HOW WE DIE IN LARGE TOWNS.*
ONE of the characteristic institutions of Birmingham is the penny class or the penny evening lecture for artisans and shopmen. Efforts to induce the hearers to pay beforehand for admission to a course of instruction seem often to have failed, and a system of merely gratuitous admission is neither desired by the promoters of evening classes nor by the workmen themselves. Accordingly, at the Midland Institute, and in other places in the town, the device has been adopted of establishing regular and continuous courses of instruction, or a series of connected lectures, and charging a penny for each single admission, without any attempt to enforce continuous attendance. It is said, however, that in this way large classes have been sustained, and that a consider- able proportion of the audience is found to consist of regular students, who pursue the entire course of lessons from the be- ginning to the end. Of the series of penny sanitary lectures given last winter, one of the most remarkable is that of Dr. Foster, which is here republished in a separate form. It is mainly con- cerned with an investigation of the rate and causes of mortality in urban as distinguished from rural populations, and with an estimate of the conditions under which certain forms of disease are preventible. But its facts and conclusions, as well as its practical counsels, deserve a far wider audience than is furnished by a local sanitary association. In order to avoid any misleading inferences from a comparison of the death-rate in single and ex- ceptional years, Dr. Foster has been at the pains to correlate the statistics for a period of twenty years, from 1851 to 1870, and so to obtain the following results :—
MORT'ALITY PER 1,000 INHABITANTS.
In England and Wales generally ... 22-2 In 12 healthy Rural Districts 174 In London ... ... 24-5
In Bristol ...
... 26-9 In Leeds ... 281 In Manchester ... 824 In Birmingham ... 26-6 In Sheffield ... . . 28-6 In Liverpool ... 85.9
Thus it will be seen that the excess of mortality in certain towns over the general average of the country, Le., in Birmingham of 4, in Sheffield and Leeds 6.5, in Manchester 10, and in Liverpool 13-7 per 1,000, is the measure of the work to be done by the sanitary authorities of the several districts. This is farther illus- trated by an analysis of the causes to which death is attributed, and the excess is shown to be due entirely to the prevalence of zymotic diseases, such as fever, cholera, diphtheria, and diarrhcea, all of which are, in the eye of the sanitary reformer, preventible, seeing that they admit of indefinite mitigation whenever the laws of health are studied and sanitary precautions are efficiently used. From all these causes, only 2.8 per 1,000 die in the country dis- tricts, while the average of seven large towns is more than two- and-a-half times as great ; and in the worst town, Liverpool, the mortality is nearly four times as great as that of the country.
• 4 Lecture on the Comparative Mortality of Birmingham and other Largo Towns. 33y Balthazar Foster, M.D. Birmingham; Corniab.
From these facts, Dr. Foster proceeds to enforce with vigour and clearness those simple rules of living, and those domestic and other precautions which to persons compelled to live in crowded towns, and to spend much of their lives in small rooms, are of primary importance. In particular, he remarks on the unusual prevalence of diarrhcea in Birmingham, Manchester, and Liver- pool, and shows that the excess of mortality has in all these places been coincident with one or other of two definite'conditions,—the tainting of the atmosphere with the products of organic decom- position, or the habitual drinking of impure water.
Still more noteworthy are the facts stated in this pamphlet respecting the exceptionally high death-rate among children in large towns. Of those under five years of age, it is shown that whereas in country districts 39 per 1,000 die annually, the num- ber in towns reaches 103 per 1,000. Taking an area of the West End of London, and comparing it with an equal area occupied by the working-classes, it is shown that the richer district, with one- sixth of the population, rears twice as many children as the poorer ; in other words, that twelve times as many among the rich as among the poor escape the perils of infancy, and are able to grow up. Bad feeding, impure air, drunkenness, and the want of maternal care are the chief causes assigned for this mortality ; and to these may be added the" want of playgrounds. In this one particular Dr. Foster thinks that the old system of building poor- houses in courts had an advantage over many new blocks of model lodging-houses, inasmuch as the court itself provided a small exercise-ground away from the dangers of the streets.
When we examine the death-rate of persons above five, the dis- advantages of town as distinguished from rural life are far less manifest. Dr. Foster computes that among older children and adults, the country death-rate is only 24 per 1,000 better than that of the town. Part of this difference is attributable to the greater risks of town life, but an appreciable proportion is due to the greater prevalence of lung disease, especially among men. In the country, women seem to suffer most from lung disease, but in towns the number of sedentary employments in factories, shops, offices, and warehouses accounts for a large annual increment to the number of deaths. The analysis given by the author of this pamphlet of the mortality prevailing in different trades enables him to point with great force his favourite moral as to the need of constant outdoor exercise and of fresh air. But the whole pamphlet is worth study, not merely for the significance and value of the facts which it conveys, but also as an example of the way in which the teaching of experience on a subject of great practical importance to the working-classes may be skilfully presented, and rendered intelligible and interest- ing to them.
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