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INTERNAL MIGRATION AND THE DEATH-RATE.
186 who desire to master the fundamentals of medicinein order that they may the better see their way in treatment. To many the Westminster scheme will appear to he merely an interesting experiment directed towards the placing of the teaching of pathology upon a new basis. Actually it is far more. This and all other plans of a like nature must stand or fall, not as they affect the teaching and study of pathology, but as they influence the teaching and practice of medicine
dietaries, and this part of the report especially deserves study by the social worker. Two-thirds of the income of the Essex families investigated was spent on food, and expenditure on boots must have meant often going short of food. This would appear to have possible direct bearing on the excessive phthisis mortality in early adult life. It is pointed out in the report that the diet would probably be most defective during the first 12 or 14 years of married life, when the father is the only wage-earner, and that this corresponds roughly with the period at which rural death-rates are high ; but as against this the curves as a whole. of growth and weight of Essex children show no signs of malnutrition or lack of growth. If the Essex dietary is, as appears probable, below a desirable level for rural workers, the low phthisis death-rates which are lower than those for London except at ages 20-25 " Ne quid nimis. for males and at ages 10-35 for females (see figure below), do not appear to be consistent with the view INTERNAL MIGRATION AND THE that malnutrition has borne a large part in the 1 IN a valuable though admittedly inconclusive inquiry, result. It appears highly improbable that the effect pursued in a thoroughly scientific way, Mr. A. B. Hill has thrown new light on the problem as to what effect migration of young persons produces on the
Annotations. "
DEATH-RATE.
relative death-rates of urban and rural areas. The general facts obtainable from the Registrar-General’s reports and quoted in Mr. Hill’s report are fairly well known. Thus, in recent years the total urban deathrate for males is in excess of the rural at all ages under 75, but closely approximates to the rural rate at the age-periods 20-25 and 25-30 years. For females the urban death-rates fall below the rural rates at ages 20-30 years and occasionally also at ages 30-35. Similarly there is a higher death-rate in the rural counties from pulmonary tuberculosis at the ages of adolescence and in early manhood and womanhood, which partially explains the difference between total death-rates in urban and rural areas. The report before us seeks answers to the question why this should be, points out the difficulties inherent in the usual explanations which are offered, and throws light on the contention which has been advanced on good authority that much of the decline in the urban deathrate from phthisis is ascribable to urban migration of the more vigorous units of population and not merely to improved and more abundant food, to better housing, and to diminished dissemination of infection. Briefly stated, the facts elicited, although not warranting dogmatic statement, appear to show that the high general death-rates from all causes in the rural parts of Essex in adolescence and early adult life are caused by corresponding high death-rates from phthisis, and that this has some relation to the migration into towns of adolescents of both sexes. The report recognises the need for evidence showing, as far as is possible, the life-history of migrants ; and by securing the cooperation of clergy and others in Essex, returns have been received from some 55 villages, relating to 402 males and 367 females, of It appears whom about one-half were migrants. thus that the information in view of secured, likely, migrants have found prosperity in the town, and that their return sick to their rural homes is relatively One explanation of the excessive rural deathrare. rates at certain ages can, therefore, probably be ruled out. But it does not follow that the homekeepers -with a high death-rate in early adult life-had intrinsically worse lives. Hence an attempt is made in the report to assess their conditions in rural life as to work, to housing and environment, and to diet. No special evil condition in rural work is revealed ; and although rural housing and sanitation are often unsatisfactory, this cannot be held responsible for the high mortality in early adult life, in view of the fact, not mentioned in this report but revealed
by the Census figures, that prevalence of overcrowding
there is terribly greater in its worst forms in
towns than in rural districts. Much valuable information is given 1
as
to rural
Internal Migration and its Effects upon the Death-rates with Special Reference to the County of Essex. By A. B. Hill; B.Sc. Medical Research Council, Special Report Series, 95, 3s. 6d,
Phthisis, 1901-10. * In ten rural registration areas in Essex.
of deficient food, even though the deficiency were greatest at these ages, would be limited to adolescence and early adult life. Nor can the " worse housing conditions " in rural districts, to which attention is drawn, be held to explain these differences, for surely their effect would not be shown to such a preponderant extent in early adult life ; and as has been pointed out, room-famine is much greater in towns than in In towns, furthermore, the opporrural districts. tunities of gross and repeated infection are much more numerous than in rural districts. The report is a careful review of a difficult and intricate problem, presenting many variables, some of them elusive in nature. It should be studied by all social workers as a competent statement of methods of investigation, of ways for overcoming these, and of caution in deducing results.
dietaries, and this part of the report especially deserves study by the social worker. Two-thirds of the income of the Essex families investigated was spent on food, and expenditure on boots must have meant often going short of food. This would appear to have possible direct bearing on the excessive phthisis mortality in early adult life. It is pointed out in the report that the diet would probably be most defective during the first 12 or 14 years of married life, when the father is the only wage-earner, and that this corresponds roughly with the period at which rural death-rates are high ; but as against this the curves as a whole. of growth and weight of Essex children show no signs of malnutrition or lack of growth. If the Essex dietary is, as appears probable, below a desirable level for rural workers, the low phthisis death-rates which are lower than those for London except at ages 20-25 " Ne quid nimis. for males and at ages 10-35 for females (see figure below), do not appear to be consistent with the view INTERNAL MIGRATION AND THE that malnutrition has borne a large part in the 1 IN a valuable though admittedly inconclusive inquiry, result. It appears highly improbable that the effect pursued in a thoroughly scientific way, Mr. A. B. Hill has thrown new light on the problem as to what effect migration of young persons produces on the
Annotations. "
DEATH-RATE.
relative death-rates of urban and rural areas. The general facts obtainable from the Registrar-General’s reports and quoted in Mr. Hill’s report are fairly well known. Thus, in recent years the total urban deathrate for males is in excess of the rural at all ages under 75, but closely approximates to the rural rate at the age-periods 20-25 and 25-30 years. For females the urban death-rates fall below the rural rates at ages 20-30 years and occasionally also at ages 30-35. Similarly there is a higher death-rate in the rural counties from pulmonary tuberculosis at the ages of adolescence and in early manhood and womanhood, which partially explains the difference between total death-rates in urban and rural areas. The report before us seeks answers to the question why this should be, points out the difficulties inherent in the usual explanations which are offered, and throws light on the contention which has been advanced on good authority that much of the decline in the urban deathrate from phthisis is ascribable to urban migration of the more vigorous units of population and not merely to improved and more abundant food, to better housing, and to diminished dissemination of infection. Briefly stated, the facts elicited, although not warranting dogmatic statement, appear to show that the high general death-rates from all causes in the rural parts of Essex in adolescence and early adult life are caused by corresponding high death-rates from phthisis, and that this has some relation to the migration into towns of adolescents of both sexes. The report recognises the need for evidence showing, as far as is possible, the life-history of migrants ; and by securing the cooperation of clergy and others in Essex, returns have been received from some 55 villages, relating to 402 males and 367 females, of It appears whom about one-half were migrants. thus that the information in view of secured, likely, migrants have found prosperity in the town, and that their return sick to their rural homes is relatively One explanation of the excessive rural deathrare. rates at certain ages can, therefore, probably be ruled out. But it does not follow that the homekeepers -with a high death-rate in early adult life-had intrinsically worse lives. Hence an attempt is made in the report to assess their conditions in rural life as to work, to housing and environment, and to diet. No special evil condition in rural work is revealed ; and although rural housing and sanitation are often unsatisfactory, this cannot be held responsible for the high mortality in early adult life, in view of the fact, not mentioned in this report but revealed
by the Census figures, that prevalence of overcrowding
there is terribly greater in its worst forms in
towns than in rural districts. Much valuable information is given 1
as
to rural
Internal Migration and its Effects upon the Death-rates with Special Reference to the County of Essex. By A. B. Hill; B.Sc. Medical Research Council, Special Report Series, 95, 3s. 6d,
Phthisis, 1901-10. * In ten rural registration areas in Essex.
of deficient food, even though the deficiency were greatest at these ages, would be limited to adolescence and early adult life. Nor can the " worse housing conditions " in rural districts, to which attention is drawn, be held to explain these differences, for surely their effect would not be shown to such a preponderant extent in early adult life ; and as has been pointed out, room-famine is much greater in towns than in In towns, furthermore, the opporrural districts. tunities of gross and repeated infection are much more numerous than in rural districts. The report is a careful review of a difficult and intricate problem, presenting many variables, some of them elusive in nature. It should be studied by all social workers as a competent statement of methods of investigation, of ways for overcoming these, and of caution in deducing results.