Front Page Titles (by Subject) BOOK IV, CHAPTER V: THE HEALTH AND STRENGTH OF THE POPULATION. - Principles of Economics (8th ed.)
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BOOK IV, CHAPTER V: THE HEALTH AND STRENGTH OF THE POPULATION. - Alfred Marshall, Principles of Economics (8th ed.) 
Principles of Economics (London: Macmillan and Co. 8th ed. 1920).
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BOOK IV, CHAPTER V
THE HEALTH AND STRENGTH OF THE POPULATION.
§ 1. We have next to consider the conditions on which depend health and strength, physical, mental and moral. They are the basis of industrial efficiency, on which the production of material wealth depends; while conversely the chief importance of material wealth lies in the fact that, when wisely used, it increases the health and strength, physical, mental and moral of the human race.
In many occupations industrial efficiency requires little else than physical vigour; that is, muscular strength, a good constitution and energetic habits. In estimating muscular, or indeed any other kind of strength for industrial purposes, we must take account of the number of hours in the day, of the number of days in the year, and the number of years in the lifetime, during which it can be exerted. But with this precaution we can measure a man's muscular exertion by the number of feet through which his work would raise a pound weight, if it were applied directly to this use; or in other words by the number of "foot pounds" of work that he does62 .
Although the power of sustaining great muscular exertion seems to rest on constitutional strength and other physical conditions, yet even it depends also on force of will, and strength of character. Energy of this kind, which may perhaps be taken to be the strength of the man, as distinguished from that of his body, is moral rather than physical; but yet it depends on the physical condition of nervous strength. This strength of the man himself, this resolution, energy and self-mastery, or in short this "vigour" is the source of all progress: it shows itself in great deeds, in great thoughts and in the capacity for true religious feeling63 .
Vigour works itself out in so many forms, that no simple measure of it is possible. But we are all of us constantly estimating vigour, and thinking of one person as having more "backbone," more "stuff in him," or as being "a stronger man" than another. Business men even in different trades, and University men even when engaged in different studies, get to estimate one another's strength very closely. It soon becomes known if less strength is required to get a "first class" in one study than another.
§ 2. In discussing the growth of numbers a little has been said incidentally of the causes which determine length of life: but they are in the main the same as those which determine constitutional strength and vigour, and they will occupy our attention again in the present chapter.
The first of these causes is the climate. In warm countries we find early marriages and high birth-rates, and in consequence a low respect for human life: this has probably been the cause of a great part of the high mortality that is generally attributed to the insalubrity of the climate64 .
Vigour depends partly on race qualities: but these, so far as they can be explained at all, seem to be chiefly due to climate65 .
§ 3. Climate has also a large share in determining the necessaries of life; the first of which is food. Much depends on the proper preparation of food; and a skilled housewife with ten shillings a week to spend on food will often do more for the health and strength of her family than an unskilled one with twenty. The great mortality of infants among the poor is largely due to the want of care and judgment in preparing their food; and those who do not entirely succumb to this want of motherly care often grow up with enfeebled constitutions.
In all ages of the world except the present, want of food has caused wholesale destruction of the people. Even in London in the seventeenth and eighteenth centuries the mortality was eight per cent. greater in years of dear corn than in years of cheap corn66 . But gradually the effects of increased wealth and improved means of communication are making themselves felt nearly all over the world; the severity of famines is mitigated even in such a country as India; and they are unknown in Europe and in the New World. In England now want of food is scarcely ever the direct cause of death: but it is a frequent cause of that general weakening of the system which renders it unable to resist disease; and it is a chief cause of industrial inefficiency.
We have already seen that the necessaries for efficiency vary with the nature of the work to be done, but we must now examine this subject a little more closely.
As regards muscular work in particular there is a close connection between the supply of food that a man has, and his available strength. If the work is intermittent, as that of some dock labourers, a cheap but nutritious grain diet is sufficient. But for very heavy continuous strain such as is involved in puddlers' and the hardest navvies' work, food is required which can be digested and assimilated even when the body is tired. This quality is still more essential in the food of the higher grades of labour, whose work involves great nervous strain; though the quantity required by them is generally small.
After food, the next necessaries of life and labour are clothing, house-room and firing. When they are deficient, the mind becomes torpid, and ultimately the physical constitution is undermined. When clothing is very scanty, it is generally worn night and day; and the skin is allowed to be enclosed in a crust of dirt. A deficiency of house-room, or of fuel, causes people to live in a vitiated atmosphere which is injurious to health and vigour; and not the least of the benefits which English people derive from the cheapness of coal, is the habit, peculiar to them, of having well-ventilated rooms even in cold weather. Badly-built houses with imperfect drainage cause diseases which even in their slighter forms weaken vitality in a wonderful way; and overcrowding leads to moral evils which diminish the numbers and lower the character of the people.
Rest is as essential for the growth of a vigorous population as the more material necessaries of food, clothing, etc. Overwork of every form lowers vitality; while anxiety, worry, and excessive mental strain have a fatal influence in undermining the constitution, in impairing fecundity and diminishing the vigour of the race.
§ 4. Next come three closely allied conditions of vigour, namely, hopefulness, freedom, and change. All history is full of the record of inefficiency caused in varying degrees by slavery, serfdom, and other forms of civil and political oppression and repression67 .
In all ages colonies have been apt to outstrip their mother countries in vigour and energy. This has been due partly to the abundance of land and the cheapness of necessaries at their command; partly to that natural selection of the strongest characters for a life of adventure, and partly to physiological causes connected with the mixture of races: but perhaps the most important cause of all is to be found in the hope, the freedom and the changefulness of their lives68 .
Freedom so far has been regarded as freedom from external bonds. But that higher freedom, which comes of self-mastery, is an even more important condition for the highest work. The elevation of the ideals of life on which this depends, is due on the one side to political and economic causes, and on the other to personal and religious influences; among which the influence of the mother in early childhood is supreme.
§ 5. Bodily and mental health and strength are much influenced by occupation69 . At the beginning of this century the conditions of factory work were needlessly unhealthy and oppressive for all, and especially for young children. But Factory and Education Acts have removed the worst of these evils from factories; though many of them still linger about domestic industries and the smaller workshops.
The higher wages, the greater intelligence, and the better medical facilities of townspeople should cause infant mortality to be much lower among them than in the country. But it is generally higher, especially where there are many mothers who neglect their family duties in order to earn money wages.
§ 6. In almost all countries there is a constant migration towards the towns70 . The large towns and especially London absorb the very best blood from all the rest of England; the most enterprising, the most highly gifted, those with the highest physique and the strongest characters go there to find scope for their abilities. An increasing number of those who are most capable and have most strength of character, live in suburbs, where excellent systems of drainage, water supply and lighting, together with good schools and opportunities for open air play, give conditions at least as conducive to vigour as are to be found in the country; and though there are still many town districts only a little less injurious to vitality than were large towns generally some time ago, yet on the whole the increasing density of population seems to be for the present a diminishing source of danger. The recent rapid growth of facilities for living far from the chief centres of industry and trade must indeed slacken in time. But there seems no sign of any slackening in the movement of industries outwards to suburbs and even to new Garden Cities to seek and to bring with them vigorous workers.
Statistical averages are indeed unduly favourable to urban conditions, partly because many of the town influences which lower vigour do not much affect mortality; and partly because the majority of immigrants into the towns are in the full strength of youth, and of more than average energy and courage; while young people whose parents live in the country generally go home when they become seriously ill71 .
There is no better use for public and private money than in providing public parks and playgrounds in large cities, in contracting with railways to increase the number of the workmen's trains run by them, and in helping those of the working classes who are willing to leave the large towns to do so, and to take their industries with them72 .
§ 7. And there are yet other causes for anxiety. For there is some partial arrest of that selective influence of struggle and competition which in the earlier stages of civilization caused those who were strongest and most vigorous to leave the largest progeny behind them; and to which, more than any other single cause, the progress of the human race is due. In the later stages of civilization the rule has indeed long been that the upper classes marry late, and in consequence have fewer children than the working classes: but this has been compensated for by the fact that among the working classes themselves the old rule was held; and the vigour of the nation that is tending to be damped out among the upper classes is thus replenished by the fresh stream of strength that is constantly welling up from below. But in France for a long time, and recently in America, and England, some of the abler and more intelligent of the working class population have shown signs of a disinclination to have large families; and this is a source of danger73 .
Thus there are increasing reasons for fearing, that while the progress of medical science and sanitation is saving from death a continually increasing number of the children of those who are feeble physically and mentally; many of those who are most thoughtful and best endowed with energy, enterprise and self-control are tending to defer their marriages and in other ways to limit the number of children whom they leave behind them. The motive is sometimes selfish, and perhaps it is best that hard and frivolous people should leave but few descendants of their own type. But more often it is a desire to secure a good social position for their children. This desire contains many elements that fall short of the highest ideals of human aims, and in some cases, a few that are distinctly base; but after all it has been one of the chief factors of progress, and those who are affected by it include many of those whose children would probably be among the best and strongest of the race.
It must be remembered that the members of a large family educate one another, they are usually more genial and bright, often more vigorous in every way than the members of a small family. Partly, no doubt, this is because their parents were of unusual vigour; and for a like reason they in their turn are likely to have large and vigorous families. The progress of the race is due to a much greater extent than appears at first sight to the descendants of a few exceptionally large and vigorous families.
But on the other hand there is no doubt that the parents can often do better in many ways for a small family than a large one. Other things being equal, an increase in the number of children who are born causes an increase of infantile mortality; and that is an unmixed evil. The birth of children who die early from want of care and adequate means is a useless strain to the mother and an injury to the rest of the family74 .
§ 8. There are other considerations of which account ought to be taken; but so far as the points discussed in this chapter are concerned, it seems primâ facie advisable that people should not bring children into the world till they can see their way to giving them at least as good an education both physical and mental as they themselves had; and that it is best to marry moderately early provided there is sufficient self-control to keep the family within the requisite bounds without transgressing moral laws. The general adoption of these principles of action, combined with an adequate provision of fresh air and of healthy play for our town populations, could hardly fail to cause the strength and vigour of the race to improve. And we shall presently find reasons for believing that if the strength and vigour of the race improves, the increase of numbers will not for a long time to come cause a diminution of the average real income of the people.
Thus then the progress of knowledge, and in particular of medical science, the ever-growing activity and wisdom of Government in all matters relating to health, and the increase of material wealth, all tend to lessen mortality and to increase health and strength, and to lengthen life. On the other hand, vitality is lowered and the death-rate raised by the rapid increase of town life, and by the tendency of the higher strains of the population to marry later and to have fewer children than the lower. If the former set of causes were alone in action, but so regulated as to avoid the danger of over-population, it is probable that man would quickly rise to a physical and mental excellence superior to any that the world has yet known; while if the latter set acted unchecked, he would speedily degenerate.
As it is, the two sets hold one another very nearly in balance, the former slightly preponderating. While the population of England is growing nearly as fast as ever, those who are out of health in body or mind are certainly not an increasing part of the whole: the rest are much better fed and clothed, and, except in over-crowded industrial districts, are generally growing in strength. The average duration of life both for men and women has been increasing steadily for many years.
[62.]This measure can be applied directly to most kinds of navvies' and porters' work, and indirectly to many kinds of agricultural work. In a controversy that was waged after the great agricultural lock-out as to the relative efficiency of unskilled labour in the South and North of England, the most trustworthy measure was found in the number of tons of material that a man would load into a cart in a day. Other measures have been found in the number of acres reaped or mown, or the number of bushels of corn reaped, etc.: but these are unsatisfactory, particularly for comparing different conditions of agriculture: since the implements used, the nature of the crop and the mode of doing the work all vary widely. Thus nearly all comparisons between mediæval and modern work and wages based on the wages of reaping, mowing, etc. are valueless until we have found means to allow for the effects of changes in the methods of agriculture. It costs for instance less labour than it did to reap by hand a crop that yields a hundred bushels of corn; because the implements used are better than they were: but it may not cost less labour to reap an acre of corn; because the crops are heavier than they were.
[63.]This must be distinguished from nervousness, which, as a rule, indicates a general deficiency of nervous strength; though sometimes it proceeds from nervous irritability or want of balance. A man who has great nervous strength in some directions may have but little in others; the artistic temperament in particular often develops one set of nerves at the expense of others: but it is the weakness of some of the nerves, not the strength of the others, that leads to nervousness. The most perfect artistic natures seem not to have been nervous: Leonardo da Vinci and Shakespeare for example. The term "nervous strength" corresponds in some measure to Heart in Engel's great division of the elements of efficiency into (a) Body, (b) Reason, and (c) Heart (Leib, Verstand und Herz). He classifies activities according to the permutations a, ab, ac, abc, acb; b, ba, bc, bca, bac; c, ca, cb, cab, cba: the order in each case being that of relative importance, and a letter being omitted where the corresponding element plays only a very small part.
[64.]A warm climate impairs vigour. It is not altogether hostile to high intellectual and artistic work: but it prevents people from being able to endure very hard exertion of any kind for a long time. More sustained hard work can be done in the cooler half of the temperate zone than anywhere else; and most of all in places such as England and her counterpart New Zealand, where sea-breezes keep the temperature nearly uniform. The summer heats and winter colds of many parts of Europe and America, where the mean temperature is moderate, have the effect of shortening the year for working purposes by about two months. Extreme and sustained cold is found to dull the energies, partly perhaps because it causes people to spend much of their time in close and confined quarters: inhabitants of the Arctic regions are generally incapable of long-continued severe exertion. In England popular opinion has insisted that a "warm Yule-tide makes a fat churchyard"; but statistics prove beyond question that it has the opposite effect: the average mortality is highest in the coldest quarter of the year, and higher in cold winters than in warm.
[65.]Race history is a fascinating but disappointing study for the economist: for conquering races generally incorporated the women of the conquered; they often carried with them many slaves of both sexes during their migrations, and slaves were less likely than freemen to be killed in battle or to adopt a monastic life. In consequence nearly every race had much servile, that is mixed blood in it: and as the share of servile blood was largest in the industrial classes, a race history of industrial habits seems impossible.
[66.]This was proved by Farr, who eliminated disturbing causes by an instructive statistical device (Vital Statistics, p. 139).
[67.]Freedom and hope increase not only man's willingness but also his power for work; physiologists tell us that a given exertion consumes less of the store of nervous energy if done under the stimulus of pleasure than of pain: and without hope there is no enterprise. Security of person and property are two conditions of this hopefulness and freedom; but security always involves restraints on freedom, and it is one of the most difficult problems of civilization to discover how to obtain the security which is a condition of freedom without too great a sacrifice of freedom itself. Changes of work, of scene, and of personal associations bring new thoughts, call attention to the imperfections of old methods, stimulate a "divine discontent," and in every way develop creative energy.
[68.]By converse with others who come from different places, and have different customs, travellers learn to put on its trial many a habit of thought or action which otherwise they would have always acquiesced in as though it were a law of nature. Moreover, a shifting of places enables the more powerful and original minds to find full scope for their energies and to rise to important positions: whereas those who stay at home are often over much kept in their places. Few men are prophets in their own land; neighbours and relations are generally the last to pardon the faults and to recognize the merits of those who are less docile and more enterprising than those around them. It is doubtless chiefly for this reason that in almost every part of England a disproportionately large share of the best energy and enterprise is to be found among those who were born elsewhere.
[69.]The rate of mortality is low among ministers of religion and schoolmasters; among the agricultural classes, and in some other industries such as those of wheelwrights, shipwrights and coal-miners. It is high in lead and tin mining, in file-making and earthenware manufacture. But neither these nor any other regular trade show as high a rate of mortality as is found among London general labourers and costermongers; while the highest of all is that of servants in inns. Such occupations are not directly injurious to health, but they attract those who are weak in physique and in character and they encourage irregular habits. A good account of the influence of occupation on death-rates is given in the supplement to the forty-fifth (1885) Annual Report of the Registrar-General, pp. xxv-lxiii. See also Farr's Vital Statistics, pp. 392-411, Humphreys' paper on Class Mortality Statistics in the Statistical Journal for June 1887, and the literature of the Factory Acts generally.
[70.]Davenant (Balance of Trade, A.D. 1699, p. 20), following Gregory King, proves that according to official figures. London has an excess of deaths over births of 2000 a year, but an immigration of 5000; which is more than half of what he calculates, by a rather risky method, to be the true net increase of the population of the country. He reckons that 530,000 people live in London, 870,000 in the other cities and market towns, and 4,100,000 in villages and hamlets. Compare these figures with the census of 1901 for England and Wales; where we find London with a population of over 4,500,000; five more towns with an average of over 500,000; and sixty-nine more exceeding 50,000 with an average of over 100,000. Nor is this all: for many suburbs whose population is not counted in, are often really parts of the big towns; and in some cases the suburbs of several adjacent towns run into one another, making them all into one gigantic, though rather scattered town. A suburb of Manchester is counted as a large town with 220,000 inhabitants; and the same is true of West Ham, a suburb of London with 275,000. The boundaries of some large towns are extended at irregular intervals to include such suburbs: and consequently the true population of a large town may be growing fast, while its nominal population grows slowly or even recedes, and then suddenly leaps forwards. Thus the nominal population of Liverpool was 552,000 in 1881; 518,000 in 1891; and 685,000 in 1901.
[71.]For reason of this kind Welton (Statistical Journal, 1897) makes the extreme proposal to omit all persons between 15 and 35 years of age in comparing the rates of mortality in different towns. The mortality of females in London between the ages of fifteen and thirty-five is, chiefly for this reason, abnormally low. If however a town has a stationary population its vital statistics are more easily interpreted; and selecting Coventry as a typical town, Galton has calculated that the adult children of artisan townsfolk are little more than half as numerous as those of labouring people who live in healthy country districts. When a place is decaying, the young and strong and hearty drift away from it; leaving the old and the infirm behind them, and consequently the birth-rate is generally low. On the other hand, a centre of industry that is attracting population is likely to have a very high birth-rate, because it has more than its share of people in the full vigour of life. This is especially the case in the coal and iron towns, partly because they do not suffer, as the textile towns do, from a deficiency of males; and partly because miners as a class marry early. In some of them, though the death-rate is high, the excess of the birth-rate over it exceeds 20 per thousand of the population. The death-rate is generally highest in towns of the second order, chiefly because their sanitary arrangements are not yet as good as those of the very largest towns.
[72.]See an article entitled "Where to House the London Poor" by the present writer in the Contemporary Review, Feb. 1884.
[73.]In the Southern States of America, manual work became disgraceful to the white man; so that, if unable to have slaves himself, he led a paltry degenerate life, and seldom married. Again, on the Pacific Slope, there were at one time just grounds for fearing that all but highly skilled work would be left to the Chinese; and that the white men would live in an artificial way in which a family became a great expense. In this case Chinese lives would have been substituted for American, and the average quality of the human race would have been lowered.
[74.]The extent of the infant mortality that arises from preventable causes may be inferred from the facts that the percentage of deaths under one year of age to births is generally about a third as much again in urban as in rural districts; and yet in many urban districts which have a well-to-do population it is lower than the average for the whole country (Registrar-General's Report for 1905, pp. xlii-xlv). A few years ago it was found that, while the annual death-rate of children under five years of age was only about two per cent. in the families of peers and was less than three per cent. for the whole of the upper classes, it was between six and seven per cent. for the whole of England. On the other hand Prof. Leroy Beaulieu says that in France the parents of but one or two children are apt to indulge them, and be over-careful about them to the detriment of their boldness, enterprise and endurance. (See Statistical Journal, Vol. 54, pp. 378, 9.)