The Day the Universe Changed - James Burke [112]
In Liverpool the death of children is so frequent and dreadful that a special system of insurance has been devised to provide … coffins and burial ceremonies. The mother, when she looks at the baby, is asked to think of its death, and to provide by insurance not for its clothes but for its shroud.
A sanitary map of Leeds, from Chadwick’s report, showing (dark) the houses of ‘the working class’as well as those (light) of ‘the first class’. Population figures are included, as are birth and death rates.
Data from Farr’s life tables. This column shows that, in a healthy district, of nearly two and a half million newborn (the first number) only a quarter (the last number) have survived to the age of forty-nine.
Farr offered the sanitarians a scientific tool with which to attack the problem. He called it a ‘biometer’. It was, in fact, a life-table of the type developed by actuaries to construct levels of premiums on insurance policies. These had been well developed by Thomas Edmonds, later actuary to the new Legal and General Assurance Society, in 1825. He showed that the rate of mortality changed regularly through life in three stages. From the age of six weeks to nine years it dropped at 32.4 per cent a year; from then until the age of fifteen it remained at a constant minimum; from sixteen to sixty it rose at 2.99 per cent a year; and from then until death it rose at 7.99 per cent a year. Edmonds developed a theoretical table, based on these ‘laws’, which compared closely with actual surveys taken in the towns. He also showed that the line of ‘highest mortality’ran from Brighton to Liverpool. The further away from it the safer one was.
Farr improved on Edmonds’s work. He produced the ‘English Life-Tables’, in which the data were arranged in seven categories: years of life; number reaching that age; number dead at that age; and the various conclusions to be drawn from the previous three sets of figures, such as rate of death and expectancy of life at all ages. By setting these tables alongside the figures for what he called a ‘healthy district’, Farr provided the medical profession with a health profile for society at large. His definition of a healthy district was one in which seventeen deaths occurred per thousand; more than this would be ‘due to preventable causes’. Farr showed that in a ‘normal community’there was an ‘indissoluble connection’between the numbers living, the mean life-expectancy, births, deaths and the rate of mortality. If numbers in any area varied from this, ‘preventable causes’were at work. Doctors should know where and when to strike.
The problem was that they had no means of doing so. Even when Farr’s figures showed an interesting anomaly, no action was taken. He analysed where cholera had struck most severely, noting that it respected neither class nor quarantine. Nor did he find any correlation with factors such as living by the sea, wealth, location or occupation. But when Farr looked at where cholera victims lived in relation to the Thames he saw something very strange. There was an arithmetically decreasing incidence of cholera in relation to the height above the river at which the victims lived. Farr was convinced that the stink from the river was in some way causing the cholera.
Oddly enough, the panic-stricken upper classes had already turned to water as a possible cure. Earlier in the century a Silesian farmer called Vincenz Pressnitz had invented the idea of a ‘water university’, sited high in the Bohemian mountains at Grafenberg, now Jesenik, in Czechoslovakia. His principle of health was that since animals stayed healthy by going