The Transformation of the World (39 page)

Gaining Lifetime

In 1800 the average life expectancy at birth for the world population was at most thirty years; only exceptionally did it rise to thirty-five or a little higher. More than a half of all people died before reaching adulthood. Few enjoyed a life after work: either at the end of the day or in retirement following years of occupational activity. Death typically came as a result of infections: it came more swiftly than it does today, when protracted degenerative disease is the main cause of death in the rich countries.
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By the year 2000, amid fast-increasing world population totals, the average life expectancy had risen to sixty-seven years, with a much greater leveling both within and between societies than in the case of incomes. In other words, people's ages increased faster than their material riches.

This “democratization” of a long life is one of the most important experiences of modern history. But there are exceptions to the rule. In the poorest countries of sub-Saharan Africa, many of which have also been hit hardest by AIDS, the average life expectancy for young adults aged twenty (
not
for the newly born) is today lower than it was in preindustrial England, China, and Japan or than it was in the Stone Age.
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Why the human life span “exploded” in the nineteenth century is a controversial question: the decisive factor is variously considered to have been advances in medicine and sanitation, better nourishment, or new public health measures. Some experts adopt multicausal models in which all these elements play a role.

A reasonably precise dating of the processes that led to this life expectancy revolution is of great interest for any characterization of the nineteenth century. Robert W. Fogel has concluded from what is known to us today that the decisive leap occurred in “the West” (by which he means Western Europe, North America, and Japan) in the first half of the calendrical
twentieth
century, beginning with the period from 1890 to 1920.
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There was by no means a constantly rising trend throughout the nineteenth century. During the early industrial age in Britain (c. 1780–1850), life expectancy initially went into decline and deviated from the high levels that England had first reached in the age of Shakespeare;
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only after 1850 did wages catch up and overtake prices, and average life spans gradually began to increase.
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In Germany, where industrialization began only around 1820, discussions were taking place a few years later about what would soon become known as “pauperism”—a new and disastrous mass impoverishment,
affecting town and country alike.
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This process, similar to that which England had undergone previously, may be attributed to two causes.
First
, the quantity and above all the quality of food did not keep pace with the physical demands of early-industrial factory labor, so that, according to Robert Fogel, the growth of real incomes registered in the statistics must be reduced by as much as 40 percent before it can be converted into physical well-being.
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In the early nineteenth century, the United States was alone among “Western” societies in guaranteeing its citizens more than the minimum degree of nourishment.
Second
, the fast-growing cities, which brought in people from far and wide, were a breeding ground for health risks. Closely packed housing, without the necessary hygienic provisions, allowed deadly pathogens to spread, the most deaths resulting not from concentrated epidemics but from “normal” diseases present in everyday surroundings. This was essentially true of all European societies that entered the phase of industrialization. And it was true only of the cities. Life in the country was healthy in comparison—a differential that closed in northwest Europe only around the turn of the twentieth century.
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The worldwide trend for the increase in longevity, which began in Europe, North America, and Japan around 1890, manifested itself elsewhere at different times.

▪
 Latin America's great advance came between 1930 and 1960.

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 The Soviet Union caught up between 1945 and 1965 (but its successor states fell back dramatically in the 1990s).

▪
 China pursued a successful health policy under the Communist regime, and its life expectancy soared from less than thirty years before 1949 to nearly seventy in 1980.
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 A number of African countries made advances in the two decades following independence, from approximately 1960 to 1980.

▪
 Japan experienced a new surge between 1947 and 1980.
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Clean Water

Many of the foundations for the gains of the twentieth century were laid in the nineteenth. But it took time for them to spread more widely. Two especially important impetuses were new knowledge about disease prevention and the development of public health care. With regard to the latter, governments began to realize the need for a systematic policy sometime after 1850. In Western Europe, their range of measures to control and separate the sick and potential disease-carriers (e.g., the kind of port quarantines long practiced in the Mediterranean and the Black Sea
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) were now expanded through infrastructural investment to remove the breeding grounds of disease. For the first time, mass health care was not entrusted to private philanthropists and religious institutions alone but was declared to be a task of the state. The “environmentalist” theories of the age showed that a start should be made with the clearance of
urban garbage and wastewater and the provision of clean drinking water. England, the world leader in this “sanitary movement,” had already begun in the 1830s to develop the basic principles and to take various pioneering initiatives. Thus, the collateral damage of the Industrial Revolution did not go unnoticed. Other countries followed suit—most comprehensively the United States, but soon also in continental Europe.
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The first step was civic and governmental initiatives to improve the water supply. The emergence of anything like a water policy presupposed recognition of water as a public good; water rights had to be defined, and public and private claims separated from each other. It was a long and complicated process to work out all the legal provisions for the ownership and use of water, including its industrial use. Even in centralized France this was not completed until 1964, and in many parts of the world it is still going on. For the creation of a modern water supply, not only political will and legal requirements but also an appropriate technology were necessary. In 1842, in one of the city's grandest festivals, New York celebrated the inauguration of a system of aqueducts, pipes, and reservoirs that supplied public wells, private households, and the fire brigade.
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The value of clean water became especially apparent after an English doctor, John Snow, established in 1849 that cholera was not transmitted in the air or by bodily contact but was a water-borne disease. It took more than fifty years, however, for his findings to become generally accepted. The fact that London's water supply was in the hands of several private corporations stood in the way of change. In 1866 cholera entered the city once again along the pipes of one of these firms, claiming more than 4,000 lives in the East End alone. Water quality improved after that, however, and private wells gradually disappeared from the scene. Cholera and typhus epidemics were no longer seen in London after 1866.
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The importance of local scientific opinion is demonstrated by the example of Munich, where the doctor and pharmacist Max von Pettenkofer was the great authority in matters of hygiene. Like John Snow, he reacted to the threat from cholera, a second epidemic of which struck the city in 1854. But in his view, to prevent the spread of the disease, the main task was to ensure that the subsoil was kept pure and that the disposal of organic refuse was improved. Since he had ruled out poor drinking water as the cause, improvement of the water supply was pursued much less energetically than in London. Only in 1874 did Munich begin to draw up plans for its modernization, but there was still opposition to the contaminated-water theory even after the outbreak of a third cholera epidemic. In 1881, the city finally pressed ahead with the construction of new water installations.
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Pettenkofer's error must have been costly to the capital of the Kingdom of Bavaria.

Munich, despite Pettenkofer's advice, also delayed the upgrading of its wastewater disposal until the 1880s. London had earlier been successful in developing a sewage system—a second prerequisite for the elimination of water-borne diseases such as typhoid, dysentery, and cholera from the British metropolis. It was
known there that a clean water supply and a proper drainage system were twin sanitary requirements. This was not self-evident, though, and Napoleon had treated Parisians to public wells and aqueducts without concerning himself with other improvements. In London a Metropolitan Board of Works was founded in 1855—the first authority with powers covering the whole city. At first, its work was impeded by confusion over precise areas of responsibility and by resistance from supporters of a radical free-market liberalism. Then came the “Great Stink.” Back in 1800 it had still been possible to fish for salmon in the Thames near London, and a few years later Lord Byron had enjoyed swimming in it. But in June 1858 such a stench rose from the river that the House of Commons, having tried coating protective curtains with chloride of lime, eventually had to suspend its sessions. The honorable members of Parliament were in a panic, realizing as they did that the exhalations of Old Father Thames were not only unpleasant but dangerous to the health. The chief engineer of the Metropolitan Board of Works, Sir Joseph Bazalgette, one of the pioneering modernizers of Europe's largest city, was commissioned to build a mostly underground system of sewers. Rumors that typhoid fever had caused the death of Queen Victoria's beloved forty-two-year-old consort Prince Albert, in December 1861, underlined the urgency of remedial action.
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By 1868 a total of 1,300 miles of sewers had been laid, of which eighty-two miles consisted of huge tunnels containing a total of 318 million bricks: one of the largest and most expensive public investments of the nineteenth century. Also part of this were the installations along the embankment, which included an underground railroad as well as all the pipes and cables of a modern capital city. The building work beneath London aroused great public enthusiasm.
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The technology used for this monument of modernity was curiously preindustrial, if one leaves aside the magnificent Florentine or Moorish pumping stations equipped with steam engines. Brick-lined sewers and glazed ceramic pipes were nothing new; the movement of the water was simply down to their angle of incline. Technically speaking, the Victorian drainage system could have been built at any time in the previous hundred years. It was all a question of perception, political will, and a new attitude to dirt.
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Whether the much-praised new installations really met all the requirements is another matter. When a pleasure steamer collided with a barge in September 1878 close to the effluent from the London sewers, there was a flurry of official speculation as to how many of the numerous casualties drowned in the Thames and how many were poisoned by its water.
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No comprehensive studies yet exist about urban hygiene on other continents. For the time being, we have to make do with a few impressions. Muslim West Asia was repeatedly praised by travelers for the high quality of its urban water supply; no report from Isfahan before its sacking by Afghans in 1722 failed to mention this point. Indeed, it was frequently remarked that nothing comparable was to be found in Europe. Western eyewitnesses condemned the barbarism of the Russians' destruction of Tatar water pipes, after their annexation of the
Crimea in the early 1780s. And in 1872 a German traveler to Syria, otherwise little impressed by the Levant, was still amazed that in Damascus, a city with 150,000 inhabitants, “every street, every mosque, every public and private house, and every garden” were provided “to overflowing” with channels and “fountains.”
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The origins of water modernization in Bombay lay not so much in public health considerations as in the inadequacy of supply for a fast-growing large city. After vigorous resistance from Indian notables, who not incorrectly feared higher taxes, a municipal water supply came on stream here in 1859, earlier than in many European cities. It also provided water for the booming cotton industry in the West Indian metropolis, and reduced the danger that owners of private cisterns would exploit periods of drought for their own profit.
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In Calcutta a sewage system was opened in 1865 and water-filtering installations in 1869.
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The first Chinese to encounter tap water were imperial emissaries on ocean steamers of the 1860s. Shanghai, where the quality of water had previously been better than in many large European cities of the time, acquired a modern waterworks and piping system in 1883; it was financed by private investors and initially served only prosperous Europeans and a few wealthy Chinese in the International Settlement, a colonial-style enclave governed by foreigners. The owners of the water plant tried to increase its operational radius and by no means wished to deprive the Chinese of clean water out of “colonial” motives. But the Chinese population remained skeptical: they had survived for generations, more or less, on water from the Huangpu River. Also the guilds representing more than three thousand water carriers protested against the new competition.
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Decline and Revival of Public Health

At first the age of modernity was an unhealthy one. In the first five or six decades of the nineteenth century, industrialization meant poverty, hardship, cultural decline, and reduced physical well-being for the working population of English cities. The country paid a price for having begun to industrialize before modern sanitary principles were understood and solutions attempted. Many people nevertheless weighed the risks of city living and accepted them of their own free will. The big cities and the new factory towns were unhealthier than the countryside—and they remained so throughout the century,
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but the wages that could be earned in them were higher. The work discipline in factories was stricter, yet many preferred to escape the tight control of country squires and clergymen, and to have the freedom to found independent clubs and church communities.
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The level of health declined in the United States too—historians like to use body size as the indicator—during the early phase of industrialization (c. 1820–50) that followed unusually favorable conditions at the beginning of the century. In Germany there were sharp oscillations in the standard of living, but with a long-term upward trend. A similar tendency was apparent in the Netherlands and Sweden, two countries that did not industrialize for a long time but experienced similar economic development centered on trade, finance, and modern agriculture.
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In
France, the onset of industrialization in the 1820s was generally associated with clear and constant improvements in every area. This was an exceptional case, in which a second-generation industrializer (unlike the United States in the same period) did not have to contend with major losses in physical well-being. Two complementary reasons have been suggested for this: first, that France urbanized much more slowly than England, thereby avoiding the health risks of overcrowded slums; and second, that the urban population ate more meat in France than in England (the opposite had still been true in the eighteenth century) and therefore developed a higher resistance to disease. Furthermore, the French Revolution had helped to foster a slightly greater equality of income distribution. That, too, seems always to be a factor promoting good health.
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