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18
said to indicate in a general way the conditions of the district which
bring about its high death-rate and infant mortality. (a) Houses in
Defective Conditions; (b) Narrow and badly arranged Courts and
Alleys; (c) Houses let in Lodgings and Tenement Houses;
(d) Workshops; (e) Removal of Refuse; (f) Overcrowding. Now
whilst it is true that these are problems to be found elsewhere in
London, it is also true that they have become more acute in the
central districts like Clerkenwell, Holborn, Strand, or St. Luke
than elsewhere. The average death-rate in Central London is
23.0, as compared with 18.0 in West London or 17.8 in North
London (which includes Hampstead).
There can be no doubt that the bulk of this difference in deathrate
is due to the very different circumstances affecting Central
London districts and outside districts. For example, in Clerkenwell
(excluding the Muswell Hill portion) there are 209 persons to
the acre, as compared with 61 persons to the acre in London as a
whole; and as Dr. Young pointed out we have as many as
11.2 persons to each inhabited house as compared with 7.7 in
London; 17.6 per cent. of the population live in single rooms and
32.1 per cent. in two rooms. So that, speaking generally, half of
our population live in tenements of two rooms at the most.
Further, in addition to this dense population, there are
structural conditions appertaining in the district which are far from
satisfactory. Old self-contained houses have become tenement
houses though they were not built to be such. Narrow streets
and courts still exist, even though there have been many
improvements within recent years. Lastly, the population consists
most largely of the working classes, small workshops abound, and
there are a large number of out-workers employed. Now in such
a population it is a difficult task not only to maintain an average
standard of health but to prevent the spread of disease when once
it arises. For example, isolation to hospital and the many
requirements of the sick are not readily secured.
These are conditions which tend to favour disease and
predispose to infection. They are in all probability the circumstances
chiefly responsible for our comparatively high death-rate.