pool, Manchester, and Leeds, the male excess though considerable, is less by about one-fourth than in the hardware towns. Phthisis alone. In phthisis there is through the whole country an excess of female deaths of 1 in 13, or nearly 8 per cent.: but in all the towns I am considering, except Wolverhampton, there is an excess of male deaths. In Birmingham the male excess is no less than one-fourth, and in London it is even one-third. If we put lung disease and phthisis together, as Dr. Greenhow did in his well-known paper of 1858, the great excess of male over female deaths, does seem to support the conjecture as to the Birmingham trades. But as there is a still greater excess in London and in Bristol, where the predominant occupations are altogether different, and as no excess is found in Wolverhampton (one of the hardware towns), it seems more probable that the male excess is owing to some other cause which is common to the great towns generally. Yet taking the two sexes together, phthisis prevails less in several great towns than elsewhere. In Birmingham for instance, the female deaths from phthisis are fewer by 30 per cent. than they are on the average of the country, and even the male deaths are rather fewer. The worst towns in this respect are London, Bristol, Liverpool, and Manchester, which are nearly as bad as the whole country. The best is Wolverhampton. Brain Disease. Diseases of the brain cause rather more deaths than even phthisis. But they do not prevail most where many persons would have expected. They are considerably lower in London than in the whole country; they are very high in Leeds, and decidedly high in Sheffield. In Birmingham and Liverpool they are something lower than even in London. Heart Disease and Dropsy. Heart disease and dropsy have many deaths attributed to them; but fewer in the great towns generally than in the country at large. London approaches the general rate most nearly. Cholera, Diarrhoea, Dysentery. I come now to cholera and the cognate disorders: diseases which from their suddenness, and their prevalence at certain seasons, attract public attention. It is remarkable that all the deaths from cholera, diarrhea, and dysentery, taken together, are throughout the country, fewer than one-twentieth of all deaths. But in the great towns they are far more: being in Liverpool, Birmingham, and Leeds, from one-eleventh to one-twelfth of all the deaths in those places respectively. They are fewer in London and Wolverhampton, and in Bristol they are as few as in the whole country. Refuse Carted away in London and Bristol. It is worthy of notice, that in London and in Bristol, the same old custom prevails, of carting away all refuse and ashes, at intervals of a few days, instead of allowing them to accumulate for months. Typhus. Typhus, as we should suppose, is more fatal in the great towns than in the country generally. The worst place in this respect is Wolverhampton; but Liverpool and Sheffield are nearly as bad, and Manchester approaches these two. Leeds and Birmingham are considerably better. Bristol, in spite of its narrow streets and “backs," stands very well; and in London (the whole metropolis) there is rather less typhus than in the whole country. Here again we have London and Bristol, with their frequent scavengers, standing at the head of the list. The deaths from typhus are only about 1 in 25 of all deaths. Scrofula, &c. The deaths from scrofula and its cognate diseases, are about as many as those from typhus: they are numerous in the great towns. The worst town is Leeds with a number not very far from twice as large as that of the whole country. Liverpool is nearly as bad. Then come, in order of demerit, London, Sheffield, Manchester, and Bristol. Birmingham is better than Bristol, though decidedly worse than the whole country. Wolverhampton is actually better than the whole country, as about 18. Violent Deaths. The only other column I will make use of, is that of deaths by violence. I am surprised to find the greatest proportionate number in Bristol; but this is probably owing to the fact that the registration district is only a small part of the town, and includes I believe the docks and the "float." Liverpool is the next worse; then come Wolverhampton, Manchester, Birmingham, and Leeds: London and Sheffield have the smallest number. Birmingham Compared. If then we compare Birmingham with the other great towns, we find that as to deaths from lung-disease, there are five towns worse than Birmingham, and two (London and Sheffield) better: that as to phthisis, five towns are worse, Leeds is the same, and Wolverhampton is better: that as to brain-disease, six towns are worse, and London is a little better: that as to cholera, &c., three towns are worse, Sheffield is the same, and three towns (London, Bristol and Wolverhampton) are better: that as to typhus, five towns are worse, while London and Bristol are better: that as to "other zymotic diseases," four towns are worse, and three (London, Bristol and Leeds) are better: that as to scrofula, &c., six towns are worse, and Wolverhampton alone is better: that as to deaths by violence, four towns are worse, and three (London, Leeds, and Sheffield) are better. Death-Rate generally. As regards all deaths from whatever causes, five of these towns are worse than Birmingham, Bristol is about the same, and London (the whole metropolis) appears decidedly better. Taking Boroughs instead of Districts. As I have already remarked however, the figures given do not indicate the mortality of the entire towns, but only of the poor-law districts known by the names of the towns. The borough of Bristol, e.g., contained in 1861, a population of 154,000; the registration district contains only 66,000 (less than half), though there is not nearly so great a difference in the other towns. If we take the boroughs, we approach much nearer to the natural limits of the towns, and we get the means of a fairer comparison with London, of which the boundaries are very wide. We see that the registration district of Bristol has a death-rate much worse than that of London, but that the city (or borough) of Bristol has a death-rate rather better than that of London. Liverpool and Manchester. Comparing the registration districts, Liverpool is much worse than Manchester: comparing the boroughs, there is little difference between them. The registration district of Birmingham has the same death-rate as that of Bristol: the borough of Birmingham has a far worse death-rate than the borough, or city, of Bristol. Other Considerations. No doubt there are other elements to be taken into account in making a final comparison of the mortality of two places. A fast increasing place has many children, and therefore many deaths; and I have elsewhere shown reasons for believing that comparing Birmingham with London, a part of the Birmingham mortality is accounted for in this way. It has been proved also, that the deaths are more numerous among the working classes than among the middle and upper classes, and that this is especially true of children. But the metropolis has a far greater proportion than is found in Birmingham, of persons of the middle and upper classes. Another difference arises from the number of female servants kept in one place and in another: because a large part of these, go away in case of illness and die elsewhere; besides that they are generally in the prime of life, and of more than average healthiness. On this ground I contend that the true mortality is best ascertained by comparing the deaths of males. In some cases, the situation of workhouses, and hospitals, modifies the returns. 27 Taking all these circumstances into account, I have maintained in another paper, and I still maintain, that though the death-rate of Birmingham appears in the register as 3, while that of London appears as 4, the true death-rate of Birmingham is considerably less than that of London. |