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We may say for certain, that it is not the fact that it is an established law of nature that a large portion of the human race must perish in infancy, or in very early youth. And yet this is both asserted, and appears to be believed, by some of our best medical writers. To this purpose Dr. Woolcombe, influenced evidently by the principles of Mr. Malthus, says (I quote at second hand from Dr. Watt's Treatise on Hooping Cough), “Since disease is one of the appointed checks to excessive population, and the plan of Providence in the creation of human life requires the termination of the existence of one third of its creatures before they have attained the age of two years, it may be doubted whether the annihilation of so efficient an instrument as small-pox can be admitted without the substitution of some equally destructive malady.” If the premises were true, the conclusion would be inevitable. But they are in direct opposition to matter of fact. In this kingdom, in country villages and parishes, the major part live to mature age, and even to marry. In one place one half have been observed to live to 30 years of age, in another to 46 years (see p. 43), and in a particular village in the Alps, called Leyzin, one half of the inhabitants reach the extraordinary age of 61 years. What proportion, in these cases, die before two years of age, we are not informed, but probably not a tenth part of those born. But the just conclusion from the facts is, that as there is this amazing difference in mortality, according to local circumstances and local habits—for both the one and the other should be always taken into the account—it does not seem essentially necessary, or “ the plan of Providence in the creation of human life,” that any who are produced healthy and perfect
* I have before me the Annual Report of the City Inspector of the number of deaths and interments in the city of New York during the years 1847 and 1848, in which I find that in the first of these years there were 15,788 deaths, and of these 7373 were of children under five years of age; nearly one half the whole mortality!
In 1848 the whole number of deaths in New York was 15,919: of adults, according to the Inspector's Report, 7020 ; of children, 8899.
According to the Report of the Health of Towns' Association, showing the comparative mortality and disease in the extreme districts of each county in England and Wales, compiled from the returns of the Registrar-General for 1841, the proportion of deaths under five years of age, to the total number of all dying in the county of Lancaster, districts of Ulverstone and Liverpool), was 47.4! True, Lancaster was found the most unhealthy of all the counties of these two countries; yet wherever observations have been made in large towns or cities, the world over, we find an alarming amount of mortality among children, and such as no one in his sober reason can for a moment attribute to a Divine dispensa. tion.-S.
into the world should perish in infancy. On the contrary, it is certain from these facts, that the greater part of the fatal diseases of infancy are under the control of situation and habits of life; and that, by a mere change of these external circumstances, they may be, if not wholly, yet for the greater part, annihilated. There is nothing, therefore, either contrary to analogy, or revolting to common sense, in the supposition that by a more exact attention to these circumstances, or by a discovery of the agents, which are more immediately destructive of human life, the whole of this tribe of diseases might be really extinguished.
Again, it appears that in certain places the expectation of life, or the number of years which, upon an average, a child at birth arrives at, is, in some places at least, double of what it is in others. For example, London and the island of Madeira are, or at least were, so circumstanced. In London, the expectation of a child at birth is estimated by Dr. Price to be little more than nineteen years; while in the island of Madeira, from the account of Dr. T. Heberden, it has been found that the same expectation is about thirty-nine years. If a child, therefore, born at London, living in London, and according to the habits of London, possesses strength of constitution sufficient to carry him to this middle term exactly, or nineteen years, it might be expected that if the same child had been removed at its birth to Madeira, and resided there, according to the habits of the place, he would still have reached the average period of this place, or thirty-nine years. Life then would have been doubled ; and whatever may be supposed the disease which would have cut him off at nineteen, this disease would not have taken place till he had arrived almost at forty years of age. Thus it is rendered almost certain, that all the fatal diseases of early life are under the control of climate, situations, and habits of life.
Let us suppose that a person, born, bred, and residing in London, dies at forty. Had such a one been transplanted to Madeira at birth, though his life would not have been doubled, he might be expected to have gained a great many years. But at forty there are none of our chronic diseases to which a person may not be supposed to fall a victim. It may be cancer, or asthma, or dropsy, or any of the acute and fatal inflammations. It becomes, therefore, highly probable, that this whole tribe of diseases is under the control of climate, situation, and habits of life.
I would not be understood as advancing this argument as a rigorous demonstration, including every possible case. Some contagions, perhaps, are fatal to persons in full health, who
would otherwise live many years. The depopulation caused in many regions by the small-pox, shows this to be the fact, I think, of that poison. It is, therefore, not improbable that the same may be true of others; and the salubrity of some places may be owing, in some measure, to the absence of these contagions. Accidents, too, as extreme fatigue or extreme cold, may extinguish life, independent of all constitutional disease. These circumstances may make the bases of an arithmetical caleulation uncertain, and cause a greater apparent disparity in the salubrity of different places, as far as depends upon locality and habits of life, than in fact exists. But after making all allowance for these grounds of uncertainty, it is still indisputable that there is a very great, and, indeed, an enormous difference in the length of life in different places, independent of what may be called accidental terminations of life, and such as fully justifies the general deductions which I have made.
I may be allowed cursorily to add, that though diseases are, in fact, a check to population, and thereby the demand for food is made equal to the supply at any given period, yet it does not appear that a deficient supply of food is commonly the efficient antecedent cause of disease, as the hypothesis of Mr. Malthus appears to imply. They are connected, not as cause and effect, but as it were accidentally, by the intermedium of the passions and interests of a certain portion of the community
-the cultivators. In common times, a very small portion, indeed, of the reigning diseases can be ascribed, with any probability, to a deficient nutriment. All the contagions and all the effects of locality-I may add all the effects of drunkenness—act as powerfully upon the rich as upon the poor; and these comprehend the great body of the reigning diseases. Nor has it ever been proved that, upon the whole, persons in easy circumstances live longer or raise larger families than the lower orders. Whatever may be the imaginary mischiefs of an excessive population, they neither are, nor does it appear that they ever have been in action. Hitherto an increased demand for food, like a demand for all other commodities, has occasioned an increased supply, and that in proportion to the demand. This is true, at least, in civilized communities, versed in the arts of agriculture.
The different healthiness of different places is popularly ascribed merely to a purer state of the atmosphere ; nor would I deny the debilitating influence of an impure atmosphere. But we should consider that the diseases of large towns, and the diseases of the country, are, upon the whole, the same dis
eases; only in the towns they appear and prove fatal at an earlier stage of life. We cannot, therefore, directly trace the specific influence of an impure atmosphere; we can only suppose it to accelerate the access of disease from other causes, or to render it more fatal. But the phenomena are essentially the same, whether they happen in great cities or in country villages; in neither the one nor the other of these situations do we meet with diseases that are absolutely peculiar, and exclusively confined to the spot on which they appear. We cannot, therefore, acknowledge distinct causes as generative of disease, in large cities, from which the country is wholly free. We can only suppose that in cities the causes, be they what they may, are more active and concentrated.
There are those who appear to think that the cssential difference of climate consists merely in a difference of temperature. They propose, by artificial methods, to correct the evils which they attribute to the coldness of our atmosphere; and they hope, by what they call a regulated temperature, to arrest the progress of, and even to cure, the most frequent and most fatal of our diseases. But it should be considered that though temperature has very considerable influence over the symptoms of disease, it has little or none over its general results and final termination.
In different climates disease assumes different forms, and fixes its seat upon different organs. In the East Indies, practitioners hardly see the greater part of our European diseases ; rheumatism, catarrh, pleurisy, peripneumony, headaches, and toothaches are wholly unknown. But instead of these almost universal European diseases, another class, which are hardly heard of with us, except perhaps for a month or two toward the close of the summer, are habitual and universal. They occupy the liver, intestines, and mesentery, occasioning redundancy of bile, hepatic congestion, fluxes, and other disorders indicative of increased mobility and irritability of all the parts of the system, comprehended within the extent of the coeliacal and portal circle. These differences may, probably, be justly ascribed to permanent differences of temperature, though we are wholly ignorant of the mode in which they operate. But in point of general salubrity, the warm climates do not appear to have any advantage over the temperate; and, therefore, though the symptoms of some particular cases of disease may be alleviated by the mere avoiding of cold, yet it is highly improbable that such a precaution alone can avert or much retard the latality of any fixed diseases.
To the proposal for the use of a regulated temperature in consumption or other diseases, there lies a fundamental objection, independent of the weakness of the proofs by which it is supported; this is, that it is applicable only to persons in easy circumstances. If there is any law in the government of the universe more steady than another, it is that nothing, which is truly useful, is not useful to all. Neither food, nor clothing, nor medicines, nor a covering from the atmosphere, nor knowledge sufficient for the guidance of life, are confined to any rank of society. Every plan of acquiring, whether it be health or happiness, which is not communicable to all, will assuredly prove abortive.
Though temperature alone will not counteract powerful morbific causes, whether of diet or of locality, it cannot be doubted, I think, that warmth is, within certain limits, favorable to the human constitution. But a change of climate includes commonly a great change of other circumstances besides temperature, and it illustrates most forcibly the effects of locality. These effects, though men have very indistinct notions as to their immediate causes, are universally acknowledged and acted upon. Upon it is founded the advice given in most obstinate diseases, to try what is called change of air. When we reflect upon the astonishing difference in the salubrity of different places, we see clearly upon what foundation this advice rests; and can feel no surprise at the great benefit which has been often experienced in obstinate diseases from a change of residence. Complaints, which have resisted the most judicious treatment, often quickly subside, as it were spontaneously, by quitting the situations in which they were formed. How many gain health instantly by going out of London? This is a point on which the voice of all ages has been unanimous. “In young persons afflicted with epilepsy," says Hippocrates, “ changes effect the solution of the disease, principally of age, and place, and manner of life.” The daily experience of every individual corroborates, in some degree, these remarks. There hardly exists a person of some experience in life who has not found, with a change of residence, some corresponding change either in feelings or health.
Upon these principles, if a person is suffering under an habitual disease, which resists medical treatment and threatens to shorten life, a more reasonable proposal could not be made than for him to remove to a situation where the bulk of the inhabitants had been observed to enjoy the best health, and to attain the greatest longevity. The ancients, as we are informed