Papers relating to the history and practice of vaccination.

Great Britain. General Board of Health.

Date:: 1857

Catalogue details

Licence: Public Domain Mark

Credit: Papers relating to the history and practice of vaccination. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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—, —- - - - —1—*—’ ' dh^»!J*vrr' ' ** That there is a connexion between health and wealth deeper than the rhyme which so naturally comes to our lips, the annual reports of the Regis- trar-General and of Dr. Letheby—the latter pub- lished in our impression of Thursday—strikingly illustrate. So long as we look to individual cases, Indeed, it seems like a mockery to suggest that gold is the elixir of life. We are answered by the smile of the lordly invalid, who envies the poorest labourer in his harvest fields; by the sigh of men who would pour out wealth untold if it would avail to rescue from the tomb those dearer to them than life; by the song of the poet, which gives long years and happiness to some village blacksmith, who feeds on brown bread and water, and toils at his forge from mom to night ; by the babble of demagogues, who, mistaking strength of muscle for strength of constitution, delight to contrast the stur- diness of the artisan with the puniness of the aristo- crat. It is when we extend our view from individuals to the mass of men that the grand result shines forth clear and unmistakeable, and nowhere is it more evident than in this London, the wealthiest city in the world, where to all appearance the luxury and the splendour that belong to the upper classes serve rather as a foil than aB a cure to the wretch- edness and mortality which prevail among the lower orders. It is scarcely credible, but yet the incontestable figures quoted by Dr. Letheby leave it beyond all doubt, that the average of health throughout the City of London is higher than the average of health throughout all England, taking town and country together. The mortality in all England is at the rate of 22 ’8 in every 1,000 of the population ; in the City of London it is at the rate of 22*3 for every 1,000 inhabitants. The advantage in our favour thus expressed in a decimal which is equivalent to only half an indi- vidual for every 1,000 is not very great, although, indeed, it comes to a considerable saving of life when the thousands are multiplied by hundreds. But, on the other hand, two circumstances lead us to regard even this small advantage with no ordinary satisfaction. For, in the first place, the improvement has been progressive ; it has been slow, but steady and sure. Gradually the mortality | has decreased, until the usual yearly death-roll of 3,763 has been reduced to 2,904 within the period of nine years during which the City has been under the rule of the Sanitary Commission. The deaths this year—22‘3 per thousand, or 1 in every 45 of the inhabitants—are 9 per cent, below the general average, and represent a saving of 286 lives. And, secondly, this gratifying result has been obtained in the face of obstacles which seemed to be almost insurmountable. Here is this City of London actually walled in from all the vivifying influences of the country by miles of obdurate brick; we are incarcerated in a maze of houses, shops, and factories, as cunningly contrived as any Cretan Labyrinth; our river is still polluted ; our streets are narrow and con- fined ; our houses, which were built when there was a tax on every brick, on every nail, on every windowpane, are sadly deficient in light and air ;| and every inch of ground is so valuable that we! are huddled together with the dingy smoke above us, and with the London fog around us, enduring, a stranger might well fancy, discomforts not very different from those which our countrymen once experienced in the Black Hole of Calcutta. And yet here are the bills of mortality, which tell us that our attempts to cope with the disadvan- tages of our position have been crowned with suc- cess, and that the average of health in the City is greater than the average of health in England at large. Such tables as these we conceive ought t* be read by the light of other tables which indicate the growth of the national wealth. Year by year, and sometimes month by month, we have called the attention of our readres to those returns of Trade and Navigation which Bhow how wonder- fully the resources of the nation have multiplied. If these returns are to be taken as the measure of our wealth, then, on the other hand, the returns of the Registrar-General and of Dr. Letheby are to be regarded as a material test of the uses to which we have turned our wealth. Has it added to the happiness, to the comfort, to the security, to the length of life ? And, depend upon it, if these questions can be answered in the affirmative, if a physical improvement is very evident, it is but the type and the accompaniment of a moral improvement which is better than wealth, and without which the lengthening of life might be merely the continuance of degradation. But, while congratulating our fellow-citizens on the results which have crowned their sanitary regulations, we should ill perform our duty if we did not insist that very'much has yet to be done. Small though the death-roll for the present year be, it is not the smallest on record,—it is only the smallest but one ; and' it is quite evident from many points of view, but chiefly from three which we shall immediately indicate, that it is our own fault if we do not attain to a still higher level of general health. Whether we compare the ages of the persons who have died, or their occupations, or the localities in which they lived, the singular disparities which are to be found lead of necessity to this conclusion. If we look to the localities, for example, it will be found that the 9 per cent, of decrease on our annual average of deaths has been chiefly effected in the central district of the City, where the improvement has been to the extent of 13 per cent, upon the average, and in some places has even reached to 38 per cent., while, on the other hand, in the western division of the City it has not been more than 7 per cent., and in the eastern has been only 3 per cent. All this—and especially that trifling 3 per cent, of the eastern district, which is the most crowded and ill-regulated part of the City, shows how much has still to be done by our sanitary officers, how difficult it is to enforce cleanliness and decency among a people habituated to crime and all sorts of brutishness, and also how great is the hope that by perseverance we may render our metropolis not only what it is now, the healthiest capital in Europe, but it may be as salubrious as the hills to which our sportsmen annually resort. Then, if we regard the ages of the deceased, we shall arrive at precisely the same conclusion. Of the 2,904 deaths for the past year how many were infants under five years of age? There were not less than 1,163— that is to say, 400 out of every 1,000 persons who died last year. The fact is, that although the average of health in London is higher than in England generally, this result is due chiefly to the extraordinary health of Londoners in the prime of life. Between the ages of 10 and 35 the mortality is comparatively small,—the ad- vantages are immensely in favour of a city life. But beyond these limits the proportion of deaths is, it appears, much larger than in the rest of England. These facts seem to point to causes which are very much, if not entirely, within our own control—causes, too, which it is by no means difficult to discover when we can lay our finger on Buch a fact as this, that the diseases which at the periods of life we have named, and especially among infants, render the mortality of London greater than the mortality of England, are chiefly . tubercular, and when we know that these diseases are mainly to be attributed to what Dr. Letheby calls “domestic vices,” including under that head all that tends to make home unhealthy and un- happy. The London atmosphere being so little injurious to persons between the ages of 10 and 35, it therefore cannot be accepted as a necessary sacrifice to our position that no less than 1,163 infants should die annually, and this, too, out of a mortality which only extends to 2,904 indi- viduals. There must be a large margin for improvement—a margin which will be still more apparent if, after having thus regarded the effect of locality and of age on the proportion of deaths, we now glance at the influence of occupation. This is in some respects one of the most curious subjects of investigation, as we proceed from Mm. to class,—from the butcher, who is comparatively a healthy animal, to the tailor and the printer, who hold life on a more precarious tenure, +Vn to the publicans and porters, after these to the painters and glaziers, to the cabmen and draymen, who come next, to the clerks and needlewomen, who are still lower in the scale, and so on to the hard-working carpenters, masons, and day- labourers, who fare the worst of all. All these classes have their peculiar diseases—phthisis being the malady of printers and bakers, fever of domestic servants and cabmen, bronchitis of painters, butchers, and costermongers, brain ^diseases of porters and bargeman, and liver disease; of publicans. It i3 impossible to escape entirely the maladies incidental to certain occupations, but surely the fact that particular complaints can be so easily apportioned among particular trades justifies the hope that, with ordinary care, their prevalence can be very much diminished. To interfere for the benefit of the trades, and to encourage those appli- ances which may tend to mitigate the injurious effects of certain avocations, is not, perhaps, so strictly within the province of a Sanitary Commis- sion as it is to provide for the purity of the atmosphere and the cleanliness of our houses and streets. Still, who can doubt that an imirmniw field for improvement lies in this direction, and that we can protect ourselves from the injury of our occupations just as much as from the incle- mency of the weather and from the impurity of the atmosphere ? And, putting these three consi- derations together,—comparing the excessive mor- tality of certain districts with the healthiness of others in their immediate neighbourhood,—ob- serving the singular immunity from disease which Londoners enjoy in those years when they are most active and most in the open air; lastly, noting the morbid influences of occupation, the brain diseases of porters, and the liver complaints of publicans, telling their own sad tale of miseries that might very often be prevented,—are we not justified in the conclusion that, although our past success has been great and reflects the highest credit on our sanitary officers, still the work which has been accomplished is as nothing to that which has yet to be achieved ? The Annual „eport upon Public Health by Mr. Simon, the Medical Officer of the Privy Council, has just been published. This Report, which is always of great value, will be found this year of unusual interest. It completes, in the first place, for all England and Wales, an account of the working of our present vaccination laws—“ an i “ account,” says Mr. Simon, “ which offers such “ a basis as there never yet has been for effective “ legislation against smallpox.” It contains also an elaborate account of the parasitic diseases of animals used for food, which we recommend to any pork or bacon eater who would like to be disgusted. But, above all, it is full of the most opportune information with regard to important measures of domestic legislation now before Parliament, and to great sanitary questions which are at the present moment forced on public notice. More attention than ever has been called this Session to the overcrowding of the poor population of the I • metropolis, to the miserable accommodation which J they obtain under the best circumstances, and to ! the gradual destruction of poor districts which is j i threatened by railways and great public works. We have been roused, moreover, by the appre- hensions of a pestilence to a sense of the terrible dangers to which neglect of these evils exposes us. At the same time the discussion on the Union Chargeability Bill has reminded us that town3 are not the only places where overcrowding 1 and foul dwellings exist. Mr, Simon’s Report j