The Anxious Triumph Page 14
It paid to be rich. Mortality in London’s poor Whitechapel in the nineteenth century was much higher than in the prosperous West End.192 The gap still exists today, but it has considerably narrowed, though poverty (or more specifically, inequality) still shortens one’s life considerably.193 By the end of the century the chances of dying in cities were not much higher than in the countryside. It was no longer so certain, as much traditional historiography tells us, that Paris was the tomb of sturdy provincial migrants.194
The middle classes, of course, lived longer than the workers and the peasants and the poor, as they do now, but they did not live long by our standards and not as comfortably. They generally died rapidly of infection instead of being kept alive by the wonders of medicine to die slowly of degenerative diseases as we do.
Compared to today, even the rich and famous did not live long in the nineteenth century. In 1800 people aged over 65 were less than 5 per cent of the population.195 A quick (anecdotal and unscientific) look at the longevity of some of Europe’s and America’s best-known writers suggests that life was short for them too. While Alessandro Manzoni and Thomas Hardy lived until the age of 88, and Victor Hugo, Giovanni Verga, Leo Tolstoy, and Wordsworth made it past 80, many others were not so lucky: Byron died at 36 (of a fever contracted at war the previous year); Shelley at 30 (drowning); Keats at 26 (tuberculosis and/or mercury poisoning); Pushkin at 37 (in a duel); Balzac at 51 (ill-health); Baudelaire at 46 (opium? alcoholism?); Edgar Allan Poe at 40 (opium and alcoholism); Emily Dickinson at 56 (kidney disease); Jane Austen at 42 (typhus? TB?); George Eliot at 61 (kidney disease); Dostoyevsky at 60 (pulmonary emphysema); Heinrich Heine at 63 (lead poisoning); Charlotte Brontë at 39 (dehydration and malnourishment while pregnant); Flaubert and Stendhal at 59 (the first of a cerebral haemorrhage, the second of medication used to treat his syphilis); Vissarion Belinsky at 37 (TB); and Anton Chekhov at 44 (TB). The idea that people were unlikely to live beyond their sixties lasted into the twentieth century: Adolf Hausrath, in his essay on the historian Heinrich von Treitschke, written in 1914, says: ‘Treitschke died at the age of sixty-two, older or nearly of the same age as his teachers – Häusser, Mathy, and Gervinus, all of whom we invariably regard as venerable old men.’196 The Bible was more optimistic about the length of our lives, promising seventy years. As Psalm 90:10 says: ‘The days of our lives are seventy years.’ Seventy years seemed reasonable: Dante’s Divina Commedia begins with the words Nel mezzo del cammin di nostra vita (‘Midway upon the journey of our life’), meaning he was thirty-five.
Given the conditions of life even in rich European countries, it was not surprising that mortality rates were still very high in the 1880s. There was, however, a dramatic improvement, at least in Europe, in longevity (see Table 6).
Table 6 Life Expectancy at Birth in Selected European Countries
Source: Alfred Perrenoud and Patrice Bourdelais, ‘Le recul de la mortalité’, p. 77.
There was a parallel, though not consistent, decline in infant mortality (see Table 7).
Table 7 Infant Mortality Rate in Selected Countries, 1881–1911
Source: R. I. Woods, P. A. Watterson, and J. H. Woodward, ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861–1921, Part I’, pp. 343–66. *The figure for Belgium in 1911 is far higher due to an exceptional outbreak of dysentery among the young.197
So over thirty years things were looking up, particularly if one survived the first five years of life (where mortality was extremely high, especially in cities). Then, after 1875, matters deteriorated for adults, at least for the ‘respectable’, employed working classes, perhaps because of the lower nutritional value of cheaper food from abroad (white flour from the USA, tinned meat from Argentina, sugar from the West Indies).198 In Norway and Sweden around 1875 the mortality rate before the fifth birthday was about 20 per cent against 25 per cent in England and 30 per cent in France, but in Italy, just after unification (1861), it was as much as 47 per cent.199
The longer life achieved today is due to a remarkable and costly improvement in nutrition, education, the environment, and public health, though the relative importance of these factors is debated.200 To put it plainly, for countries as for individuals, it is better to be rich than to be poor, since prosperity enables one to have a better diet, a more hygienic home, and a cleaner environment, thus increasing one’s resistance to or reducing encounters with diseases.
Progress of this kind often requires public intervention. In the nineteenth century, improvements in health were not only the result of economic growth (the beneficial workings of ‘the market’) but of the conscious and direct intervention of public bodies.201 In 1875 the British government passed the Public Health Act to reduce unhygienic living conditions so as to combat the spread of diseases such as cholera and typhus, and began improving its public health system. Ten years later typhoid rates in England had fallen by half. Between 1880 and 1920 hundreds of American cities municipalized their water systems (293 in 1880 to nearly 8,000 in 1932). The death rate from typhoid plummeted, in some instances by 70 per cent.202 Improvements in public health, sewers, sterilization, pasteurization, purification of water were a major factor in improving life expectations. By 1900 public water supplies were available to over 40 per cent of Americans and sewers to almost 30 per cent. Filtered water, available to only 30,000 people in the USA in 1880, became available to 10 million by 1910, bringing about a drastic reduction of typhoid mortality.203
In some cases richer did not mean healthier. Scotland, considerably poorer than England, had a lower infant mortality rate throughout the nineteenth century. And, as we can see from the table above, Italy did better than Prussia. Today Kerala does better than wealthier regions in India.204 In 2010 life expectancy at birth in Costa Rica was better than in the much richer United States.205 Sweden led the world in life expectancy from the eighteenth century (when it was not rich) until about 1978, when it was one of the richest. Then Japan, which in the 1920s had health standards similar to those of Egypt, took the lead.206 Nor is democracy necessarily better for one’s health. In 2014 fifteen Baltimore neighbourhoods (mainly black) had a life expectancy worse than that of North Korea (70.6 in 2015). A baby born in the wealthy suburb of Roland Park, in the north of the city, was likely to live to the age of 84 (the US average is 79). One born three miles away, in downtown Seton Hill, was expected to die at the age of 65, nineteen years earlier.207 Other studies have confirmed the huge disparity in life expectancy in the USA.208 In 1979 (before economic reform had even started) life expectancy at birth in communist China was 64, better than democratic India (52), better than the average for low-income countries (50), and even better than the then average of middle-income countries (61).209 In 2015 communist China (and communist Vietnam) was still ahead of democratic India (76 and 68.3), and communist Cuba, with 79.1 years, was only marginally below the USA with 79.3 years. 210
Around 1860 the eight great killer diseases (whooping cough, measles, scarlet fever, diphtheria, smallpox, typhoid, typhus, and tuberculosis) were responsible for 30 per cent of the total annual deaths in England and Wales. By the beginning of the twentieth century their share had dropped to under 20 per cent thanks to a combination of factors, including public health acts and preventive medicine.211
The importance of state action was not underestimated by most contemporaries. Edmund A. Parkes, an English military physician and hygienist and veteran of the Crimean War, had no doubts over ‘the necessity of state interference’, adding that ‘In all civilized countries’ there are laws ‘removing conditions which injure the health of the people’, and suggesting that England should have stronger laws of that kind.212
Those who still believe in progress can take comfort: today’s poor, on the whole, live longer than yesterday’s rich. In 2004 life expectancy in sub-Saharan Africa was 46.1 – the lowest in the world, but still higher than that in almost all European countries in 1880.213 Progress, then as today, was very uneven. In spite of
fairly strong growth rates in 1880–1900, life expectancy in Russia and Italy remained well behind Germany, France, the United States, and Great Britain. Of course, in Latin America it was even worse: between 1865 and 1895 in Brazil, Chile, Colombia, Costa Rica, and Panama the life expectancy of a child at birth was a dismal 26.9.214 We do not have reliable data on mortality rates in late nineteenth-century Asia but they were probably worse than Europe’s and certainly far worse than now. What we do know is that, with the exception of the Irish Famine of 1845–51, in western Europe in the nineteenth and twentieth centuries there were no serious peacetime famines, unlike European Russia, where famine devastated whole areas in 1891–2, 1921–2, and 1932–3. The typical diet in France at the start of the eighteenth century was as poor as that of Rwanda in 1965 (then the most malnourished country in the world, according to the World Bank).215 Even in what are now regarded as the more prosperous areas of western Europe there were serious differences: the average Belgian in the early nineteenth century consumed 2,500 calories per day while the average Norwegian consumed only 1,800, a figure that persisted in nearly all of Asia, Africa, and most of Latin America until the 1950s.216 Today the World Health Organization recommends a daily intake of 2,000 calories for the average person.
Killer diseases, such as smallpox, typhus, malaria, and tuberculosis, spread far better in towns than in the countryside, though in the course of the nineteenth century the spread of smallpox was increasingly controlled by vaccine. A relatively new disease, cholera, devastated cities throughout the world in the nineteenth century. It began on the Ganges Delta and continued its deadly journey, reaching Russia in the early 1820s and then western Europe.217 Expanding trade enabled it to reach China and then the Americas; devoted pilgrims took it to Mecca, where it killed 15,000 people in 1846.218 Those who survived took the disease back home. In Egypt it killed 30,000 in 1848 and twice that many in 1865.219 Cholera continued its murderous march, killing 24,000 in Paris before it went on to Brussels. Between 1847 and 1851 it had killed a million people in Russia.220 In the period 1865–8 it killed 160,000 in Italy.221 In Naples alone 42,000 people died of it in the second half of the nineteenth century (10 per cent of its population). The virulence of the epidemic was not due to the cholera germ by itself but to the debilitated state of much of the population and the dismal hygienic conditions caused by bad housing, poor sanitation, and a rudimentary or non-existent sewage system.222 In Hungary the cholera epidemic of the 1870s noticeably slowed down population growth.223
In 1854 in London’s Soho, 616 were killed by the contaminated water pumped in what is today Broadwick Street, the source later being famously identified by Dr John Snow. In 1866 almost 4,000 Londoners died of cholera, mainly in the East End of London, including 916 just in the one week ending 4 August.224 In 1892 the killer disease hit Hamburg, a rich city, leaving 9,000 dead.225 The problem in Hamburg was that the local elite was committed to a policy of laissez-faire and neglected public health; the dead were victims of what today we would call ‘neo-liberal’ economics. When Robert Koch visited the city during the epidemic he contrasted unfavourably the conditions of the workers of Hamburg with those of Alexandria and Calcutta: ‘I forget that I am in Europe,’ he said.226 Eighty years later, when the same bacteria (associated with infected shellfish) struck again Naples and Bari (1973) and Portugal (1974), it killed very few people, mainly because social conditions had improved remarkably.227
Outside Europe epidemics were worse. In 1855 there was an outbreak of bubonic plague in Yunnan. It advanced along the tin and opium routes, reaching the Gulf of Tonkin. Chinese junks and, later, faster ships carried the disease, reaching Guangzhou (Canton) and Hong Kong in 1894. Two years later it surfaced in India, hitting port cities from Calcutta to Mumbai and Karachi. Thousands died. In 1899 the plague hit Alexandria, then Buenos Aires in 1900 and other Latin American cities. South Africa and Australia were not spared.228 It reached San Francisco in 1900. Since most of the city’s victims were in Chinatown, Chinese immigrants, depicted as filthy and diseased, were blamed.229 In fact almost everywhere the poor were blamed for the plague – their poverty, squalor, poor hygienic conditions and the overcrowding of their dwellings providing the necessary evidence. In some instances, such as in Sydney, in addition to the Chinese, the causes of the disease were attributed to the wrath of God or paper currency.230 Some, quite rightly, blamed the rats (though it was actually their fleas that carried the disease). Some advocated public health measures. Public health scientists such as the justly celebrated Louis Pasteur and Robert Koch, pioneers of ‘germ’ theory, received the backing of their respective countries (France and Germany). This may be hardly surprising in our age, when the state intervenes compelling us to wear seatbelts when we drive cars, but in the nineteenth century making laws compelling people to be vaccinated or securing the purity of water and food was controversial.231
So accustomed were the inhabitants of even the wealthiest nations of the world to the catastrophic effects of pandemics in the decades preceding the Second World War that they paid relatively little attention to them.232 The great influenza of 1918–19, which killed far more people in Europe and the Americas than the preceding ‘Great War’, has hardly been commemorated in novels and films; it is not remembered in monuments and songs, nor is it remembered in rituals anywhere – unlike the victims of the First World War. Mexico may have been then still in the midst of years of revolutionary upheavals, but many more died of the flu pandemic of 1918 that wiped out hundreds of thousands of people, ‘the most devastating blow to human life in Mexico in 350 years’.233
Things did get better, at least in Europe, but slowly. In 1806 a newly born boy in France could expect to die before the age of 33, a girl would last a few more years. By 1850 the situation had already improved: longevity was lengthened by ten years for men, by five for women. Progress in the next fifty years, however, was minimal: just over one extra year for men and less than four for women.234
In the United States mortality rates had started to decline in 1870.235 In part this was due to the somewhat improved circumstances of the now liberated slaves, since slaves worked from childhood until death, often in field gangs and in appalling conditions.236 Nevertheless, even after abolition their conditions remained far below that of Europe’s poor. Those who stayed in the South worked as sharecroppers on the same fields still owned by their former masters.237 They had few skills, no economic resources, and faced a dour and obtuse racism that no equivalent ethnic group had to face in Europe during the nineteenth century.
Only the Native Americans, pitilessly decimated (such massacres later celebrated in numberless films), fared worse. The population of Native Americans collapsed between 1500 and 1800 while that of Europe continued to increase, particularly that of Great Britain, which trebled during these three centuries in spite of the constant emigration to North America.238 The natives were killed not only by the colonists themselves but, and in greater numbers, by the new diseases. In what Alfred Crosby has called ‘the Columbian Exchange’, the colonizers, from Spain and Portugal as well as France and England, exported to Europe these new foods, such as maize, potatoes, various kinds of beans, peanuts, tomatoes, etc.. They imported into the Americas diseases such as smallpox, measles, whooping cough, typhus, and chicken pox, which vastly increased the mortality of the native population of the New World. Indigenous Americans were the chief victims of this new globalization, since ‘The most spectacular period of mortality among the American Indians occurred during the first hundred years of contact with the Europeans and Africans.’239 The main reason was that the Indians had ‘little or no resistance to many diseases brought from the Old World’.240 Encountering the Europeans was the equivalent of being invaded by contaminated monsters from outer space as in a sci-fi horror film.
In pre-Columbian America, north of Mexico, there might have been between 5 and 18 million Native Americans, and about 75 million in the entire New World.241 By the time the conquest of the ‘West’ had
been accomplished by settlers there were very few natives left in the USA. In California alone, the indigenous population plunged from 85,000 to 35,000 between 1852 and 1860. By 1890 fewer than 18,000 Californian Native Americans were still alive.242 In Brazil, at the beginning of European colonization there were probably 5 million people divided into self-governing units. Diseases and massacres then took their toll and those who remained in 2010 were 896,917 individuals, or 0.47 per cent of the population.243
INDUSTRY
By the beginning of the nineteenth century, agricultural productivity had barely increased since the Middle Ages. This was not necessarily a problem. All it meant was that several members of a farming household had to produce not only what was necessary to feed themselves but also enough to feed other members unable to work because they were too young or too old.244 Those too old or feeble were kept alive out of inter-generational solidarity (sooner or later, those who worked, if they did not die young, would become old in turn). In the absence of a welfare state, to have many children was a rational choice: it was one’s pension, one’s insurance against old age. And since so many died at birth or soon after birth, it was necessary to have as many children as possible. The sooner they could work the better.
France was an exception to this pattern. In the nineteenth century its population, compared to other, similar countries, was stagnant because of an exceptionally low birth rate. This made for a tight labour market, which legal restrictions on child labour made tighter still.245
Why did the French breed so little? The usual explanation is that, quite deliberately, many French farmers opted for a small family to preserve the size of their land, which otherwise would be divided, according to legislation, among too many heirs. This was particularly marked in the first half of the nineteenth century, when French peasants seemed particularly prone to the use of contraceptives, unlike peasants elsewhere.246 This remains the most likely explanation, since there was no significant difference in the percentage of women of child-bearing age in France as compared to Germany, England, and Italy in 1870, nor in the age of marriage.247 In the years before the outbreak of the First World War, a new cause of low birth rates was identified: the excessive length of military service delayed the beginning of the reproductive cycle by keeping young men away from young women (and husbands from their wives).248 One of the effects of the slow rise of the population in France was that few of them emigrated.249 Germans and Poles, Italians and Jews, Irish and Chinese, English and Scots left their homes and went to the United States, to Latin America, to the colonies. The French, by and large, stayed in France.