The general sanitary condition of the population of Scotland and the pressure of the preventible causes of death appears to be lower than in England, and higher than in Ireland, and so it appears from the recent census is the average age of the living.
It may be conceived that the low average age of the living in these cases is ascribable mainly to an increasing proportion of children incidental to an increasing population. Not so, however: the average age of the living is more powerfully influenced by disturbing causes affecting the population of adults, each with accumulated years, than by causes affecting the infantile population. One adult of 50 years added to the living is equal to the addition of 50 infants, and so with the average ages of deaths. The average ages of the living appear to have increased and not diminished with the increasing population. Be the sanitary condition of the poorest classes and the amount of disease and death what it may, as compared with former periods (and there is direct evidence that it is in populous districts increasing), there has been some improvement in the residences of the middle and higher classes; household drainage and cleanliness has in some districts been improved; the quantity of town and land drainage and cultivation has of late increased in various proportions in each country; and the decrease in the causes of mortality appears to have been followed by an increase of the average age of the living, of particular classes at the least, sufficient to present an increase, though a dreadfully slow one, in the average age of the adults living. The increase of the proportion of adults may be represented as follows:—
In abundance of employment, in high wages, and the chief circumstances commonly reputed as elements of prosperity of the labouring classes, the city of New York is deemed pre-eminent. I have been favoured with a copy of “The Annual Report of the Interments in the City and County of New York for the Year 1842,” presented to the Common Council by Dr. John Griscom, the city inspector, in which it may be seen how little those circumstances have hitherto preserved large masses of people from physical depression. He has stepped out of the routine to examine on the spot the circumstances attendant on the mortality which the figures represent. He finds that upwards of 33,000 of the population of that city live in cellars, courts, and alleys, of which 6618 are dwellers in cellars. “Many,” he states, “of these back places are so constructed as to cut off all circulation of air, the line of houses being across the entrance, forming acul de sac, while those in which the line is parallel with, and at one side of the entrance, are rather more favourably situated, but still excluded from any general visitation of air in currents. As to the influence of these localities upon the health and lives of the inmates, there is, and can be, no dispute; but few are aware of the dreadful extent of the disease and suffering to be found in them. In the damp, dark, and chilly cellars, fevers, rheumatism, contagious and inflammatory disorders, affections of the lungs, skin, and eyes, and numerous others, are rife, and too often successfully combat the skill of the physician and the benevolence of strangers.
“I speak now of the influence of the locality merely. The degraded habits of life, the filth, the degenerate morals, the confined and crowded apartments, and insufficient food, of those who live in more elevated rooms, comparatively beyond the reach of the exhalations of the soil, engender a different train of diseases, sufficiently distressing to contemplate, but theaddition to all these causes of the foul influences of the incessant moisture and more confined air of under-ground rooms, is productive of evils which humanity cannot regard without shuddering.”
He gives instances where the cellar population had been ravaged by fever whilst the population occupying the upper apartments of the same houses were untouched. In respect to the condition of these places, he cites the testimony of a physician, who states that, “frequently in searching for a patient living in the same cellar, my attention has been attracted to the place by a peculiar and nauseous effluvium issuing from the door indicative of the nature and condition of the inmates.” A main cause of this is the filthy external state of the dwellings and defective street cleansing, and defective supplies of water, which, except that no provision is made for laying it on the houses of the poorer classes, is now about to be remedied by a superior public provision.
Or an excess of deaths over the ages of the living of more than three years and three months; denoting, if the like excess prevailed from year to year, an increasing pressure of the causes of mortality. If the mortality be the same from year to year the chances of life would appear to be lower in New York than in Dublin, where, according to the data given by the Census Commissioners, it would appear to be 25 years 6 months.
In America little attention and labour appear to have been bestowed in any of the rural districts on general land drainage. Yet nature inflicts terrible punishment for the neglect of the appointed and visible warnings and actual premonitory scourges, amongst which are the mosquitoes and the tribes of insects that only breed in stagnant water and live in its noxious exhalations. The cleansing and the general sanitary condition of the American towns appear to be lower than in England or Scotland, whilst the heat there at times is greater and decomposition more active; pestilence in the shape of yellow fever, ague, and influenza is there more rife, the deaths in proportion to the population more numerous, and the average age of death (so far as there is information) amongst the resident population much lower.
Notwithstanding the earlier marriages, and the extent of emigration, and the general increase of the population, the whole circumstances appear to me to prove this to be the case of a population depressed to this low age chiefly by the greater proportionate pressure of the causes of disease and premature mortality. The proportionate numbers at each interval of age in every 10,000 of the two populations are as follows:—
Here it may be observed, that whilst in England there are 5025 persons between 15 and 50 who have 3610 children or persons under 15; in America there are 4789 persons living between 15 and 50 years of age who have 4371 children dependent upon them. In England there are in every ten thousand persons 1365 who have obtained above 50 years’ experience; in America there are only 830.
The moral consequences of the predominance of the young and passionate in the American community are attested by observers to be such as have already been described in the General Sanitary Report as characteristic of those crowded, filthy, and badly administered districts in England where the average duration of life is short, the proportion of the very young great, and the adult generation transient.
The difference does not arise solely from the greater proportion of children arising from a greater increase of population, though that is to some extent consistent with what has been proved to be the effect of a severe general mortality; the effects of the common cause of depression is observable at each interval of age: the adult population in America is younger than in England, and if the causes of early death were to remain the same, it may be confidently predicted that the American population would remain young for centuries.
The difference at the different stages of age appear also to prevail in proportion to the different pressure of the causes of disease and mortality in different districts in England:e. g.In the town parishes of Middlesex the average age of the living above 15 years is 35 years and 10 months; but in Hereford it is 39 years and 2 months. In Middlesex the average age of the adult population, that is of all above 20 years, is 38 years and 8 months; whilst in Hereford it is 42 years and 1 month.
The comparative amount of disease and death elsewhere it need scarcely be said, in no way affects the positive amount of evil in this country, or dispenses with the duty of adopting such practical measures as may be preventive of a single one of the cases of preventable deaths which abound in masses in the large districts having the least unfavourable averages.
The instances have been adduced to exemplify the suggestions of amendment in the mode of measuring the amount and influence of mortality, and more especially to show the importance of giving the average age as well as the numbers of deaths and the average age of the living in each class of the community.
The subsequent district returns and the notes extracted from the reports made by the local registrars to the Registrar-General, in corroboration of the General Sanitary Report, will show the immense importance to the community of the facts that require investigation. It cannot be too urgently repeated that it is only by examinations, case by case, and on the spot, that the facts from which sound principles may be correctly distinguished. They can only be well classed for general conclusions and public use by persons who have large numbers brought before their actual view and consideration, and who have thus brought before them impressively the common circumstances for discrimination, which no hearsay, no ordinary written information will present to their attention. The attainment of this immensely important public service might properly have been submitted as a principal instead of a collateral object, to the improvement of the practice of interment, for the appointment of such a small well qualified agency as that proposed, § 225, of some five or six trustworthy officers of public health for each million of a town population with the requisitepowers and responsibilities for ascertaining the actual amount of the preventible causes of death, and informing the local officers and the public of what is to be done for their removal.
The districts are placed in the order of the average age of death of the whole population during the year 1839, commencing with the highest average.