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(ii.) It was urged, in 1912, that one of the reasons for concluding that migration had played
an important role in connection with declension of phthisis, was the shifting of age incidence of
phthisis mortality during the last 50 years from young adult to middle age, and, then in males,
more particularly, to older ages. The phenomenon in question was first noted by Dr. Tatham
in 1907. Its bearing upon the migration theory was pointed out in 1912. Since 1914 there
has been a backward movement, the maximum rate of mortality reverting again towards the
younger ages (see p. LXXI., Ann. Rep. of Reg.-Genl. for 1918). Following upon removal of
the presumed cause (migration) there has thus supervened diminution of the effect (altered
age-incidence).
It would appear that while the facts concerning interchange of population as between country
and country are now widely appreciated (witness the legislative enactments already referred to and the
rigour of the tests applied in America and in the Colonies on landing) sufficient significance is still not
being attached to those relating to migration between urban and rural areas in one and the same country.
Dr. Greenwood, in his discussion of the statistics of England and Wales relating to young women,
shows quite conclusively how the recent figures, those subsequent to 1911, the year for which the Registrar
General first instituted partial correction, confirm the view that the young women who go to work
in the towns are apt to return to their country homes to die. But he does not say much about the young
men—they too migrate from country to town, though it is true they do not seem to return home to die
in quite the same proportions; and, yet the evidence as to the extent to which certain urban death rates
benefit at the expense of those of surrounding areas is unmistakable in the case of these young men,
though not quite so conspicuously so as in that of the young women. In the second part of this report
a question affecting the young lads and girls raised by Dr. Greenwood is considered in some detail. Dr.
Greenwood found the correlation coefficients for ages 15—25 between crowding and tuberculosis were
decidedly negative and he examined a suggestion as to the beneficial influence of blind alley employments
in this connection. A more far-reaching hypothesis, it would appear, is, however, one of combined
selection and partial immunisation of survivors. This hypothesis is fully considered in Part II. p. 70.
If the force of the reasoning thus applied, in the case of the ages 15—'25, be admitted, the argument
cannot rest here ; indeed, it now remains to show that the immunising influence of town life upon those
who become acclimatised to it, explains more than it might at first be held to do—it may in fact apparently
be applied throughout life and not merely to adolescents.
But, first a word as to the ages of town immigrants. London it is now agreed, draws in, as it
were like a vortex, the enterprising and ambitious girls and boys from miles around. But, perhaps, even
more important from the phthisis point of view is the fact that the lure of London continues to be
exerted in later years. At the higher ages there are, however, marked distinctions and differences
qui sex and qua quality. The female immigration apparently reaches its maximum at an earlier age than
the male, and the male curve continues at a higher level long after the female curve has noticeably
declined. Moreover, as the age of the immigrants is increased their quality becomes poorer and this is
particularly the case in the males. Young single women and single men coming to London are, it is
agreed, as a rule, enterprising and ambitious; after a time the young men fetch up their sweethearts
from the country and start house-keeping in London, and a considerable number of young married
people, perhaps with small families, come too. Friends join friends, and so on. But there is a noteworthy
falling off in immigration of women after 30 or 35; but few country women come to London to stay there
after 40; and very few after 50 years of age.
Mr. Thomas A. Welton, F.S.S., F.C.A., in his great work on "England's Recent Progress,"
published in 1911, gives "Migration-graphs" for numbers of localities. In speaking of London he
notes that the remarkable manner in which (p. 39), "The gain of women from outside seems to diminish
at age 30—35, and to become a loss on balance at 35—40, is likewise in accordance with probability.
Mr. Welton's curves relating to 10 large towns (given on pp. IX. and X.) show how the ages of male
immigrants (1891-1901) differ markedly from those of females. At first, in early years, the numbers
may be presumed to be practically identical, then at 15—20 the girls have forged ahead, later (25—30)
the young men begin to gain on them. Between 30 and 35 the men immigrants are the more numerous,
their immigration having reached a high level does not fall away so rapidly as in the case of women, and
the males maintain this higher level throughout the remaining ages. Even at 40—50 the temptation to
make a fortune seems to draw men to London. Some no doubt bring wife and family with them, but
often single men come and even when 50—60 is reached there are apparently still optimists (men, not
women), who aspire to the Lord Mayoralty. But not so many Dick Whittingtons realise their ambitions
among these older men as among the young apprentices. It may be added here, in connection with
female migration, that Sir A. Newsholme, ("The Prevention of Tuberculosis"), supplies an instructive
chart contrasting female death-rates in 1861-70 with those in 1891-1900. In the later decade the rates
are notably higher in adolescents and lower in women over 25. This result corresponds well with increase
in migration into the towns in the case of adolescents, and out of the towns in the case of other women
(loc. cit., p. 170).
The attempt has been made at various census enumerations (undertaken by the London County
Council), of homeless persons in the London streets, or temporarily lodged in night shelters, to gauge the
extent to which the older homeless men are Londoners. In the sense of being London born very few of
course comply,but if a limit of duration of stay in London be applied, say, of one month, or two months,
it is remarkable how considerable a percentage fail to pass the test. Twelve years ago, on a February
night when the Embankment was frequented by some hundreds of homeless persons, enquiries made at
the King's Tents, then open to men without any home to go to, showed that from 25 to 30 per cent, of
the inmates had tramped up to town in search of work within a period of less than six weeks. Such
men constitute a large source of supply of phthisis cases to common lodging-houses and infirmaries.