decline of tillage farming, is confirmed by a consideration of the relative yield in energy from the several employments of land. These different yields are simply results of the large differences in calory value between cereals and other forms of food. Sir Thomas Middleton has worked out the consequences thus: Food Value in Calories per acre of the Principal Farm Crops.* Moreover, not only is the calory value of meat far less than that of grain, but the average arable land will produce as much meat per acre as the grass, in addition to the wheat and barley it has to sell."† Averages, of course, somewhat obscure the wide differences in soil and climate to be found in a country like England; nevertheless they give a reliable general impression. And the reason why English farmers have in the past abandoned tillage and laid down their land to grass, and so lessened the real food supply of the land, had not been that the land had ceased to be able to produce the previous quantity of food, or even because the gross money return would be less than that obtainable from pasture farming, but because the net return was less, or was expected to be less (which had the same result), when costs were deducted from receipts. The presumption, therefore, for the future, is that if arable cultivation still further declines, though the money value of the total national agricultural produce may increase, its food value will positively decrease. And this, in conjunction with the growth at the same time of the population, will accelerate the further dependence of this country on overseas supplies. 27. The successful provisioning of this country during the Great War is a legitimate cause of national satisfaction. But the difficulties in doing so were vastly greater, and the risks incurred were far more serious than the Commission anticipated in 1905. It would be absurd, in the present stage of the world, to pass from the old satisfaction with our condition of dependence to the opposite extreme, and dream of making this country self-sufficient. Some centuries hence the face of the world may be transformed, in consequence of the growth of population in the lands from which thickly-peopled industrial countries now draw food supplies. But, for a long time to come, this country, at any rate, will obtain much the larger part of its food from across the *The whole Table VII (p. 59) should be examined, with the accompanying explanation. † Sir Daniel Hall, Agriculture after the War (1916), p. 33. seas. Even Germany, though it had consciously aimed at self-sufficiency for twenty years before the war, and succeeded in making long strides in that direction, could not manage to be a great exporting country for manufactures without becoming, to an extent which proved ultimately fatal, an importer of foodstuffs, both directly and in the form of fodder and fertilisers. It does not follow that Germany's policy, of becoming as self-sufficient as it could under the circumstances, was not an appropriate one for a country in her position and with her outlook. It is indeed the bare historical fact that "her balance of agricultural and industrial strength fitted Germany to endure a prolonged period of isolation better than any other European Power."* However, as this country cannot even distantly approach Germany in this respect, the question of the wisdom of her pre-war policy is not, for us, a practical one. And with regard to this country it is not necessary to go beyond the proposition that any further decline in our home supply of food may well be viewed with grave concern, and would furnish primâ facie justification for appropriate measures to keep up production. It is not necessary to lay stress even on the desirability of maintaining the present proportion which British produce forms of the total supply: it is sufficient to concentrate attention on the evident national riska risk as much psychological as material-in any further absolute decline. 28. And in view of this risk, it is evidently desirable that the country should be able to ascertain at any time just where it stands in that matter. It is not a satisfactory state of things that for information of so momentous a character the country should have to rely on occasional official enquiries, hastily set on foot as a result of a scare. What is called for is a series of Reports, prepared as part of the ordinary official work of the departments, and issued at regular intervals. An appropriate occasion would be the Decennial Census of Production. 29. In 1916 a Committee of the Royal Society, at the request of the President of the Board of Trade, drew up a Report on the Food Supply of the United Kingdom, which served as the basis for the subsequent policy of the Government. Representatives of the Ministry of Agriculture and of the Board of Trade sat on the Committee and furnished the figures of crops, live stock and imports; while the physiologists estimated their food value in relation to human needs. It would be altogether appropriate that the Census of Production Department of the Board of Trade, which will, in any case, be collecting information as to the money value of agricultural output, should be made responsible for the preparation of a similar Report on the Food Supply of Great Britain, as an appendix to their main Report, and that they should invite the co-operation of a Committee of the Royal Society for the determination of food values. 30. The Annual Agricultural Statistics issued by the Ministry of Agriculture contain information as to the changes which have taken place in the year, and in recent years, in the use of the land, as between arable and grazing; in the extension or shrinkage of the several crops, and in the number of livestock. They contain also information as to the sources of overseas supply. These Reports do not attract much attention. It would be well, therefore, if the decennial Report on the Food Supply proposed in the previous paragraph were supplemented by the information which the Ministry of Agriculture could furnish. This could show what exactly were the causes in English agriculture for any changes in the total food value of the British supply, and the changes also which were taking place in the sources of the overseas supply. July 1923. Fayle, Seaborne Trade (Official History of the War), Vol. III, ch. xxvii. + Published as a White Paper, 1917, Cd. 8421. MEMORANDUM II. CONSIDERATIONS OF NATIONAL HEALTH. By Sir WILLIAM ASHLEY. 66 1. The advantage in health which rural life enjoys over that in towns was perceived as soon as serious attention began to be directed to Vital Statistics. What had probably often been remarked before-that the Country is more heaithful than the City "-was definitely asserted by Graunt for this country as early as 1662. In that and previous centuries the excessive mortality in the towns was due very largely to periodical visitations of pestilence. But after the great plagues ceased, the towns continued to be at a great disadvantage. Some improvement would seem to have been effected in the towns before the advent on a large scale of the new manufactures which may be approximately dated 1815; and then apparently began a retrograde movement.* We get on to surer statistical ground with the establishment in 1836 of the General Register Office, and the series of reports by Dr. Farr. In 1851-60, the deaths in "30 large town districts" were 2.8 per cent.; in 63 healthy districts 1.5 per cent.† As town life and aggregation of population are only two names for the same thing, Farr came to the conclusion, from the English facts before him, that increase of density always implies, when once the town stage is reached, an increase of mortality, not of course in proportion to the density itself, but in some discoverable mathematical ratio. At various times he put forward slightly differing formulæ as expressing the relation; and though none of them exactly fit the facts, they fit nearly enough to show that, in the second and third quarters of the 19th century, growing urbanisation and higher mortality did, in fact, go together. 66 2. Since, however, Farr began his work, and largely as a result of his efforts, great advances have been made in statistical methods. One such development of technique has an important bearing on the present subject. The figures first considered had been of actual or recorded death rates in particular districts at particular times. Comparisons based on such figures were quite sufficient to prove the superior salubrity of country over town. But they were too favourable to the town for this reason. It is a generally observed fact that mortality differs as between the sexes and as between the several age-groups. Towns contain as a rule a larger proportion of the more favoured sex and of the more favoured ages. Their mortality, therefore, is less than if their population were made up either in the same way as that of the country districts or in the same way as that of the country as a whole. Accordingly, since 1883, the Registrar-General has adopted the device of "correcting" the recorded death-rate in such a way as to show what the mortality would have been in the several districts if they had had the same age and sexdistribution as the whole country. The Corrected Death-rate" is obviously a truer statement of comparative healthiness. And the effect of "correction" may be illustrated by the fact that the "crude" or "recorded" death-rates per thousand in 1897 for 33 towns in England and Wales, on the one side, and for the rest of England on the other, were 19.10 and 16.52 respectively, while the "corrected" death-rates were 20.65 and 16.26.§ 66 *Farr, Vital Statistics (1885), p. 150. † Ib., p. 160. Newsholme, Vital Statistics (Ed. 3, 1899), p. 154. § Ibid., p. 108. 3. That there continued down to the Great War to be a marked difference between the mortality of town and country appears from the latest figures of the Registrar General. It will be sufficient to give the Standardised Death-rates per 1,000 for County Boroughs and Rural Districts" for England and Wales for the last four years : 66 4. So far we have compared the total mortality in the several districts. It is important to go on to the further fact, that the relative superiority of the rural districts is shown at all ages. We have been furnished by the Medical Statistician of the Ministry of Health with an instructive comparison for the year 1914. He has calculated what proportion the death-rates at the several ages, in the rural and urban districts respectively, bear to the death-rates for these ages for the whole country. By rural" is here meant the population in areas subject to Rural District Councils; while "urban" covers county boroughs as well as urban district councils. It need hardly be said that this a very rough and ready classification, but it is the only one available for the purpose. This brings out clearly the two facts that Rural Males have an advantage in health, so far as the death-rate is a criterion, at all ages; and that that advantage is a very considerable one in the adult years from 35 onward. It shows also that Rural Females have likewise an advantage over Urban in sixteen out of eighteen age-groups, and a considerable advantage-if somewhat smaller than in the case of menin the adult years from 35. The probable explanation of the smaller advantage to women may appear when we come later to consider the causes which are operating in country life. That in the two age-groups, 20-25 and 25-30, the mortality among women in the country is slightly higher than that among women in the towns is a problem which has not yet been sufficiently investigated: it is perhaps due, in part at least, to the townward movement of the stronger and more ambitious country women seeking situations as domestic servants. 5. From the death-rates at the several ages have been constructed the tables showing Expectation of Life, upon which is based the whole business of Life Insurance. The statistician to whom reference was made in the previous paragraph has worked out, in his recent Milroy Lectures before the Royal College of Physicians, the length of the working life of men in great industrial towns and in non-industrial areas for the several districts of England. The general conclusion to which he arrives may be summed up in his own words : "Every man who passes his productive years (from 25 to 55) under the rural conditions will have nine-tenths of a year more to live in that productive period than a man of the same entering age in the industrial towns."* 6. The Annual Reports of the Registrar-General furnish figures not only of general mortality, but also of the mortality from particular diseases and in particular occupations. Turning first to the returns as to particular maladies it appears that one at least of the most grievous among them-viz., phthisis "increases with urbanisation, from a minimum in the rural districts to a maximum in London." This is the conclusion of the Superintendent of Statistics in the Registrar-General's Office.† The standardized figures for the four years, 1911-1914, show much the same difference each year between the several groups of districts. The average rate for the four years, per million inhabitants, was as follows:--London County Boroughs Other Urban Districts 1,315 7. Passing now to particular occupations, we get suggestive results by combining the recorded mortality year by year in the various occupations with the number of persons in those occupations as revealed by the decennial Census. Here again Farr led the way; and fifty years ago he pointed out that "farmers and agricultural labourers are among the healthiest classes of the population." There are, indeed, grave and perhaps insuperable difficulties in the way of exact statistical comparison. There are the technical difficulties in the way of classification; and there is the further consideration that, since some trades are, in fact, concentrated in particular districts, the effects of occupation are crossed by those of geographical situation. Some industries, such as coal mining and the heavier metal trades demand such physical powers that what may be called "unconscious industrial selection" provides them with an exceptionally large proportion of stalwart men. Nevertheless later statistics, even when used with all the caution of the best modern methods, are quite sufficient to confirm Farr's conclusion, in spite of the notorious defects in the housing and diet of the agricultural labourer. For the years 1890-1892, for instance, the following comparison is available, for the period of life between 25 and 65; a period which has been selected by the successive Statisticians of the Registrar's Office as that in which the influence of occupation is most felt."§ It is based on the mortality in what is known as the "standard population," i.e., the recorded mortality "corrected in accordance with age-constitution. 66 * Milroy Lectures on the Influence of Industrial Employment upon General Health. Reprinted from the British Medical Journal (1922), p. 11. † Report of the Registrar General for 1911. Farr, Vital Statistics, p. 403. Newsholme, p. 172. |