These figures are nearer to expectations, although unsatisfactory for those who aim at 100 per cent. efficiency. The proportions of Grade I. varied from 80-85 per cent. in rural areas, over 75 per cent. in mining areas, 72 per cent. in the suburbs around London, down to 49 per cent. in the crowded industrial areas of Lancashire. Some of the Scottish returns in particular indicate the price of urbanisation, at the ages of eighteen to twenty-one." 5 There is nothing in these figures to suggest that the British people have degenerated more than other nations. The German pre-war figures showed 72 per cent. fit or prospectively fit for service and 28 per cent. less fit or unfit for service, with the same contrast between the rural and urban, the agricultural and the textile areas, as is noted in Britain; while the United States rejected 21 per cent. of their draft of men from twenty-one to thirty years of age. In the latter country the higher proportion of rejections were from the urbanised and more industrial States, and the lowest from the more rural and sparsely populated areas of the West. 6 In general it may be noted that many of the causes of low grading at all ages were defects which would readily yield to treatment in their initial stages, and that great advantage would arise from the establishment of a social tradition in favour of early treatment, and in particular against septic mouths and uncared-for teeth. The younger members of the community are greatly in advance in these respects, and it is clear that the school, and its ancillary accompaniments, must now be reckoned among the most powerful of public health agencies. Actual data on stature are very sparse in the reports of the recruiting boards; the figures are below those of the British Association Committee taken as a whole, but differ little if at all in those areas in which corresponding classes of the community can be compared, while the relation between physique and occupation is of the same order in the two reports. The Ministry returns show that a large number of the adult male population examined as conscripts in 1918 had statures between 64 and 67 inches, but the average figure obtained has little significance as an index of the whole pre-war population, since a large proportion of the tall stock had already enlisted. The returns from the United States show that the average stature of the members of their draft who had been born in Britain was Scottish 67-9, English 67-7, a distinctly higher figure, probably to be explained by the greater tendency of the taller stock, the Nordic, to emigrate to fresh fields. The lowest statures quoted by the recruiting 7 • Report, Ministry of National Service, vol. i., p. 132. 5 Rep. Inter-departmental Committee on Physical Deterioration, vol. iii., P. 56. Defects found in Drafted Men.' Washington. 6 7 Report of Medical Dept., U.S.A. Army, vol. xv., Pt. I., p. 106. boards were found among the casual labourers and the textile workers, who had been subject to bad conditions of environment. The returns from the School Medical Service show that stature is on the whole greater in England and Wales to the south of a line drawn from the Severn to the Wash, with an extension northward to include Lincolnshire and the East Riding of Yorkshire; in addition, scattered areas containing many tall children occur in Westmoreland, on the coast of Cumberland, in the far north of Lancashire, in the hilly districts of Staffordshire and in Merioneth. This line of demarcation clearly marks off the industrial from the rural districts, though it also largely coincides with areas of former Saxon, Danish and Norwegian occupation. The children in factory towns and mining areas are in general definitely shorter than those in rural districts. Arthur Greenwood, considering the returns from a large number of education authorities, found that the results could be expressed in terms of those for all England and Wales with the following results :All England and Wales 8 100 Glamorgan and Monmouth (Coal and Iron Towns) Lancashire Cotton Towns 98.0 98.0 96.6 Staffordshire Pottery and Hardware Towns These findings agree closely with those of the recruiting boards, and a comparison of the two shows that the inferiority in the textile towns becomes more noticeable after the school age. In London' the physique is best on the whole in the suburban areas on the higher ground, and is worst in the poorer districts to be found in the central areas, along the Thames flats and in the valleys of the small streams that once flowed across the site of the present county. In Scotland the best physique is to be found in the rural areas, except in the Western highlands and islands where environmental factors other than urbanisation have tended to stunt growth and the racial type differs. As in England, industrial districts are below the average. The best physique is found in the great public schools, then in order come the secondary schools, the trade schools and the ordinary elementary schools; these correspond pretty well to the leisured and professional, the commercial, the artisan, and the factory and labouring classes, respectively. The stature of the children from the better-class schools, many of whom present Nordic traits and all of whom have been brought up in a favourable environment, is equal to any in the world. The general average for all types of schools is, however, below that of the children of British descent in the Dominion or the Commonwealth. The advantage of the latter supports the opinion that the emigrant stocks from Britain contained a large proportion of Nordic elements, and also suggests that the children flourish under the new environment. 8 Greenwood, Health and Physique of School Children, pp. 27-28, and Appendix A. L.C.C. Report of Medical Officer (Education), 1910, pp. 131-133. Even the worst estimates of the present-day physique, when compared with such records as exist of the former inhabitants of the British Isles, afford little evidence of a deterioration of stature in members of a particular racial type, but rather of a change in their relative proportion in the total population. In neolithic times, so far as can be gleaned from skeletal remains, the average stature of adult males was about 63 inches with a few taller individuals interspersed, who were perhaps of the ruling caste; the Saxons averaged about 66 inches, the Norwegians and Danes were a little taller. The stocks in each district remained in comparative isolation until the advent of roads and railways and the demand for labour in new areas caused a greater degree of intermixture. Even now, rural areas which had originally a predominant Nordic occupation contain a taller and fairer population; in the cities the degree of intermixture has proceeded to such an extent that there is relatively little relation between stature and hair colour. Throughout the medieval period, stature remained little affected so far as can be judged from clothes, implements and armour, which would suit the larger number of the present-day people and would indeed be too small for the better built. In the eighteenth century there were many recruits whose stature was only about 63 inches. Records of children of Lancashire operative and labouring classes, taken in the second quarter of the nineteenth century, when compared with similar figures at the present day show little change until the last few years. Since the initiation of the School Medical Service, it has become evident that a gradual improvement is in progress. In London elementary schools there has been a gain of a full half-inch in stature since 1904, while in the public schools average gains of an inch or more are recorded. The changes in weight are even more general and significant. It is noteworthy that the average weight of the crews in the Oxford and Cainbridge boat race, who were always chosen from the pick of the undergraduates, has increased nearly a stone in the last sixty years. Comparisons which have been made between children who have suffered from illnesses and those who have had none of importance, show the greater stature of the latter class and indicate one of the ways in which urbanisation exerts malign effects and also the advantages of care in childhood. Many children fail to attain their full stature on account of morbid factors which may act on the growing bones directly, as in rickets, or indirectly through malnutrition resulting from infectious ailments, catarrhs or actual privation. The predominant factor in the determination of stature is of course heredity, but where the soil and climate are unpropitious and poverty prevails the physique of all the inhabitants is depressed irrespective of their racial type. Collignon and others have shown that those removed from such districts in early life recover their normal stature, while those brought into the unfavourable surroundings are proportionately dwarfed. Taking a more general survey, the health of a people under varying conditions may be measured by the variation in the duration of life as to which data are available for recent years and to some extent for the past. The duration of human life appears to have steadily increased from the earliest times. So far as can be judged from skeletal relics, early man did not live much beyond early adult life, though some individuals. such as the old man of Cromagnon, attained to old age. The words of the Psalmist suggest that in his time the duration of life of those who survived the vicissitudes of infancy and early adult life was much the same as at the present day. The great gain has been that more now live to middle age or beyond. Macdonell and Pearson analysed the data on mummy cases from the time of the Roman occupation of Egypt 10 and the 'Corpus Inscriptionum Latinarum' of the Berlin Academy," which gives the age at death of some thousands of Roman citizens who had lived either in the City of Rome or the provinces such as Africa, at the early part of the Christian era, and were able to construct rough life tables indicating the probable expectation of life at different ages. These may be compared with tables constructed by Halley on the data in the bills of mortality of seventeenth-century Breslau, by Milne for eighteenth-century Carlisle,12 and with those constructed on modern census and registration data. AVERAGE EXPECTATION OF Life for EACH PERSON LIVING AT THE BEGINNING OF THE AGE INTERVAL, IN YEARS. The results show such an increase in the expectation of life at the earlier ages as to emphasise Karl Pearson's comment on the Egyptian data : either man must have grown remarkably fitter to his environment or else he must have fitted his environment immeasurably better to himself.' Even in the early days, however, the disadvantages of the more urban surroundings are evident in the lower span of life in the Imperial City as compared with the Roman provinces. `That a similar difference existed in the British Isles is certain, though from lack of data detailed comparison is impracticable until the last century. The expectation of life varies from class to class much as does physique, being greater for the professional classes than for the agriculturist, for the agriculturist than for the miner, while the latter in turn is a better life than the tailor or the textile worker. From life tables based on the mortality experience of the years 1911-12, the expectation of life appears to be greater in the South than the North of England and to vary in each area with the degree of industrialism and urbanisation. It also seems when the data as to numbers of survivors are plotted on a map that there is a greater expectation in those areas which, at any rate until recent times, were occupied by a predominantly Nordic population. 10 Pearson, K., Biometrika, vol. i., pp. 261-264. 11 Macdonell, W. R., Biometrika, vol. ix., pp. 366-380. 12 Pearl, R., Biology of Death, pp. 79-101. 13 Unpublished data by courtesy of B. Spear. General health has often to be estimated from the records of mortality, though it must be remembered that morbidity is much greater than mortality and that the after-effects of injury or disease may long affect the physique of the sufferer. Lethal agencies are sometimes local, sometimes widespread in their action, and may at times exert a selective action on the population affected. Tertullian long ago maintained that earthquakes and wars, famine and pestilence have to be regarded as a means of pruning the luxuriance of the human race. These vary greatly in their mode of action and powers of selection. Earthquakes need not be considered so far as England is concerned during the historic period. War in early culture might occasionally wipe out a whole population, but more often the skilful and strong survived; in modern war the selection favours those whose physique does not permit of active military service and is thus opposite in tendency. This indeed has been offered as a partial explanation of the poorer physique recorded of those French conscripts who had been born during the wars at the beginning of the last century, when the fittest of the adult male population were absent or killed. War acts more lethally through the social disorganisation, and the consequent famine and disease, which follow in its train, than through any casualties in the field; from these direct experiences on its own soil, England had been singularly free since the Norman period. Philip de Comines remarked England has this peculiar grace that neither the country, nor the people, nor the houses are wasted or demolished; but the calamities fall only on the soldiers and especially on the nobility.' 15 The wider effects of war were only felt, and then but locally, in the campaigns of the Stuart reigns, though there was great suffering earlier in the forays on the marches of Wales and Scotland. Thanks perhaps to the great demand for labour and to the separation allowances, as well as to the seat of action being abroad, the recent war has exerted no obvious harmful effects. The children have been well nourished and there was no great increase of defective children, such as had been anticipated by some, even in the areas most exposed to air raids. There was, it is true, an increase in the number of children who were troublesome and educationally 14 Supplement to 75th Annual Report of Registrar General of England and Wales, Part II., p. 34. 15 Philip de Comines ed. Godefroy, Mémoires, III., p. 155. Quoted by L. Creighton, Hist. of Epidemics in Britain. vol. i., p. 224. |