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Leader (1850-1860), 25th September 1858, Edition 2 of 2, Page 20, 1004 THE LEADER. [No. 44ds Septembeb 25,...

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    • 1004 THE LEADER. [No. 44ds Septembeb 25,...

      1004 THE LEADER. [No. 44ds Septembeb 25,...

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      As shown in details in Tables I ., II ., III ., IV V ., and VI inclusive , the mortality per cent , has been determined for the different terms of life , and for the various classes of diseases . 1 st . For the whole of England and Wales . 2 nd . For I « oridon . Srd . For those districts of the kingdom in which the density of population varies from 28— . 72 per hectar ( the hector equals nearly 2 j ttcres ) . 4 th . For districts in which the density varies from 84— . 99 . 5 th . For Lancashire ( . 28 or 7-10 acres ); and 6 th . For the residue of the population of England and Wales .

      If it be true that increasing density of population , particularly in the sense in which it is understood in regard to barracks ' sleeping accommodation , has a tendency to augment diseases of the lungs more than all other diseases , then it is evident that districts in ¦ which the sleeping accommodation differs so widely must show a marked difference in the ratio of deaths taking place from phthisical causes . No doubt the results of the influence of a uniformly and generally increased density of population in a district which

      is not , in any considerable portion of it , highly intensified in its overcrowding , would be uniformly compared with the results of a district or section of population which is throughout overcrowded . ; but in London , or Lancashire , and in the third district of England now-under consideration , we have been long accustomed to hear reports through the M Health of Towns Commission" of great and , in many instances , of major portions of them being overcrowded to a degree which shocks morality and the ordinary notions of common decency .

      Into these details it is now unnecessary to enter ; they are patent to all giving attention to questions affecting the . public health . Although , therefore , there is no one district of the kingdom in which there is a uniform system of overcrowding , still there ] are many—and among them those now under reviewr- ^ in which the overcrowding' of the large portions of them- is such that if the hypothesis be of any value , there must be at the least a slightly augmented ratio of death from consumption compared with the general ratio of increase from all causes . Let us see . how fax- thia is . in agreement with recorded facts . It must be clearly understood that the hypothesis on which the commissioners rest their concTiisions i » not simply that overcrowding may induce phthisis in an increased ratio—that would probably be denied by no one . ,

      In the army , the deaths from diseases of the lungs axe absolutely , as well as relatively , to the deaths from all , other causes , in a ratio so high , beyond all precedent and example , as to form a new and important problem for solution in vital statistics . The hypothesis , therefore , of the Commissioners resolves itself into the following : —That " overcrowding /' although it increases the general mortali ty , has the peculiar characteristic of intensifying the deaths from diseases of the lungs greatly beyond those from all other causes . " . On referring to Abstract B . preceding , it will be found that the total excess of deaths above the average for England and Wales is 1981 . 57 , while at the same ages , in diseases of the " respiratory organs " only , it will be seen there is ah excess of no less than 1 . 397 . 45 deaths , or at about 70 percent , of the whole

      . This result deserves the most careful and patient consideration . Again , on referring to the abstract B . preceding , it will be seen that , according to the mortality of England and Wales , the normal ratio of deaths from diseases of the " respiratory organs" is 44 . 48 per cent . ; and yet of the whole excess of deaths from all causes no jess than 70 per cent , is due to thejorggns of respiration . The full importance of this result will be perhaps better appreciated by , the following illustration : — Actual number of deaths from diseases of the respiratory organs ... ... = 3 2 . 675 . 0 Normal number of deaths = 1 , 277 . 6 Difference of excess 5 = 1 . 397 . 4 = 109 percent . If the residue of the deaths from all other causes whatever be viewed in this manner , the results are—Actual number of deaths from all other causes ,,. « = » 1 . 807 . 0 Normal number of deaths = > 1 . 211 . 8 Difference or excess « 595 . 2 ¦ = » 49 per cent . These results conclusively show that the condition of the army is such as to induce an excess of diseases Of the organs of respiration , with a much higher intensity than all other diseases collectively } in fact , the excess of deaths from diseases . of the organs of respiration , la considerably more than double that from all other causes . This peculiar feature in the mortality or the army has iwt been observed Jin any other series of observations , and , it is of the utmost importance to

      determine whether the solution of it offered by the Commissioners be the correct one . Should their hypothesis be found not in accordance with facts and experience , then the most serious consequences must result from it to the sanitary state of the army ; as , without the true solution , there is little chance of effectual remedies being applied . In Tables I . to VI . inclusive , appended , are given the ratio of mortality per cent , from all specified causes at the different terms of life ; but "I shall now refer simply to the results for the soldiers' ages as given in the following abstract of the tables . Abstract C . Ratio of Deaths from each Cause to the total Deaths from all Causes in the following Districts . ( Soldiers Ages . ) r ~ # - ^ : " "" Group of Diseases . gj Is 1 li | ji J'f IP £ 2 o « ° ? p 1 . Phthisis 37 . 0 35 . 2 30 . 0 35 . 4 36 . 2 43 . 7 2 . Residue of Tubercular *) j Diseases , and Diseases f q , o « io < i in * 92 84 of the Respiratory Or-f J | f _ £ l J ^ . i £ f . _ ff _ f ^ gans- J 4 g 5 ^^ 483 456 ^ 4 52 . ! 3 . Zymotic Diseases ... 19 . 1 22 . S 21 . 4 20 . 3 17 . 6 11 . 6 4 . Diseases of the Nervous" ) j System and Digestive V 12 . 6 12 . 5 12 . 5 13 . 5 13 . 3 10 . 7 Organs .............. J I ^ ta ;* !! . ^ } 8 > 2 J 10 . 7 10 . 9 11 . 7 15 . 3 6 . Other Diseases . " . "" III ! . ' .. 10 . 8 11 . 9 ! 9 . 1 9 . 7 12 . 0 10 . 3 7 . Ail Causes-. loo . o ioo . o ; ioo . o 100 0 100 . 0 loo . Q A careful examination of the results given in this abstract , leads to a conclusion quite at variance with the hypothesis of the Commissioners . In fact , in the densest districts , the mortality from diseases of the lungs is relatively to the deaths from all causes much less than in the more thinly peopled districts . In London the deaths are 44 . 8 per cent . England and Wales , 46 . 5 „ And in the residue of the coun- . try , after deducting the districts enumerated in Abstract C . .. . ... ... 52 . 1 „ It will be seen that the effect of density and overcrowding is not to intensify pulmonary disease so much as the class of zymotic diseases . The third line of this abstract gives a striking illustration of this ; reading from the last column toward the first , it will appear that the relative amount of zymotic diseases to those from all causes increases gradually , and almost uniformly , with the ratio of density , from 11 . 6 per cent , in the least dense districts to 22 . 6 per cent , in London , the most closely-packed district ; the results for England and Wales , which include all the districts , being of course intermediate . The diseases of the nervous system and digestive organs exhibit a somewhat remarkable uniformity throughout all the groups . It is when the results of the mortality in the army are given in the particular form of expression adopted in the preceding abstract , that they appear anomalous , the mortality from diseases of the lungs being among the Household Cavalry ... 59 . 0 of the whole deaths . Dragoon Guards , & c ... 53 . 9 do . Infantry of the Line ... 57 . 3 do . Foot Guards ... ... 67 . 7 do . These results are very singular , and will appear still more so if it be kept in view—throwing out of comparison the Household Cavalry , a very small body , and therefore subject to marked fluctuationsthat as the general mortality increases , so does the ratio of deaths from diseases of the lungs increase . If , therefore , over-crowding were the main cause of developing so inordinate an amount of consumption , the barrack accommodation for the different branches of the service should be found contracting in the order in which the general mortality , as well as that from consumption , increases ; but it happens to be quite otherwise . A careful examination of the preceding facts , it is believed , does anything but snpport the hypothesis now under consideration of the Commissioners . There is however , another and in some respects a more simple , and in unskilful hands a safer , way of solving this question , and that is , instead of taking the ratio of the mortality from " one cause" to the mortality from " all causes , " to determine the actual rate of mortality from " each cause , " and I have accordingly placed all the preceding results in that form . The detailed tables hereto appended give the results for various terms of life ; but in the abstract to which I ask the attention of the section , reference will be made to the results for the soldiers ' ages only . In the preparation of the following abstract , the actual mortality per cent , at the given ages was in the first place determined , and then the differences per cent , between these results and the corresponding ones for England and Wales were found , and the

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      snow , cause of death in the army , whether it is in greater or less activity than in the country generally . Abstract D . " Differences between the Mortality ' per cent , in the following Districts , and that for England and "Wales { Soldier ' s Ages . ) ~ ~ " ~~ i a * £ « .- &« it Group of Diseases . | g | St | J g | ¦ ¦ . . S ^ « ° * «* ^ R LSS orTu ^ iy ^^^^ ^^ cular Diseases and f Diseases of the Re- C Spiratory Organs .. J + 19 . 8 + 32 . 3 + 17 . 7 —13 . 5 —36 . 5 ... ^ ., + 15 . 2 + 22 . 2 + 7 . 5 — 12 6 —19 0 3 . Zymotic Diseases .... + 41 . 7 + 38 . 0 + 16 . 7 —17 . 2—5 G 3 4 . Diseases of the Nero vous System and > Digestive . Organs- J + ij » . 8 + 22 . 2 + 16 . 7 — 4 . 8 —38 . 9 5 . Sudden and External Causes _ 10 . 0 + 20 . 9 + 10 . 0 — 36 + 9 . 1 6 . Other Diseases ...... + 32 . 1 + 3 . 7— 1-8 , — 0 . 9—31 . 2 7- All Causes .. ¦¦ + 19 . 9 | + 23 . 1 + 9 . 6 — 10 . 2—27 . 8 In viewing the preceding abstract it is right to explain that the results in the first line are of the most importance , as in the army Phthisis Pulmonalia constitutes about 80 per cent , of the deaths from diseases of the I lungs , and about 50 per cent , of the deaths from all causes . This being explained , the results in abstract D are , as bearing on the applicability of the hypothesis in question on the causes of the mortality in the army , even more remarkable than those in abstract C . In every instance , except one , the differences between the mortality per cent . in the respective districts from phthisis , and that for England and Wales , are less than the differences between the mortality from all causeg , showing that death from phthisis is more positive in its determination—in other words , less subject to fluctuation , and less . affected' by external causes than the other diseases in the aggregate . In . London , the densest of the districts , the increase beyond that of ' the country generally from death by phthisis is 14-per cent ., while the increase from all causes is about 20 per cent . ; but in the least dense portion of the kingdom ,-as shown in the last colum of Abstract 1 > , the decrease from Phthisis is precisely 14 . 8 per cent ., but that from all causes 27 . 8 per cent ., reversing exactly the positions held by ihese diseases in the army , as already pointed out , in which it was shown that the deaths from diseases of the lungs were in excesa of the normal number 109 per cent ; but the deaths from other causes were in excess only 49 per cent . There appears , therefore , no relation between the hypothesis advanced by the Royal Commission and the causes of the actual increase of mortality which ha 9 taken place . If the great havoc made in the ranks of the British army while at home had been occasioned through deaths from zymotic causes , then the hypothesis under ^ discussion would , if applied to that class of diseases , have held good , and the conclusion they have arrived at might have been suggeative of ulterior proceedings , beneficial to the bravo men have to fight our battles , improving to their moral conditions and physical power , thereby enhancing the financial resources of the empire . The results in the third line of Abstract D . are exactly confirmatory of those in Abstract C , showing that density of population is only powerful in developing zymotic diseases . It i 3 somewhat remaricable that the results of the two abstracts , w-wmott the mode of expressing the relation of the facts recorded is so decidedly different , should agree precisely , showing , in both instances , tlmt ttie oj"y diseases which follow the order of density in their development is the zymotic class . , If in Abstract l / the results for the deaths from the whole chvss of diseases of the " r oPjfJ ^ J organs" be taken into consideration instead ot tnos « from phthhbjwfmonaK * , only the same reason » n « JJJJ argument will bo found to apply , tho death" from consumption being always more ^ nstant , affected by external circumstancea , and showing ^ disturbance in their development in the f' 110 * 0 ™ districts than the remaining diseases . In " ,,, ' tion , pare In any considerable portion of }™ J ?^ Zo which is either more orlosa crowded than t eavorog of the kingdom , tho deaths from phthisis an « d'BOWj of tho respiratory- organs , and tho ratio will . 1 > J taun always subject to loss perturbation than tho rosiuuw of all other diseases . , , „„_„ there * If the hypothesis of the commissioners * ore tnoi ^ fore well founded this would not be ^ 'jSm < Soidlng in which there was a large amount ofow-JJ | would , when compared with those J' ^ affkea show , to a less or greater extent , tho wo 1 >' peculiarity of tho mortality in the army « J 1 ? ( B on lJ ora ( ng deaths from consumption moro than tnosu other causes . Tho present n ^ W ?*" "' 'J " poBito shows that overcrowding produces *»© ™ ' { ° a jnoffect , and that deaths from consumption

      1004 The Leader. [No. 44ds Septembeb 25,...

      1004 THE LEADER . [ No . 44 ds Septembeb 25 , 185 S .

  • Citation
    • Leader (1850-1860), Sept. 25, 1858, page 20, in the Nineteenth-Century Serials Edition (2008; 2018) ncse-os.kdl.kcl.ac.uk/periodicals/l/issues/cld_25091858/page/20/