THE DISEASES OF TOWNS:

THEIR EFFECTS, CAUSES, AND THE MEANS OF PREVENTION.*

'A HEALTHY body is good; but a soul in right health, it is the thing beyond all others to be prayed for; the blessedest thing this earth receives of heaven. Thus writes, and not untruly, Thomas Carlyle; but a soul in right health has never yet existed in a body in bad health. If we would have the former strong, the latter must be strong as well. The sane body is essential to the sane mind. Good digestions, and hopeful, joyous, energetic states of mind are inseparable. Men have come to learn this. From a woeful waste of human life and happiness this truth has been at length evolved.

This has been learnt by individuals, and their mode of life has been shaped accordingly. They have studied the laws of health, and disease has, in consequence, been avoided, or its virulence decreased. In a general sense, even the average health of the world has been increased; the epidemics which carried everywhere sorrow and death in the middle ages, now no longer exist. From the annals of the times we learn that, in England, in 1093, the living could scarcely bury the dead. In 1196, a fierce pestilence broke out, which destroyed such numbers, that scarcely any were left to minister to the sick; the customary funeral services ceased. In many places large ditches were made, into which the dead were thrown. In the summer of 1257, during the dog days, two thousand dead bodies were carried to the cemetery of St. Edmonds. In the following year, about the feast of the Trinity, the pestilence grew intolerable; 15,000 perished in London alone; in England and elsewhere many thousands died. In 1848, the black death, which broke out at Southampton, destroyed half the population. In a royal edict of December, 1349, it is said, "non modica pars populi

• Popular Lectures on the Prevailing Diseases of Towns. livered a tthe Brighton Literary and Scientific Institution. general request. By W. Kebbell, M.D., Physician to the pensary.

Recently dePublished by Brighton Dis

est defuncta;" in another, of 1350, a stronger phrase is used, "magna pars populi est defuncta." In 1352, scarcely a fourth part of the people had survived the plague. It spared the great, to fall with redoubled fury upon the workmen and servants. Crowded cities were depopulated. In 1379, a plague broke out in the northern part of the island; villages and cities were stripped of their inhabitants. In this extremity, the Scots fell upon the country, and, before making their incursions, prayed "God, and St. Mary, and St. Andrew, shield us this day from the foul death that Englishmen die from." In 1477, the pestilence, which occurred after the death of the Duke of Clarence, was so fierce that the past fifteen years' war consumed not the third part of the people, that only four months miserably and pitifully despatched and brought to their graves. In 1484, shortly after the 7th of August, a disease appeared among the people, lasting the rest of that month, and all September, which for sudden sharpness and unwonted cruelty surpassed the pestilence. It killed some in opening their windows; some in playing with children in the streets; some in one hour, many in two it destroyed; and, at the longest, to them that merrily dined, it gave a sorrowful supper. This was the sweating sickness, which recurred in 1506, 1517, 1528, and 1551. Owing to the want of any systematic registration of deaths in those days, we have no means, says Dr. Kebbell, of forming more than a conjecture of the probable number that fell victims to these desolating pestilences, either in this country or abroad but their great fatality may be judged of from the following record of deaths from the plague in London during the seventeenth century; at which time, it must be remembered, a considerable abatement had taken place in their severity. According to M'Culloch there died of the plague in London, in 1598, 26,005; of other diseases 15.764; in 1603, the plague killed 36-269; while other diseases destroyed but 5.773. In 1625, the deaths from the plague were 35-417; from other diseases 18.848. In 1665, the numbers of the dead were, from the plague, 68-596; from other diseases 28-710. In the other towns of Europe the pestilence was generally more destructive than in those in this country. In consequence of improvement in living, we no longer suffer such scourges. The epidemic of the greatest consequence which has occurred since the great plague of London, is the cholera of 1832; but the deaths occasioned by this disease were trifling, compared with those which resulted from the pestilences of former days. In London and its vicinity the number of deaths from cholera was estimated at 5,000, that of the entire country at 65,000; but had the same rate of mortality prevailed from this epidemic

as in the plagues of the seventeenth century, the deaths, in the metropolitan district alone, it is computed, would have exceeded half a million. The royal navy affords remarkable illustrations of how disease may be checked, and life preserved. Admiral Rosier, in 1726, sailed with seven ships of the line for the West Indies, but so destructive were the effects of disease that he buried his ships' company twice, and afterwards died himself of a broken heart. In 1740, Anson sailed with a fleet of five ships, carrying 1,250 men. After they had been but two months at sea the ships' companies became very sickly, and after twelve months nearly two-thirds of the crews had perished. The sanitary condition of the sailor is now better attended to. The result is shown in the following statistical return of Dr Wilson :

In 1779 the proportion dying was 1 in 8 of the employed.

1811

From 1830 to 1836

1. 1

321 -72

Before Howard went, like an angel of mercy, to visit the felon in his jail, our prisons were the fruitful sources of disease. A great change has been made in this respect. Mr. Chadwick states that the medical practitioners, who are well acquainted with the general state of health of the population surrounding the prisons of Edinburgh and Glasgow, concur in vouching to the fact upon their own knowledge, that the health of the prisoners is generally much higher than the health of almost any part of the surrounding population; that the prisoners, as a class, are below the average health when they enter the prisons; that they come from the worst districts; that many of them come from the lodging-houses, which, in those towns, are the constant seats of disease; that they are mostly persons of intemperate habits; that many of them were in a state of disease from intemperance and bad habits, and notwithstanding the depressing influence of imprisonment, the effect of cleanliness, dryness, better ventilation, temperance, and simple food is almost sufficient to prevent disease arising within the prison, and to put the prisoners in better working condition at the termination than at the commencement of the imprisonment. Our modern pestilence, for such typhus fever may be called, inasmuch as it annually attacks from 150,000 to 200,000 individuals, of which number it destroys 16,000, always haunts the abodes of filth. The track of the cholera, in 1832, was found to be pretty nearly the same. The natural conclusion is, that as we have escaped the diseases by which parts of Europe were almost depopulated in times past, a more diffused knowledge of the laws of health, and a better observance of them would

free us from many of those diseases by which man is yet made

to mourn.

Men rarely die of old age. They die the victims of circumstances that might be at once removed. Of the 125 people who die in London every day, only nine die of old age. Death may generally be attributed to bad air and bad food. Hence it is that the mortality of towns is much higher than that of the country. It appears, says Dr. Kebbell, that in a million of population, the mortality of towns exceeds, annually, that of the country districts by 7,773. Estimating the population of towns in England and Wales at 4,500,000, which is considerably under the actual number, as this estimate includes only the metropolis and the chief provincial towns, the excess of deaths in the towns of that portion of the country, as contrasted with the mortality of rural districts, amounts annually to 34,978; that for the United Kingdom, on the supposition that the amount of town populations, and the rate of mortality among them is the same in other parts of Great Britain as it is in England and Wales, to more than 60,000 annually. Thus, as compared with the rate of mortality in healthy, rural situations, there is in the towns of the United Kingdom, at the lowest computation, an annual sacrifice of more than 60,000 lives. But a more correct way of estimating the mortality of our large towns, is to ascertain the sum total of deaths which occur in them over what may be considered a healthy standard. This has been considered by sanitary reformers as a mortality not exceeding two per cent., and to which it is considered possible to reduce the rate of mortality in all towns, there being a great many towns in the kingdom, some of them of considerable size, in which the average mortality does not exceed that amount. According to this view, therefore, all the deaths which occur in any town above this rate of mortality, are to be considered as sacrificed to the neglect in them of sanitary measures. Now it has been ascertained by Dr. Guy, that the excess of deaths over two per cent. in thirty-six of our large towns, taking the average of three years-1841, 1842, and 1843-amounted to 20,100. The population of the metropolis, at the period of the census, was 1,873,817; and the average annual excess of deaths above two per cent. for the same three years, was 8,404, which, when added to the preceding number, makes the excess of deaths amount to 28,505. But there are several large towns, not included in this calculation, which also suffer from a high rate of mortality, and if they were added, the total excess ofdeaths would be raised to considerably more than 30,000. If the sanitary state of the entire population of England and Wales were raised to one annual death in fifty, instead of its present rate of one

death in forty-five, there would be an annual saving of life in that portion of the country of no less than 35,000 lives, and in the United Kingdom, on the supposition that the mortality in Scotland and Ireland is only equal to that of England and Wales (it is in fact much greater), there would be an annual saving of upwards of 60,000 lives. But to be able to realise the whole of the evils consequent upon the neglected state of our towns, in addition to the actual waste of life thereby occasioned, there must be taken into the calculation the attending amount of unnecessary sickness, and the various other evils which are the result of a high rate of mortality. We are not in possession of the requisite data from which to ascertain the proportion which the number of cases of illness bears to the number of deaths; but, taking Dr. Lyon Playfair's estimate of twenty-eight cases of sickness to one death, which must be somewhere near the truth, the number of cases of unnecessary sickness in England and Wales, will amount to 1,000,000, and in the United Kingdom to 1,700,500. "If you find it difficult," observes Dr. Guy, "to realise so enormous a waste of health and life, you have only to imagine a town of 35,000 or 60,000 inhabitants annually swept away from the face of the earth, above those who would die in the course of nature if sanatory measures were in universal operation. To form a vivid idea of the amount of unnecessary sickness in the United Kingdom, you must imagine that, in a city the size of the metropolis, every man, woman, and child it contains, is the subject of one attack every year over and above the sickness which would occur in the course of nature under a wise system of preventive measures." Another mode of illustrating the difference in the degree of salubrity between town and country districts, is to compare the average age attained by the respective populations. "The average age attained by the labourers in the county of Rutland, is thirty-eight years; that by the labourers in Wiltshire (the county of the lowest wages) is thirty-three years. Taking the latter as our standard of comparison, the lower orders in Liverpool lose eighteen years of life, in Bethnal Green seven, teen years, in Manchester sixteen years, in Bolton union fifteen years, in Leeds borough fourteen years, in Derby twelve years, in Whitechapel union eleven years, in the Strand union nine years, in Bath eight years, in Kensington union seven years, in Truro five years.

This increase in the amount of deaths in towns, over that in the country, arises generally from culpable indifference, or an undue regard to private interests. Nuisances are permitted to breed fever and disease. A grand exemplification of this we draw from the present rate of mortality in Liverpool. In