June 19, 1884] 



NA TURE 



185 



fever, or deformed in scrofula or rickets, or feeble and con- 

 stantly invalid, so that they are never fit for more than half 

 work or work which is only half well done. These losses can- 

 not be counted, but they must be large ; and there are others 

 more nearly within reckoning ; the losses, namely, which are 

 due to the deaths of those who die young. It may justly be said 

 that all that they have cost during their lives is so much money 

 sunk ; so much capital invested and lost. If they had lived to 

 work, their earnings would have been more than sufficient to 

 repay it ; but they have died, and their cost is gone without 

 return. The mortality of children under 15 in 18S2 was 

 nearly a quarter of a million : what have they cost ? If you say 

 only 8/. a piece, there are more than 2,000,000/. sterling thus 

 lost every year. But they have cost much more than this, and 

 much more still is lost by the loss of the work they might have 

 lived to do. 



I will add only one more illustration of these losses, which is 

 always suggested by looking at tables of mortality. The 

 deaths of persons between 25 and 45 years old, that is during 

 what may be deemed the 20 best working years of life, are 

 annually between 60,000 and 70,000; in 1882 they were 

 66,000. Think, now, of the work lost by these deaths ; and of 

 how much of it might have been saved by better sanitary pro- 

 visions. If one looks at the causes of their deaths, it is certain 

 that many might have been prevented, or, at least, deferred. 

 Say that they might have lived an average of 2 years more ; and 

 we should have had in this year and last an increase of work 

 equivalent to that of at least 6,000,000 weeks; as much, in other 

 words, as 6,000,000 people could do in one week. 



More instances of losses of work by sickness and premature death 

 might easily be given, but not easily listened to in this huge hall. 

 Let these suffice to show something of our enormous annual loss, 

 not only of personal and domestic happine-s — that is past 

 imagining — but of national power and wealth. Surely we ought 

 to strive more against it. 



But, some may ask, can these things be prevented ? are they 

 not inevitable consequences of the manner of life in which we 

 choose or are compelled to live ? No ; certainly they are not. 

 No one who lives among the sick can doubt that a very large 

 proportion of the sickness and the loss of work which he sees 

 might have been prevented ; or can doubt that, in every succeed- 

 ing generation, more may be averted, if only all men will strive 

 that it may be so. 



Let me enumerate some of the chief sources of the waste as 

 they appear to one's self in practice, or as one looks down a table 

 of mortality. 



Of the infectious fevers, small-pox might be rendered nearly 

 harmless by complete and careful vaccination. Typhus and 

 typhoid, scarlet fever and measles, might, with proper guards 

 against infection, be confined within very narrow limits. So, 

 probably, might whooping-cough and diphtheria. 



Of the special diseases of artisans there are very few of which the 

 causes might not be almost wholly set aside. Of the accidents to 

 which they are especially liable the greater part, by far, are due 

 to carelessness. 



Of the diseases due to bad food and mere filth ; to intemper- 

 ance ; to immorality ; in so far as these are self-induced, they 

 might, by self-control and virtue, be excluded. And with these, 

 scrofula, rickets, scurvy, and all the widespread defects related to 

 them, might be greatly diminished. 



It can only be a guess, but I am sure it is not a reckless one, 

 if I say that of all the losses of work of which I have spoken, 

 of all the millions of weeks sadly spent and sadly wasted, a 

 fourth part might have been saved, and that, henceforth, if 

 people will have it so, a still larger proportion may be saved. 



We may become the more sure of what may be done by look- 

 ing at what has been done already. Let me show some of it ; 

 it will be a relief to see something of the brighter side of this 

 picture. 



In a remarkable paper lately read before the Statistical Society, 

 Dr. Longstaff says : — " One of the most striking facts of the 

 day, from the statistician's point of view, is the remarkably low 

 death-rate that has prevailed in this country during the last eight 

 years." In these years the annual death-rate has been less than 

 in the previous eight years, in the proportion of two deaths to 

 every 1000 persons living. The average annual number of 

 deaths has been 50,000 less in the last than in the previous eight 

 years. Doubtless many things have contributed to this grand 

 result, and it is not possible to say how much is due to each of 

 them ; but it would be unreasonable to doubt that the chief 



good influence has been in all the improved means for the care 

 of health which recent years have produced. This is made 

 nearly certain by the fact that the largest gains of life have been 

 in the diminution of the deaths from fever, and of the deaths in 

 children under 15 years old ; for these are the very classes on 

 which good sanitary measures would have most influence. 



The annual number of deaths from typhus, typhoid, and the 

 unnamed fevers, has been about 11,000 less than it was about 

 20 years ago. The annual number of deaths of children und.'r 

 5 years old has been about 22,000 less than it was ; and that of 

 children between 5 and 15 has been upwards of 8,000 less. 



These are large re-ults, and though they tell of only deaths, 

 yet they bear on the chief subject I have brought before you — 

 the working power of the nation ; for, however much of the 

 average we might assign to improved methods of medical treat- 

 ment of fever, yet the diminished number of deaths means a very 

 large diminution in the total number of cases. The deaths 

 during the working years of life were 6,500 less ; and, this being 

 so, vi e may hold that, if the average mortality was, say, 25 per 

 cent., the diminution in the total number of cases must have 

 been at Last 25,000; and if we may believe, as before, that each 

 of the-e involved ten weeks of sickness, we have, in these 

 fevers alone, a clear saving of 185,000 weeks' work in every 

 year. 



And so with the diminution of the mortality among children, 

 there must have been a greater diminution in the number of 

 costly and work-wasting illnesses, and a large saving of money 

 that would otherwise have been sunk. And not only so : but 

 many of the children saved in the last eight years will become 

 bread-winners or care-keepers ; and who can tell what some of 

 them will become ? or what the world would have lost if it had 

 lost them? 



Let me add only one more reckoning. In a paper last year, 

 at the Statistical Society, Mr. Noel Humphreys said "that 

 if the English death-rate should continue at the low average of 

 the five years 1876-80, the mean duration of male life in this 

 country would be increased by two years, and that of female 

 life by no less than 3 .4 years as compared with the English Life- 

 table." And he showed further that "among males 70 per 

 cent, and among females 65 per cent, of this increased life 

 would be lived between the ages of 20 and 60 years, or during 

 the most useful period." 



I should like to be able to tell the value in working-power of 

 such an addition to our lives. It is equal to an addition of 

 more than 4 per cent, to the annual value of all the industry, 

 mental and material, of the country. 



But some will say — admitting that it is desirable, seeing how 

 keen the struggle for maintenance already is, can more than 

 this be done ? and the answer may be and must be, much more. 

 In this, as in every case of the kind, every fruit of knowledge 

 brings us within reach of something better. While men are 

 exercising the knowledge they possess, they may be always 

 gaining more. This Exhibition has scores of things which are 

 better helps to national health than those of the same kind which 

 we had twenty years ago, and with which the gains already made 

 were won. If I were not in near official relation with the jurors 

 I would name some of them : there are truly splendid works 

 among them. 



But do not let me seem to disparage the past in praising the 

 present. It is difficult to speak with gratitude enough of what 

 has been done, even though we may now see ways to the yet 

 better. 



Any one who has studied the sources of disease during the last 

 thirty years can tell how "and where it has been diminished. 

 There is less from intemperance, less from immorality ; we have 

 better, cheaper, and more various food ; far more and cheaper 

 clothing ; far more and healthier recreations. We have, on the 

 whole, better houses and better drains ; better water and air, 

 and better ways of using them. The care and skill with which 

 he sick are treated in hospitals, infirmaries, and even in private 

 houses, are far greater than they were ; the improvement and 

 extension of nursing are more than can be described ; the care 

 which the rich bestow on the poor, whom they visit in their 

 own homes, is every day saving health and life ; and, even more 

 effectual than any of these, is the work done by the medical 

 officers of health and all the sanitary authorities now active and 

 influential in every part of the Kingdom. 



Good as all this work has been, we may be sure it may 

 become better. The forces which have impelled it may still be 

 relied on. We need not fear that charity will become cool, or 



