PRESERVATION OF HEALTH. 



mortality was, for males, I in 33^ ; for females, 

 1 } n 3Sf; whereas in the year 1800 it had di- 

 minished to i in 34| for males, and i in yj\ for 

 females. From mortuary tables preserved with 

 considerable accuracy at Geneva, it appears that 

 at the time of the Reformation, one-half of the 

 children born died within the sixth year ; in the 

 seventeenth century, not until the twelfth year 

 in the eighteenth century, not until the twenty- 

 seventh year. By the Registrar-general's Re- 

 port for 1871 (table 37, p. xciii.) the average 

 mortality of London for 32 years, 1840-71, was 

 24-4 per looo. For 1871 it was 24-6 per 1000, 

 that is, about i in 40-6. Knowing that early in 

 the seventeenth century the city was dense and 

 ill cleaned, and that the habits of the people 

 were not then what they are now, we cannot 

 doubt that this great diminution of mortality 

 is owing to the improved conditions in which 

 human beings now live in the metropolis. Between 

 the years 1730 and 1750, 74 of every 100 children 

 born in London died before they were six years 

 of age; a century later, only 31 and a fraction 

 out of every 100 died under the same age that 

 is to say, the deaths of children in London were 

 only half as numerous as they were a hundred 

 years before. About a century ago, the mor- 

 tality of the children received into the London 

 hospitals was of astonishing amount. Though 

 it seems scarcely credible, we have good reason 

 to believe that, of the 2800 annually received, 

 2690, or twenty-three in every twenty-four, died 

 before they were a year old. It was at length 

 seen that this mortality was the effect of over- 

 crowding, impure air, and imperfect aliment ; 

 and after an act of parliament had been pro- 

 cured to compel the officers to send the infants to 

 nurse in the country, only 450 out of 2800 died 

 in the first year. ' Now in England ' (Letter to 

 Registrar-general by William Farr, M.D., Ap- 

 pendix to Report, 1871, p. 224), 'about 800,000 are 

 born annually, and by the life table 119,594 of 

 them die in the first year, some from congenital 

 weakness and blight ; but great numbers, not, I 

 conceive, from the cruelty of their parents, but 

 either from the necessities of their condition of life, 

 or from their ignorance of the best modes of 

 nursing children.' If much, therefore, has so far 

 been done for the preservation of infant life, it 

 seems that much yet remains to do. The experi- 

 ence in infantile mortality of recent years shews 

 the following results : 



BORN Livc to ages 



>RN " i. a. 3. 4. 5- 6- 7- 8. 9. 10. 



513, 431, 403, 388, 379, 372, 367, 363, 360, 357, 355. 



From this it will be seen that of the 513 born, 146, 

 or 28-4 per cent, die before completing their sixth 

 year. 



The facts ascertained with regard to differences 

 of mortality in different places are equally striking. 

 A remarkable instance of the effect of marshes 

 upon health is cited by M. Villermd. Formerly, 

 the district of Vareggio, in Tuscany, was 

 marshy, and its few miserable inhabitants were 

 every year visited by severe agues. In 1741, 

 floodgates were erected to keep out the sea, the 

 marsh was dried up, and ague appeared no more. 

 Vareggio subsequently became a populous and 

 healthy district. The Isle of Ely is a marshy dis- 

 trict in the east of England, and it was ascertained 



that of 10,000 deaths which occurred in it between 

 the years 1813 and- 1830, no fewer than 4732 were 

 of children under ten years of age ; the proportion 

 of deaths of children under ten in all the other 

 agricultural districts of England being only 3505, 

 or as about 3 to 4 of the former number. Of 

 10,000 deaths between ten years and extreme old 

 age in the same period, there were, of persons 

 between ten and forty, 3712 in the Isle of Ely, 

 and only 3142 in drier districts. 



The population of England at the census of 

 1871 was (Registrar-general's Report, p. vii.) 

 22,712,266. Of these, ' nearly thirteen millions of 

 people,' says the Registrar's Report (p. xix.) ' are 

 comprised within districts or sub-distncts wherein 

 the chief towns are situate, and the death-rate 

 among these in 1871 was 25 per loco, or slightly 

 in excess of the annual average ; amongst the 

 residue, or nearly ten millions, inhabiting the 

 smaller towns, or scattered over the purely rural 

 districts, the rate was 19-5, or slightly below the 

 average. For general purposes, this comparison 

 may be taken as giving a fair idea of the relative 

 advantage as regards the duration of life which a 

 residence in the country confers over one in 

 towns ; bearing in mind, of course, that there are 

 special causes of unhealthiness in some country 

 places, and that the towns themselves have a wide 

 range of death-rate.' 



It is now ascertained that England is more 

 healthy than any continental country, the next to 

 it in this respect being France. In continental 

 cities, the annual rate of mortality is seldom less 

 than 30 in 1000, and the rate frequently rises to 

 40 in looo. In 1869 the death-rate per 1000 was, 

 in England 22-3, in France 23-5, in Austria 28-9, 

 and in Prussia 277. 



Within the last few years, a great impetus has 

 been given to the sanitary condition of the cities 

 of the empire by the introduction of efficient 

 drainage and of wholesome water, by the syste- 

 matic removal of nuisances, and by the improve- 

 ment of the dwellings of the poor. ' Hitherto,' 

 says the Registrar-general (Report, 1871, p. vii.), 

 'the sanitary works of the country have been 

 partial, and have been confined to places where 

 the local authorities have displayed extraordinary 

 energy ; in some places, such as Manchester, 

 Salford, and Glasgow, the water supply is good, but 

 other grave defects counteract its results ; in other 

 places, as in South London, the water supply and 

 the drainage have been greatly improved, with the 

 best effects ; in other districts, the main drain 

 has been carried out effectually, but the subsid 

 drains, and the house drains, are imperfect ; and 

 the population outside drained towns is increasing 

 rapidly, without a system of sewerage, and often 

 with a bad water supply ; dwelling-houses are still 

 crowded ; the state of the small towns, the vil- 

 ages, the farm-yards, and of many of the cottages, 

 remains much as it was, and whole regions of 

 great counties arc, in 1871, in a condition as 

 unsatisfactory as they were in 1838. 



' What was wanted was administrative machinery, 

 which will now be supplied by the new Sanitary 

 Act to the whole country ; and I shall watch with 

 interest, and endeavour to record with impartiality 

 the results of its operation.' 



The following is a table prepared by Dr Lethe- 

 ay, shewing the saving of human life effected by 

 sanitary improvements in certain English towns : 



