Читать книгу The Philosophy of Health (Vol. 1&2) - Thoman Southwood Smith - Страница 9

But it is not improbable that the Romans made some deduction from what they knew to be the real value of life among the citizens of Rome, on account of the use of the money appropriated to the aliment, which the purchaser of the estate retained in his own hands. It has been shown that the average mortality at present at Ostend is one in thirty-six; which is the same thing as to assert that a new-born child at Ostend has an expectation of thirty-five and a half years of life. The Roman allowance from birth, à primâ ætate, was thirty years. If we suppose the Romans deducted from the real value of life five and a half years for the interest of money, it would bring the Roman allowance and the duration of life at Ostend to the same. The like deduction at the age of seventeen would likewise bring the probability of life in both cases to the same. It is not likely that the Romans, without any record of the individual facts, and acting only on a general principle of utility, the best they could find, would make any variation for the intermediate years of childhood and youth: consequently the presumption is, that the duration of life at Rome, 1300 years ago, was very much the same as it is throughout Europe at the present day. This estimate, however, for the reasons already assigned, includes only the resident citizens of Rome, the male sex, and the higher classes. What the mortality was at Rome among the lower class, including the slaves—what it was in the Roman provinces, and in the less civilized countries of that age—we have no means of forming even a conjecture. What it was in Europe during the succeeding ages of barbarism we do not know. In civilized Rome, the value of life had probably reached a very high point; in barbarian Europe we may be sure it fell to an exceedingly low point. From that low point, in civilized Europe, it has been slowly but gradually rising, until, in modern times, the whole mass of the European population has, to say the very least, reached the highest point attained by the select class in ancient Rome. But in some favoured spots in Europe, the whole mass has advanced considerably beyond the select class in ancient Rome. In England, for example, the expectation of life, at the present day, for the mass of the people, as compared with that of the mass at Ostend, which, as has been shown, is the same as that of the whole of Europe, is as follows:—

At	birth	41½	years.
At	12	46¾
	17	41½
	22	38⅜
	27	35¼
	32	32
	37	28¾
	42	25½
	47	22¼
	52	19
	57	16
	62	13
	67	10½
	72	8
	77	6

It should be borne in mind that the females of the mass exceed in duration the lives of the males at every age by two or three years.

The earliest statistical document bearing on the rate of mortality, in any European nation, emerging from the state of barbarism, appears to be a manuscript of the fourteenth century, relating to the mortality of Paris, from which M. Villermé has calculated that the mortality of Paris at that period was one in sixteen. How the individual facts contained in this manuscript were collected, from which M. Villermé's calculation is made, does not appear; and it makes the mortality so excessive as to be altogether incredible. Yet a statement scarcely less extraordinary is made with regard to Stockholm, in the middle of the last century. From a table given by Dr. Price, vol. ii., p. 411, it appears that, for all Sweden, between the years 1756 and 1763, the expectation of life

Of males at birth, was Females,

33¼ years.35¾ years.

while at the same time it was at Stockholm,

For males at birth,Females,

14¼ years.18 years.

Whereas, for the twenty years preceding 1800, it

was, for all Sweden, at birth,

MalesFemales,

34¾37½ years.

Hitherto, in all places which man has made his abode, noxious agents have been present which act injuriously upon his body, tending to disturb the actions of its economy, and ultimately to extinguish life. All these noxious agents, of whatever name or quality, may be included under the term Causes of Mortality. Inherent in the constitution of the body are conservative powers, the tendency of which is to resist the influence of these causes of mortality. The actual mortality at all times will of course be according to the relative strength of these destructive agents, and the relative weakness of these conservative powers. There are states of the system tending to enfeeble these conservative powers. Such states become tests, often exceedingly delicate, of the presence and power of the destructive agents to which the body is exposed; and such, more especially, are, the states of parturition, infancy, and sickness. During the prevalence of these states, in which the conservative powers of the body are weak, life is destroyed by causes which do not prove mortal in other conditions of the system. Accordingly, in every age and country, the rate of mortality among its lying-in women, its infants and its sick, may be taken as a measure of the degree in which the state of the whole population is favourable or unfavourable to life.

The change that has taken place in the condition of lying-in women during the last century in all the nations of Europe cannot be contemplated without astonishment. The mortality of lying-in women in France, at the Hôtel Dieu of Paris, in 1780, is stated to have been one in 15. In 1817, for the whole kingdom of Prussia, including all ranks, it was one in 112. In England, in the year 1750, at the British Lying-in Hospital of London, it was one in 42; in 1780, it diminished to one in 60; in the years between 1789 and 1798, it further decreased to one in 288; in 1822, at the Lying-in Hospital of Dublin, it was no more than one in 223; while during the last fifteen years at Lewes, a healthy provincial town, out of 2410 cases there have been only two deaths, that is, one in 1205. There is no reason to suppose that the mortality in the state of parturition is less at Lewes than in any other equally healthy country-town in England.

Equally striking is the proof of the diminished violence of the prevalent causes of disease and death derived from the diminished mortality of children, the vital power of resistance being always comparatively weak in the human infant, and consequently, the agents that prove destructive to life exerting their main force on the new born, and on those of tender age. From mortuary tables, preserved with considerable accuracy at Geneva since the year 1566, it appears that at the time of the Reformation one-half of the children born died within the sixth year; in the seventeenth century, not till within the twelfth year; in the eighteenth century, not until the twenty-seventh year; consequently, in the space of about three centuries, the probability that a child born in Geneva would arrive at maturity has increased fivefold. In the present day, at Ostend, only half of the new-born children attain the age of thirty; whereas, in England, they attain the age of forty-five.

No less remarkable is the progressive diminution of mortality among the sick of all ages. Hippocrates has left a statement, which has come down to our times, of the history and fate of forty-two cases of acute disease. Out of this number, thirty-seven were cases of continued fever; of these thirty-seven febrile cases twenty-one died, above half of the whole. The remaining five were cases of local inflammation, and of these four were fatal; thus, of the whole number of the sick (forty-two), twenty-five were lost. Now, even in the Fever Hospital of London, to which, for the most part, only the worst cases that occur in the metropolis are sent, and even of these many not until so late a period of the disease that all hope of recovery is extinct, the mortality ranges in different years from one in six to one in twelve; and for a period of ten consecutive years, it is no more than one in seven; while, in the Dublin Fever Hospital, where most of the cases are sent very early, the average mortality from 1804 to 1812 was one in twelve. At the Imperial Hospital at Petersburg, the average mortality for fourteen years, ending in 1817, was one in four and a half. In the Charité of Berlin, on an average of twenty years, from 1796 to 1817, it was one in six. At Dresden, it was one in seven; at Munich, it was one in nine, the lowest of any hospital of equal size in Germany. In the year 1685, the average mortality at St. Bartholomew's and St. Thomas's Hospitals was from one in seven to one in ten. During the ten years from 1773 to 1783, it decreased to one in fourteen. From 1803 to 1813, it was one in sixteen. The average for fifty years from 1764 to 1813, was one in fifteen. In the smaller towns, the mortality is still less. It is less in Edinburgh and Dublin than in London; while in the hospital at Bath during 1827, even among the physician's patients, the mortality was only one in twenty. In the German provincial towns, the diminution is still more remarkable. In the hospital at Gottingen, for example, it is only one in twenty-one.

If the accuracy of these statements could be relied on, they would not only afford striking illustrations of the well-known fact that extraordinary differences prevail in the rate of mortality in different places, at different periods, and under different circumstances; but they would further prove that, during the last century, a steady and progressive diminution of mortality has taken place in all the countries of Europe. But of the truth of this there is much more certain evidence than can be derived from calculations, the trustworthiness of the data of which is not established, and the correctness of the calculators not known. Both the fluctuations of mortality and the increase in the value of life in the different countries of Europe, from the earliest period when statistical facts began to be collected and compared, are exhibited in a striking point of view in the following table, drawn up by Mr. Finlaison. The facts relating to selected lives and to the mass of the people are distinguished from each other, in order that they may be contrasted. The data are derived from the most authentic sources, and the calculations are made by men of the highest authority.

2

Let us trace from this table the differences that have taken place, in different countries at different periods, in the duration of life at a given age. Let us take the age given in the first column, namely, fifty. Assuming, then, the highest degree of longevity hitherto attained at the age of fifty to be twenty-three years, it appears that, between the years 1700 and 1725, the mass of the people in Breslau, in Silesia, fell short of reaching this period by 275 weeks; the inhabitants of the town of Ostend in Flanders, between 1805 and 1832, by 276 weeks; the nominees of the tontine of England, between the years 1693 and 1775, by 269 weeks; the inhabitants of the town of Northampton in England, between 1735 and 1780, by 209 weeks; the mass of the people in Sweden, between 1775 and 1795, by 207 weeks; the public annuitants of Holland, between 1615 and 1740, by 186 weeks; the inhabitants of all Belgium, between 1725 and 1832, by 183 weeks; the persons assured at the Equitable Office, between 1760 and 1834, by 119 weeks; the inhabitants of all England and Wales, between 1811 and 1831, by 100 weeks; the English government annuitants, between 1775 and 1832, only by 35 weeks.

From these statements, it appears that, towards the close of the seventeenth century, the duration of life in England was considerably less than in France: less even than in Holland nearly a century earlier. Thus, the nominees of the tontine of France, between the years 1693 and 1745, at the age of fifty, according to M. De Parcieux, fell short of the maximum longevity by 133 weeks; the public annuitants of Holland, seventy-eight years before, namely, between the years 1615 and 1740, according to M. Kersseboom, fell short of the maximum longevity by 186 weeks; whereas, the nominees of the tontine of England, between the years 1693 and 1775, according to Mr. Finlaison, fell short of it by 269 weeks; a difference nearly double that of Holland, and quite double that of France in persons of the corresponding rank in society.

Since that period, surprising changes have taken place in all the nations of Europe; but in none has the change been so great as in England. From that period, when its mortality exceeded that of any great and prosperous European country, its mortality has been steadily diminishing, and at the present time the value of life is greater in England than in any other country in the world. Not only has the value of life been regularly increasing until it has advanced beyond that of any country of which there is any record; but the remarkable fact is established, that the whole mass of its people now live considerably longer than its higher classes did in the seventeenth and eighteenth centuries. Thus, by inspecting the preceding table, it will be seen that between the years 1693 and 1715, the nominees of the tontine of England, at the age of fifty, fell short of the maximum longevity by 269 weeks; whereas, the mass of the people in all England and Wales, between the years 1811 and 1831, fell short of it only by 100 weeks; the entire mass having not only reached the select class, but absolutely advanced beyond it by 169 weeks.

There cannot be a more interesting and instructive thing than to connect these facts with their causes. This will be attempted in a subsequent part of this work; but the reader will be incomparably better prepared for the investigation when the processes of life have been explained, and the influence of physical and moral agents upon them traced. And with this exposition we now proceed.