A SANITARY OUTLOOK 359 



stretched across the room on which, on the payment of a penny, men 

 were entitled to rest their arms and sleep standing." I do not know 

 that in many places things are quite as bad as that, but in all our large 

 towns and in our small towns, too, housing conditions and overcrowd- 

 ing exist that are an outrage on decency and a disgrace to our civil- 

 ization. 



And heavy are the penalties we pay for these housing conditions 

 and this overcrowding in combination with other insanitary influences 

 that appertain to towns ! The urban death-rate for England and 

 Wales is 17 per 1,000 living; the rural death-rate is 12.9; the urban 

 infantile death-rate is 165 per 1,000 births, the rural rate is 126. In 

 every city and town with the increasing density of population on square 

 space, there is an increasing general and special mortality at all ages, 

 but particularly under one year, in insanitary areas. Typhoid fever 

 causes a much greater loss of life in the town than in the country. 

 The urban death-rate from pneumonia exceeds the rural by 87 per cent. 

 The mortality from consumption is at the rate of 1,298 per million 

 living in urban districts and of 1,108 in rural districts. Urban areas 

 suffer more severely from cancer than do rural areas. And almost all 

 these diseases, as well as others which I have not mentioned, because 

 they figure less largely as causes of death, are most prevalent in the 

 most densely built parts of the town, and in the most densely populated 

 areas of these parts, and prevail in these areas in proportion to the 

 number of inmates in the houses, of persons per room, and of insani- 

 tary dwellings such as back to back houses, stable dwellings, tenement 

 houses, cellar dwellings and flat houses. 



That the townsman is shorter lived than the countryman is incon- 

 trovertible. Dr. Tatham calculated that in the rural districts of 

 England the average expectation of life at birth is 51.48 years for 

 males and 54.04 for females, whereas in Manchester it is only 28.78 

 for males and 32.67 for females, which means that each male has to 

 sacrifice 10.48 years or 39 per cent, of his life, and each female 9.82 

 years or 34 per cent, of her life for the privilege of being born in an 

 urban area. To show the social waste involved in such heavy mor- 

 tality, it is enough to point out that 100,000 males born in Manchester 

 would be reduced to 62,326, and 100,000 females to 66,325 in five 

 years; while in the healthy districts it would take fifty and forty-eight 

 years respectively to bring about the same reduction. Clearly the con- 

 centration of the population produces a prodigious drain on the vitality 

 of the people, another indication of which is supplied by Dr. Shrub- 

 shalPs observation that town life tends to extinguish the fair-haired 

 Scandinavian and Teutonic elements in our people which are giving 

 way before the brunette elements of southern derivation. 



And the pernicious consequences of such concentration are dis- 



