 220
Welton, Thomas A. 2 2 6} Bowles, Robert L., M.D. 22 0
Christison, Sir Robt., Bart.. M.D. - 5 5 0 | Crothers, R., M.D. - 110
Rivers, Major-General A. P. - - 2 2 0° Hendriks, Frederick - 220
APPENDIX. | 555

£ sd. £ sda
Lewis, Waller A., M.B. 2 2 0 | Chapman, J. H. 110
Farre, Arthur, M.D., F.RB.S. 220 Little, James, M.D. 220
Sibley, 8S. W., M.D. 3 3 0 | Martin, James, M.D. - : 110
Till, W. T., MD. 110 Porter, H. W., B.A. 22 0
Rogers, H., M.R.C.S. 2 2 0 | Winstone, Benjamin, M.D. - 110
Russcll, Hon. F. A. R. 10 0 Ballard, Edward - - 110
Stephenson, E. J. - - 2 2 0 | De Grave, J. ¥., M.R.C.P. 1010 0
Wilkinson, R. - 2 2 0 | Davis, T. - 110
Begley, W. C., M.D. 3 8 0 | Foster, M., M.D., F.R.S. leh ©
Baylis, Mrs. C. O. 11 0 | Davis, E., M.R.C.S. 110
Morris, Thomas, M.D. - 55 0 Wilson, J. H., M.K.Q.C.P. 110
Thomas,G. D.P.,M.D. - 110 Tatham, J. F. W., M.D. 110
Priestley, W. O., M.D. 5 5 0 | Wilson, E. J., MB. - 110
Cleaton, John D., M.R.C.S. 5.5 0 Tilley, S., F.R.C.S 22 0
Williamsy, F. J. 010 6 | Shiers, D., M.D. « - 110
Hill, Berkeley, F.l.C.8. 3 3 0 | Barnes, Robert, M.D. 22 0
Ace, the Rev. Daniel, D.D. 110 Thompson, James, M.D. 110
Wells, T. Spencer, F'.R.C.S. 5 5 0 | Jellicoe.Charles - 110
Tidy, C. Meymott, M.B. - 110 Mapother, E. D., M.D. 110
Quain, Richard, F.R.C.S., F.R.S. 5 0 0 Holden, Luther, F.R.C.8. - 5 5 0
Radford, Thomas, M.D. 110 Mann, Horace - 22 0
Hallett, J. G. P., M.A. 6 6 0 | Wood, Mrs.8.G. - 5 0 0
Waters, A. C. - 05 0 Cadge, William 220
Balfour, J. Graham, F.R.S. - 220 Webb, F. E., M.R.C.S. - 110
Sayer, G. bh. H. - 02 6 Sutton, J. Maule, M.D. 220
Brown, J. B. 2 2 01! Hastings, G. W., M.P. 10 10 0
Tytheridge, H. B. H. 0 5 0 | McIntyre, J., M.D. 22 0
Roth, Matthias, M.D. 1 1 0] Keeling, J. H., M.D. 110
Sutherland, John - 5 0 0 | Langshaw, J. P.,F.R.CS. - 110
Hawkesley, Thomas, M.D. - 1 1 04 Major, H.C. - 110
Dunbar, Eliza W., M.D. - 1 1 0 | Hollis, W. M., M.R.C.S. - - 110
Elliott, Robert - 11 0| Hughes, H.S.,M.RCS. - 2 2 6
Dickson, Frank, F.R.C.P, - 1 1 0] McKellar, E., M.D. - 110
Wilkes, James, F.R.C.S. - 5 0 0 | Hardman, William, M.B. - 110
Martin, J.B. - 5 5 0 | Williams,R. Price - sp O50: 7h
Thompson, Sir H. - 5 5 0 | Tripe, J. W., M.D. - - 110
Tonsino, P. - - 1 0 0 | Sykes, J., M.D. - - 110
Clapham, J. : 2 2 0 | Bddowes, A., M.D. - 110
Jones, George, M.D. - 1 1 © | Eddowes, W., M.R.C.S. 110
Lee, John, L.8.A. 1 104} Rayne, S. W., ¥.R.C.S. ae
Soames, E. - - 5 0 0] Page, H., M.B.C.S., S.Sce.C.Cantab 1 1 0
Pochin, J.D. - - 5 5 0] Turner, G. - - PR 0
Porter, G. H., M.D. 2 2 0] Rix, W. H., WLRGS. e 2 2G

 

With the full concurrence of Dr. Farr, the amount of subscriptions,
less the expenses for printing, advertising, postage, &c., was invested in
Bank of England Stock in the names of the Honorary Treasurer and of
the Honorary Secretary, as Trustees, on the understanding that the
dividends should from time to time during his lifetime be re-invested,
and that after his death the dividends of the accumulated fund should
be applied by the Trustees to supplement the slender provision that
Dr. Farr had been able to make for the support of his three unmarried
daughters.

On the death of Dr. Farr in April 1883, the Executive Committce of
the Testimonial Fund brought the claims of Dr. Farr’s daughters before
the Government in the hope that some pension might be allotted to them,
but the efforts on their behalf only resulted in a contribution of 4001. to
the Testimonial Fund. Miss Nightingale, who had originally subscribed
ten guineas to the Fund, made a further donation of 1001. to the Fund
on Dr. Farr’s death. These sums, together with the sum of 921. 13s. 6d.,
which had accrued as dividends, were also invested in Bank of England
Stock. The Fund was not finally closed until after the receipt of the
[ APPENDIX.

556

sets forth the receipts,

and J. Whittall,
disbursements, and investments in connexion with the Fund :—

October dividends in 1883. The following Balance Shect, audited by
J. O. Chadwick

Messrs.

 

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This was the net result of the Farr Testi

6d.

From the above Balance Sheet it may be seen th

received on behalf of the Fund, including
1,7241. 17s. Od., and that the total expenses were 1871. 2s. 3d.

Fund was finally closed, and the Balance Sheet
1883, the nominal amount of Bank Stock

two Trustees was 524/, 8s. 1d.,

worth 1,5500. 15s.

Fund.

B
a
os
8
o
8
26
gn
ae
a
= 8
Pa
m6
4A
A
a
°
a
INDEX.
659

INDEX,

Accidental deaths (see Violent deaths).

After-lifetime, or expectation of life, 310, 478.

Ages; incomplete return of in marriage
registers, 68, 76 ; law of mortality at all, 119;
variable methods of stating, 206; causes of
death at different; mortality of males and
females at different (Table), 306; at death
from different diseases; mean age at death
of persons dying from certain causes, 1848-
72 (Tables), 308, 309; mortality at different,
from cholera, 1848-9, 337; in relation to
cholera epidemics, 385; fever mortality at
dificrent, 390; mean at death, 456; mor-
tality at groups of, for Life Table purposes,

449.

Ages of the Population; enumerations of, 4,
373; eflect of birth-rate upon, 38; length ofa
generation ; centenarians, 41; mean age of
population, 44; proportion of married at
different ages of each sex, 46; of the Deatf-
and-Dumb and Blind (Table), s9; in Census
Reports; in Death registers, 179 ; age con-
stitution of the population, 180; mortality at
groups of, in England, Carlisle, Belgium,
and Sweden, 180; mortality of males and
females at groups of, 1838-44 (Table), 121 ;
ditto 1838-62, 182; ditto, 1838-71, 183; pro-
portional mortality at different, 184; of
males and females at various periods of,
1861-70, 185.

Alcoholism, mortality from, 282; deaths as-
erihbed to at different ages, 1871-6 (Table),
283; mortality of publicans compared with
that of the clergy (lable), 284; a mixed
dietary of food with alcohol desirable, 285.

Annuities, deferred, 532. :

Area of parishesand townships first computed
in i831], 4.

Averages, constancy of, 455.

Bakers, mortality of, 396, 402.

Belgium ; death-rates at groups of ages, 180.

Bills of mortality, of Queen Elizabeth, 218.

Births; annual number; influence upon
population, 21; may be increased in two
ways, 22; registration of, 1837-76, 89; to a
marriage, 1856-60, in England and Scotland,
93; comparative fecundity of English and
Scotch women, 95; to a marriage, 1864-74,
97, 98; fecundity in France, 98 ; sex propor:
tions, 104; defects of register; statistics of
jirst-born ; note on first-born, 105 ; still-
born, 107. ‘

(See also Illegitimate Births.) |

Birth-rate, among married women in 1859, 89 ;
in counties, in 1854, to 100 married women
aged 15-55 (Table); among married and
unmarried women, 90, 93; in counties in
1845-57, to 100 married women aged 15-55
(Table), 91; in counties in 1845-57, to 100
unmarried women ee 16-55 (Table), 92; to
100 women in England and in Scotland
(Table}, 95; and fecundity in European
States, 973; possible increase of, 99; when
high, do not necessarily imply high death-
rates, 111; relation between and death-
rates, Hass .

Blacksmiths, mortality of, 397, 402. :

Blackstone, Justice. Numbers of Lincal
ancestors, 30. ott

Blind, the; enumeration and distribution of,
51-33, $43 occupations of, 53; causes of
blindness, 5s; blindness at groups of ages,
58-Sy. :

Booksellers, &c., mortality of, 402.

Bronchitis, mortality from, 268, 269.

 

Budd, Dr. W.; precautions against diffusion
of zymotic diseases, 329.

Butchers, mortality of, 396, 400.

Carbonic acid; its influence upon the public
health, 161.

Carlisle; death-rates at groups of ages, 180;
life table, 480.

Carpenters, mortality of, 307, 402.

Causes of death, their nomenclature, classifi-
cation, and mortality; importance of, and
first steps to procure, registration of, 209 ;
cireular of the Royal College of Surgeons,
&e., with respect thereto, 210; explanatory
statement as to, 211; practical utility of,
212; analysis of, 215; analysis still imperfect,
216; plagues the first diseases distinguished,
216; sporadic diseases, 217; defects and im-
perfections of registration, and of coroners’
returns, 218; bills of mortality of Queen
Elizabeth, 219; methods of registration of,
on the Continent, 221; imperfect security of
incomplete registration against murder; the
Essex and Norfolk poisonings, 223; statisti-
cal nosology, 231; analysis of morbid  phe-
nomena—nomenclature, 234; composition of
the body ; changes the body undergoes, 235 ;
method of distinguishing diseases, 236 ; cha-
racteristics and classification of, 238-245;
zymotic diseases and_their exciting prin-
ciples, 245 ; report on the nomenclature and
statistical classification of, 250; epidemic,
endemic, and contagious, 253; constitutional,
local, developmental, violent, 254; what are
they? 256; for the most part certified,
though often inadequately, 257; history of
the registration and classification of, 259;
medical certification of, 262; compulsory
ditto, 264; in inquest cases 265; in the
metropolis, 1629-1835, 303, 304; at different
ages, 306; epidemics, infectious and zy-
motie, 317.

Census: scope of inquiry at each enumera-
tion, 1€01-11-21-31-41-51, 6.

Census and population registers, 33 ; enume-
ration of ages, 37; enumeration of children,
206..

Centenarians (with Table), 41-44.

Chastity, its effect upon mortality, 441.

Chemists ; mortality of, gor.

Childbirth, mortality of women at different
ages in, 1847-54 (Table), 241; chances of
death from, 271; in Sweden at four periods
of life, 1830-85 (Table), 272.

Children, mortality of, 188; number living at
each month of age under one year (Table),
189; mortality in London, 195 ; mortality of
in_ registration districts, 1851-60, 201 ; mor-
tality of, 1861-70, with some causes, 203;
deaths of under five years in Healthy Dis-
tricts, and in Liverpool, from 19 groups of
causes, 204; mortality of in Wuropean
States, 205 ; Censns enumeration of, 206,

Cholera, epidemic of 1848-9, 333; information
relating to preserved at General Register
Office, 334; sex mortality from, 336; mor-
tality at different ages, 337; (Table), 338;
curation of cases of, 1848-9, 339 ; epidemics
of, 1831-2 and 1848-9 compared, 340 ; effect of
the water supply on the epidemic of 1848-9,
341; effects of elevation upon, 343-347; con-
ditions most conducive to fatality from, 344 ;
rise and progress of the epidemic, 1853-4,
351; local fatality of, in 1853-4 (Table), 353;
sex and age mortality, from 1853-4 (Table),
354; elevation and mortality from, 1853-4
560

Cholera—continued.
(Table), 355; mortality from, and water
supply, 1853-4, 357; four epidemics of in
England, 363; in London, 1866,- 365 5 origin
and causes of, 366; localization of in Hast
London, in 1866, 369; in the several water-
fields of London, in 1866, 345; scientific
clements of, 379; elects of density upon, 382 5
eflects of sewerage, 383; effects of wealth
und poverty, 384; fatality of as affected by
sex and ave, 385; attacks of, 387; attacks
and deaths, males and females, in proportion
to population, and ratio of deaths to at-
tacks (Table), 388; duration of fatal cases,
388; deaths from on different days of the
week, 389.
Classitication of Causes of Death, 209, 256.
Clergymen, mortality of atfourages compared
with that of publicans, (Table) 284; dura-
tion of life of (Table), 287; mortality of, gor.
Clerks; mortality of, yor.
Climate, influence of wpon health, 411.
Coachmakers, &c. ; mortality of, 402.
Coaehmen ; mortality of, gor.
old, effect of upon mortality, 415-416,
Condorcet on human perfectiubility, 135.
Constitutional diseases, classification of, 254.
Cornish miners; mortality of (Tables), 404-407.
Coroners; returns of violent deaths 1852-6,
290; returns show improvement in accuracy
of information, but still defective, 292 ;
salarics of, and expenses of inquests, 298.
Cotton Famine and mortality in Lancashire,

 

141.

Counties; method of forming, for registration
purposes, 8.

Coventry, deatir-rates in three decades, 136, 137.

Crickhowell, death-rates, 1841-70, 136, 138.

Darwin, Mr. C.; theory of pangenesis, 324.

Deaf-and-Dumb, Enumeration and distri-
bution of, $6-57 ; congenital mutism, §8; deaf
mutism at groups of ages, 58-59.

Deaths, in England, 116; importance of the
subject, 117; carlicst returns of, 122; pro-
gress of public health possible, 130; from
plagues, 150; in 30 large town districts,
1851-60 at allages (Table),160; by 12classes
of fatal diseases in city and rural districts
(Table), 168; at groups of ages, males and
females, 1838-44 (Table), 181; of children
(0-5) with some causes, 1861-70, 203; from
small-pox in London, 1661-80 (Table), 214;
of women in Childbirth in each year, 18 (7-54
(Table), 270; from alcoholism at different
ages, 1871-6 (Table), 282; ascribed to in-
sanity, 1871-6 (Table), 283; from violence
in London England, and Foreign countries
prior to 1839, 287, (Table), 288; on railways
and in mines, 296 ; (Tables) 297; on railways,
1868, 537; deaths from certain causes to a
million deaths from all causes, 1851-70
(‘Lable), 308 ; economic effect of, by different
diseases, 313; from cholera in dillerent days
of the week, 389; from fever in the London
Hospital, 1848-57 (Table), 390; of kings and
peers, 392; weekly excess of by cold (Table),
416; in public institutions, 417.

Death, ages at, in registers, 179 ; mean age at,
480; the rate of mortality and probability
of dying, 490.

Death-rates, definition and value of; Dr. Le-
theby’s attack on Dr. Parr’s system, r11;
effects of density of population upon, 113 ;
their constitution and their significance as
tests of health and health progress, 116;
mortality reports, 118; local; history of ;
law of} 119; significance of, 120; varies at
different ages and in populations according
to their mean ages, 121, 1253 above 17 per
1,000 implies imsanitary conditions, 121, 132;
propositions based upon, 122; disturbing
elements, 124; relation between death-and
pirth-rates, 125 ; method of comparing local
with standard, 128; can be reduced; in
certain “healthy” districts, 131; sanitary
work and decline of, 136; and high prices of
wheat, 138; and cotton famine in Lan-
eashire, 1415; and water supply: cifect of
temperature upon, 142; male and female in
London; relative, of males and females, at
seven age-periods in eight grouns of dis-

 

[INDEX.

Death-rates—continwed.
tricts. 1861-70, 145 ; ruraland urban; healthy
district, 146,147; in Rothbury, an_excep-
tionally healthy district, 149; healthy and
unhealthy district, 150; of healthy and un-
healthy districts compared at various ages,
and excess due to unhealtkiness (Table),
152; excessive in towns, 153 ;in London, 154;
in Manchester, 159 ; 1.30 large town-districts
1849-53, compared with what it would be
had the healthy-district rate prevailed
(Table), 160; causes of excessive urhan, 161;
is excessive mortality in cities inevitable ?
Tyo; excess of in town compared with
country districts from certain diseases
(Table), 171; relation between and density
of population, 172; in seven groups of dis-
tricts and the mortalities deduced from the
densities of these groups (Table), 175; in-
creases as density increases, 176; Increase of
at each of twelve age-periods in seven groups
of districts experiencing different rates at
all ages (Table), 177; relative, at exch of
twelve age-periods in eight groups of dis-
tricts (Table), 178; at different ages, 149;
at groups of ages in England, Carlisle, Bel-
gium, and Sweden, 180; of males and females
at groups of ages, 1838-44 (able), 181; ditto,
1838-62, 182; ditto, 1838-71, 183; propor-
tional, at different age-periods, 184; ditto,
in England, in 30 large town districts, and
in 63 healthy districts (Table), 185; at
various age-periods, of males and females,
1861-70, 185; definition of mortality, 185 ;
per cent., 1861-70, at different aves in filty-
one healthy districts in England, London,
Manchester, and Liverpool (Table), 187; of
children ; of infants, 188; embryonic mor-
tality, 189; per cent. of children at each
month under one year (Table), 189; of in-
fants from all causes in cighteen large towns,
1870-5 (Table), 190; of infants from different
causes in England, in Scotland, and in
filteen large towns, 1873-5 (Table), 191; of
illegitimate infants, 196; of legitimate and
illegitimate infants in twenty-four districts,
1871-5 (Table), 197; of infants in Glasgow
(Table) ; of infants at each month of the
first year, 199, (‘Lable), 200; per 1,000 births
of infants at cach month cf age in “ healthy”
districts aud in Liverpool (Table), 201; of
children (0-5) in Registration Districts,
1851-60, 201 ; of children in European States,
205; from phthisis and diseases of the
respiratory orguns (Tables), 266-269; Puer-
peral, 1847-54, 269; of women bearing
children at different ages (Table), 241; in
Lying-in hospitals, 273 ; in maternity chari-
ties, 248; from alchoholism, 282; of publicans
compared with that of clergymen (Table),
284; of grocers, 1860-1 and 1871 (‘T'able), 286 ;
from violence in London (Table), 288; in
Sweden, Prussia, and France (Table), 288 ;
from violence on railways 1863-72 (Table),
297; from violence in mines (Table), 207;
from suicide in certain English counties,
300; in London from twenty classes of
diseases (Table), 304; of males and females
at different ages (Table), 306; from certain
causes, 1851-70 (Table), 309; from cholera
at different ages, 337; from cholera and
diarrheea at twelve age-periods in 1840
(Table), 338; from diarrhoea and cholera, of
males and females, at different ages (Table),
354; from cholera in districts of London
supplied by different water companies
(Tables), 358, 359; from cholera in 1866, at
different elevations (Table), 381; from cho-
lera in relation to density of population, 382 ;
ditto in relation to wealth and poverty, 384;
from cholera in the two sexes and at
different ages, 385; from fever at different
ages, 390; of kings and peers, 392; of males
engaged in different occupations, 394-399,
398-404; of miners, 404-411; in the Navy
and Mercantile Marine, 411; excessive, duc
to cold, 416; in public institutions, 417; of
the insane (Table), 431; correction of, for
deaths in local public institutions, 435 ;
influence of marriage on the mortality of
French people, 438; in 1853, of males and
INDEX. |

Death-rates—e ontinued.
females under their various conjugal con-
ditions, at different ages (Table), 441.

Death registration; character and efficiency
of the registrars; fictitious entries, 222;
inefficiency of security alforded by incom-
plete registration agaiust murder; the Essex
and_Norfolk poisonings, 223; some imper-
fections in, 224; desirability for a registra-
tion medical officer and advautages of other
proposed amendments, 225, 220; cost of
proposed improvements, 228; analysis of
evidence afforded by the death registers, 229 ;
and Life and Annuity Tables, 447.

Delirium Tremens, Sir Thomas Watson upon,

283.

De Moivre’s hypothesis and the construction
of life tables, 464.

Density of population, 34; in London in 1868,
138; cause of excessive mortality in towns,
16s, 166, 168, 171 relation between and
death-rate, 172; effects of, upon health, 173;
recorded mortality in seven groups of dis-
tricts and the mortality deduced from the
densities of those groups (Table), 175; the
greater the density the greater the mortality,
1965 its effect upon diffusion of cholera
(Lable), 382.

Developmental Diseases, classification of, 254.
Diarrhoea; mortality from, at 12 age-periods,
1849 (Table) 338; relation to cholera, 351.
Diseases of town and country, 166; mortalities

from, compared, 168, 171.

Districts, healthy, 147, 149; healthy and un-
healthy, 150.

Drapers, mortality of, 402.

Dock-yard labourers, sickness among, 507.

Earthenware makers, mortality of, 403.

Economic effect of deaths by different diseases,

313.
Editor, remarks by, 5, 67, 87, 111, 445, 497.
Education, its alleged influence upon suicide,

300; progress of, shewn by signatures in

marriage registers, 517; and crime, 518;

signatures at marriage and educational test,

518; in England and in Scotland, 520; pro-

gress of, 522.

Flevation in relation to cholera, 343, 355, 379.
Emigration, economically considered, 61; only

apparently a loss to the mother country, 62.
Epidemics, laws of, 317; of small-pox, 1838-9,

318; effect of, on mortality of subsequent

years, 330; of influenza 1847, 330; of cholera,

1848-9, 333; of cholera, 1853-4, 351; of

cholera, 1866, 374.

European States ; mortality of children in, 205 ;

deaths by violence in, in 1876 (Table), 299.
Family nomenclature in kngland and Wales,

S45.

Farmers, mortality of, 395, 403.

Fecundity ; (see Births and Birth-rates).

Fever; mortality at different ages, 390.

Food ; value of a mixed dietary of, with alcohol,
285.

Thais mortality of infants, 189-190; deaths
and death-rates from violence (Table), 288 ;
influence of marriage upon the mortality, 438.

Friendly Societies, sickness in, s01; propor-
tion of sick per 100 members, 502; sickness
in, according to various returns, §03.

Gamekeepers, mortality of, 402.

Gencration, a; length of, 41.

Glaisher, Mr., on the evaporation of water
from the Thames, 342.

Glasgow, mortality of infants (Table), 199;
fatality of small-pox in, 322.

Graham, Professor, on the diffusion of gascs,

 

162.

Graunt, Captain John, upon the Bills of
Mortality of Queen Elizabeth, 219.

Grocers ; mortality of, 1860-1 and. 1871 (Table),
286, 397, 402. ;

Hairdressers, &c.; mortality of, 402.

Health-of-Towns Bill, 156.

Health, progress of, 130, 135 ; improvement of,
in towns, 178.

Health insurance, 498, §12, $14.

Health and mortality of different classes of
population, methods of determining, 471.

Healthy districts; table showing method of
comparing mortality in, with death-rates of

 

561

Healthy districts—econtinued.

London, 129; some of their characteristics.
1313 names of some, 146; mortality in, 147;
two exceptionally. 149; mortality compared
with that in unhealthy, 1g0, 152; death-
rates of males and females, at different ages,
in (Table), 187; mortality of infants at each
month of the first year of age, 199 (Table).
200; number and proportion of deaths at
different months of age to one thousand
births, 1839-46 (Table), 201; deaths under
five years of age from nineteen groups of
causes (Table), 204; general description of
Life Table for, 491; basis and use of Life
Table for, 493.

History of Life Tables, 450.

Homicide, small mortality from, 258.

Hospital, mortality in, 423; treatment of in-
fectious dliseases, 424.

Houses; definitions of, 9,10; first enumera-
tion of those building; apparent decline of
building probably due to more rapid con-
struction, 11, 12.

Hull, death-rates in three decades, 136, 138.

Illegitimate births, their registration, 100, rot ;
true measure of, 101; and early marriage;
proportion of, and of spinsters to females
aged 20-40 (Table) ; decline of, 503.

Tlegitimate tnfants; mortality of, 196 ; (Table),
197; mortality of in Glasgow, 199.

Infants; mortality of, 188; mortality from all
causes in 18 large towns, 1870-75 (Table),190 ;
mortality from different causes in England,
in Scotland, and in 15 large towns, 1873-5
(Table), 191; causes of high mortality of,
192; mortality of in certain factory towns,
compared with numbers of females engaged
in textile manufactures (Table), 194; causes
of high mortality in towns, 1873-5 (Table),
19s; mortality among illegitimate, 196 ; mor-
tality of legitimate and illegitimate (Table),
197; mortality of in Glasgow (Table), 199;
mortality of at cach month of the first year,
199; (Table), 200; number and proportion of
deaths at each month to 1,000 births in
healthy districts and in Liverpool (Table),
2H 3 mortality and Census enumeration of,
200.

Influenza, epidemic of 1847, 330.

Innkeepers (sce Publicans.)

Inquests, certification of causes of death, 265.

Insanity, deaths ascribed to, 1871-6 (Table),
283; isitafatal disease? 429; what is the
excessive mortality from due to? 430.

Insurance, selection of lives for, 482; rise and
progress of, 484; against railway accidents,

537+

Ireland; life tables for, 460; curious feature
of Irish tables, 461.

Italy, deaths by violence in, in 1876, 299.

Kings, mortality of, 392, 393.

Labourers; wages and cost of maintenance of
(Tables), 534, 35 ; Value of future earnings
and cost of maintenance of (Table), 536.

Lancashire, cotton famine and mortality, 141.

Legitimation; law of in Scotland, 95.

Letheby H., M.B., upon the increase of
population, 29; on high birth-rates pro-
ducing high death-rates, 111.

Life; in England 116; natural lifetime, 117;
possibilities and difficulties of extending
duration of 132; loss of, in large towns 160;
number of children living at each month of
age under one year (Table), 189; effect of
the extinction of any disease on the dura-
tion of, 309 ; after-lifetime, or expectation of,
310, 478; expectation of in years in Surrey,
Liverpool, and London (Table), 454; uncer-
tainty of individual, 455; mean duration
of, 456; duration of among males in
Manchester and in England, 477; selection
of lives for insurance, 482.

Life and Annuity Tables, based upon death-
registration, 447; valueof to Friendly Socic-
ties, 448; of various authors, 448 ; mortality in
groups of ages, for purposes of, 449; history
of, 450; the Swedish and Carlisle Tables, 451 ;
other continental, 452; rural and urban, 483 ;
uncertainty of individual life and constancy

_of averages, 455; mean duration of life and
mean age at death, 456; construction of ;

NWN
562

Life and Annuity Tables—continued.

De Moivre’s hypothesis, 464; short method
of constructing, 465 ; properties and applica-
tions of ; Dr. Price’s fallacies, 468; English
Nos. I. anc II, 479; Northampton, Carlisle,
and Experience table, 480; construction of
English, No. IIL, 485; general description
of, Healthy Districts, 4gr; basis and use of
Healthy District table, 493.

Liverpool; increase of mortality at different
ages, as compared with the death-rates of
fifty-three “healthy ” districts (Lahle), 1477;
great mortality in, 186; death-rates per
cent., 1861-70, at different ages (Table), 187;
mortality of infants at each month of the
first year, 199; (Table), 200; number and
proportion of deaths at different months of
wze to one thousand births, 1839-46 (Table),
zor; deaths under five years of age from
nineteen groups of causes (Table), 204; Life
‘Table for, 453.

local diseases, classification of, 254.

London; ponulation, deaths, and mortality
at different ages, 1861-70 (Table), 123; Popu-
lation at various ages, 1851, and actual
deaths and death-rates, 1819-53, compared
with the probable results had the “ healthy
districts”? rate of mortality prevailed
(Table), 129; water supply, 143; male and
female mortality in, 145; mortality in, Ulus-
trative of excessive urban mortality, 154;
mortality in compared with Lewisham, 157 ;
area, elevation, and density, 1863, 158; in-
erease of mortality at different ages, as
compared with the death-rates of fifty-three
“healthy” districts (Table), 177; infant
mortality in (Lables), 190-19%; deaths from
small-pox in each year, 1661-80 (Table), 214;
causes of death in, 1629-1835, 303; number of
deaths in, from twenty classes of diseases
(Table), 304; cholera epidemic of 1866, 365 ;
cholera in the several water-fields of in
1866, 378; cholera mortality in districts of,
in relation to their density of population
(Table), 382; Life Table for, 453. :

Lunatic Asylums; mortality in, 423; im-
proved treatment of patients in, 426; mean
term of residence in, 27 ; proportions of in-
mates that die and thatrecover (Table), 432.

Lying-in Hospitals, puerperal mortality in,

273+
Warpioenalds death-rates in three decades, 136,

157+

Malthus; Theory of Population, 13, 18, 29.

Man; cost, and the present and future
economic value of, 531; wages of labourers
in Norfolk (Table), 534; wages and cost of
maintenance of agricultural labourers in
England (Table), 535; money value_ of
(Table),336; value of future wages (Table),

Manchester : excessive mortality of compared
with that of Surrey, 1N38-44, 159; increase of
mortality at different ages as compared with
the death-rates of fifty-three “healthy ”
districts (Table), 177; death-rate per cent.,
1861-70, at different ages (Table), 187; dura-
tion of lifein, 4773 (Table), 478.

Marks, percentage of married women who
signed by, in 1851, in counties (Table), 102;
number and proportion per,cent. of infor-
mants of death, and of persons married,
signing by, in 1864 (Table), 227.

Marriages; influence upon increase of popu-
Jation; number of persons married; pro-
portion of population unmatried; age at

marriage, 20, 2t, 443 early or late the more

fruitful, 23; duration of married life, 45 ;
effect ot altcration in the age at, 45; 1 baro-
meter of prosperity, 68; other causes of
fluctuations in numbers of, 69; decline of
proportion of, to the female population, aL:
form of as affected by commercial pros-
perity, 72; eflect of cotton famine upon in
Lancashire, 73; in successive generations, 75 ;
seasons; ages ut, 76; of minors, 77; grenter
tendency to among widuwers and widows,
vnan among bachelors aud spinsters, 80; and
religious worship, 81; fecundity of, 93; pro-
portional numbers of married and unmarried
women in England and Scotland, 1851-60

     

 

[INDEX.

Marriages—continicd.

(Table), 94: as affected by the law of legiti-
mation in Scotland, 95; influence of on the
mortality of the French people, 438.

Marringe rate ; causes of fluctuations in, 68 ;
in England, 1796-1845, to the female popu-
lation (Table) ; and commercial prosperity,
42; depression of by cotton famine, 43; sum-
mary of fluctuations of 1839-77, 44; of
minors with their previous conjugal condi-
tion (Table), 78; of bachelors, spinsters,
widowers, and widows (‘Table}, 79, 80.

Mean age at death, 456; varies according to
locality and occupation, 458 ; crroneous ap-
plication of, 442, 478.

Mean duration of life, 486; deduced from in-
complete observations, 462; differences
between English and Mr. Finlaison’s and
the Actuaries’ Tables (Table), 463; in
metropolitan districts, 467.

Medical practitioners ; mortality of, 4or.

Mercantile Marine; mortality in, 411.

Merthyr Tydfil; death-rates in three decades,
136, 138.

Metal-workers ; mortality of, 403.

Meteorology, 416.

Meteorological conditions, influence
health, 412, 414, 415.

-Wetropolitan police, sickness among, $11.

Alidwives, inetficient qualitications of, 279.

Milne, Mr., upon life tables, 474.

Miners, mortality of, 397, 403, 404.

Mortality, effect of chastity upon, 441 ; rate of,
and probability of dying, 490; in increasing
populations, 470; methods of determining
the relative health and mortality of different
classes of population, 471; at various ages
from different diseases, 499. (See also Death-
rates).

National prosperity; the marriage-rate a
barometer of, 68; other measures Of, 69; as
affecting the forms of marriage, 72.

Navy, mortality in, 411.

Newport, death-rates in three decades 136,138.

Nomenclature of English and Welsh families,
$45; lifty common surnames and the nun-
bers of their occurrences in the registers, £45.

Nomenclature of diseases (sce Causes of
Death).

Northampton Life Tables, old and new, 480.

North Witchford, death-rates in three decades,

136, 137.

Occupations; as first enumerated, 7; Census
inquiry and classification, 48; double occu-
pations ; industrial Census, 49 ; of the blind,
53: mortality of various, 392, 394, 398.

Odd Fellows, M.U., analysis of sickness returns
in 1844, 503.

Orsett, death-rates in three decades, 136, 137.

Peers, mortality of, 393, 394.

Phthisis, mortality from, 266, 267, 268, 269, 308.

Plagues frequent in England before 1665, r<0.

Population; scope of enquiry at the first six
Censuses, 6-8; principles of, 12; theories of
Malthus and Sir J. Steuart considered, 14-18 ;
law of increase, 19-29; influcuece of increase
upon the prosperity of the State, 23; how
the rate of increase is affected by the mar-
riage-rate, 24; practical bearing of the
question in colonising, 26; a fallacy ex-
plained ; relation to the mean life-time, 27;
depends upon duration of generations,
fertility of marriages, change of matrimonial
condition, emigration, 28; and upon abun-
dance of necessaries of life, 29 ; increase and
decrease of, 29; causes of Changes in, 31;
influence of birth-rates upon, 32; Census
and population registers, 33; period in
which population doubles itself, 34; density
and proximity, and method of calculating
these, 34-36; Sex proportions (with Tnble).
36-373 effect of prolongation of life wpon:
factors of, 40; meanage of; civil or conjugal
condition, 44; proportion of married of each
sex at differentages ; effeet of marriage upon,
46; occupations of the, 48-so; infirmities
of, So-s9; economic value of, 59-64 and
531-73; age constitution of, 31, 180; males
and females in England in 1841, at groups
of ages (able), 181 ; mortality in inereasing
populations, 470.

upon

 
INDEX, |

Preventable diseases, 310.
Price, Dr., fallacies of life tables prepared by,
fi

408.

Prison mortality, 418.

Professions, mean age of, at death, vary, 458.

Proximity of population, 34. ‘

Prussia; deaths and death-rates from violence
(Table), 288.

Publicans, &c., mortality of, at four ages com-
pared with that of the clergy (Lable), 284;
duration of life of (Table), 287. _

Public institutions; mortality in, 417, 422;
method of correcting local death-rates for
deaths in, 437.

Puerperal mortality, 1817-54, 269; deaths of
women in child-birth, 1847-54 (Table), 270:
mortality of women bearing children at
different ages, 1817-54 (Table), 271; in Lying-
in hospitals, 273 ; in maternity charities, 278.

Railway accidents, risk of, and insurance
against, 537; risk decreasing, «39; mortality
from, great among railway servants, 539;
great cost of litigation arising from, 540;
principles of compensation suggested, $41.

Railway servants, mortality of, yor.

Rawazzini’s, Bernard; De AMorbis Artificum
Diatriba, and De Principum valetudine
tuenda, 308.

Registrar General’s Annual Reports; state-
ment of particulars published m cach,
1837-75, 314-317; necessary delay in pub-
lishing, 530.

Registration of births and deaths; defects
of, 522; results of, and improvements in
laws of, §24; in sub-districts, 529.

Registration of deaths, methods of, observed
on the Continent, 221. ke

Respiratory organs; mortality from diseases
of, 266, 267, 268, 269. \

Rothbury, an exceptionally healthy district ;
population, 1861-71, at various ages, deaths,
and mortality, 1861-70 (Table), 149.

Salisbury, death-rates in three decades, 136,

134.

Saniiation, improves the economic value of
the population, 63; value of, tested by death-
rates of children, 114. .

Sanitary work, and decline of mortality, 136.

Scotland; definition of house differs from the
English, 10; fecundity of women in, 95;
mortality of infants from different causes,
1873-5 (Table), 191, 192.

Seasons; influence of, upon health, 412, 414,

415.

Sewerage, advantages of a good system, 383.

Sex proportion of population, 36; proportions
of, at birth, 104; in relation to cholera
epidemics, 383.

Shoemakers, mortality of, 397, 402.

Shuttleworth’s, Sir J. K., return of wages of
Jabourers in Norfolk (‘Table ), $34.

Sickness, relation of, to mortality, 498; and
mortality at various ages and from diflerent
diseases, 499; early sickness tables, sox ;
definition of, go1; in Friendly Societies, so ;
among dockyard labourers, 507; among
Jabourers in FE. India Company’s service,
509; in metropolitan police, 511; sick-time
increases with age in geometrical progession,
512.

Signatures in registers a test of education,

518. : 3 shai
Small-pox; inoculation and vaccination for, .

7133 ;dcaths from, in London, 1461-80 (Table),
214; death-rates from, in London, 1629-
1835; the epidemic of 1838-9, 318; beneficial
effect upon, of vaccination, 321, 323.

Sporadic diseases, 217.

Statistical methods for determining the rela-
tive health and mortality of different classes
of population, 471.

Statistical nosologies and methods of arrange-
ment, 231; necessary features of, 232.

Steuart, Sir James, Theory of Population, 14.

Stoke-Damercl, death-rates in three decades,

136.

Subdistrict registration, 529.

Suicides ; see Violent Deaths. r

Surrey, mortality of compared with that of
Manchester, 159: Life ‘Table for, 453.

Sweden; death-rates at groups of ages, 180;
child-bearing at four periods of life, 1830-35

 

563

Sweden—eontinued.

(Table), 272; deaths and death-raies from,
violence (Table), 288.

Tailors, mortality of, 397, 402.

Thames, the, and the water supply and
cholera epidemic of 1848-9, 341.

Tobacconists, &c. ; mortality of, 402.

Tool-makers; mortality of, 402.

Towns; mortality in urban districts, 146;
excessive mortality in, 153, 134; loss of life in
large, 160; causes of excessive urban mor-
tality, 161; mortality grows with extension
of, 165 ; diseases of town and country, 166;
causes of, 167 ; deathsin rural compared with
town (districts from 12 classes of diseases
(Table), 168; diseases incidental to child-
hood more fatal in, 191; improvement of
health in, 178; proportion of deaths at
different ages to 1,000 living at all ages in 30
large districts, compared with all England
and 63 “healthy” districts (Table), 185;
infant mortality from all causes in 18 large
(Table), 190; infant mortality from different
eauses in 15 large (Table), 191; high mor-
tality and its causes in certain large, 192;
numbers of females engaged in household
duties and in textile manufactures in 1871,
together with rate of infantile mortality,
1873-5, in certain factory towns (Table), 194.

Town and country ; diseases of, 166 ; mortali-
ties in, compared, 168, mt

Urban mortality. (See Towns.)

Vaccination, beneficial effects of, 133, 321, 323.

Violent deaths, classification of, 234; in Lon-
don, England, and Foreign Countries prior
to 1839; in the London Bills of Mortality
(Table), 288; in Sweden, Prussia, France,
and England (Table), 288 ; Coroners’ returns
of 1852-6, 290; on railways; in mines, &c.
293; from chemical injuries, burns, poison,
&¢e.; from asphyxia, 294; from suicide, 295 ;
in_mines and on railways, 1863-72, 296; o11
railways at groups of ages, 1863-72 (Table) ;
in mines at groups of ages, 1863-72 (Table),
297; international statistics of, 298; in Italy
in 1876, 299; suicides in 1838 ; by suicide in
certain English counties; effects of educa-
tion upon suicide, 300 ; manner of suicide,
1858-63, 302.

Wages; of labourers in Norfolk (Table), £34;
and cost of maintenance of agricultural
labourers in England (Table), 533; value
of future (Lables), 536.

Water-closets, their introduction and adoption,

383.

Water supply; relation to mortality, 142: in
London, 143 ; improvement of and provision
for analyses, 144; and the cholera epidemic
of 1848-9, 341; and cholera mortality 1853-4,
3573 mortality from cholera in London dis-
tricts supplied by different water companies
(Tables), 338, 359; influence of on cholera.
mortality in South London (Table), 361;
East London Water Company and the
cholera epidemic of 1866, 34>.

Watson, Sir Thomas, on Delirium Tremens, 328.

Watt, Dr., on Small-pox, 321.

Waves of zymotic disease, 317-20.

Weavers, &c., mortality of, 397, 402.

Welsh miners, mortality of, 409.

Wheat, high prices of in relation to death-
rates, 138.

Whittlesey, death-rates in three decades, 136,

137.

Wisbech, death-rates in three decades, 136, 137.

ee een death-rates in three decades,
136, 137.

Women, fecundity of, 22; in Scotland, 9:.

Workhouse mortality, 417.

Worship ; certified places of, 82; table showing
number of at each Aecenniad, 1688-1852, 83.

Yorkshire, &c. miners; mortality of, 408.

Zymotic diseases ; difficulties of counteracting,
133; their exciting principles, 245 ; some cha-
racteristics of, 248; classification of, 233; cha-
vacteristics of some, 310; effect of extinction
of upon duration of life, 311 :‘laws of, 319-20:
cause and effect of, 320 ; developed or diffused
by over-crowding, 321; generated by living
molecules, 325, 327; uecessity for sanitary
and other precautions, 328; Dr. Budd‘s
precautions against diffusion of, 320.

   
Lonbown: Printed by ExrRE and SPoTTISWOODE,
Trinters to the Queen’s most Excellent Majesty.
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