8. Report of Metropolitan Commissioners of Lunacy

554

9. Clinical Lecture on Varyx. By M. Velpeau. His Operation for Varicose Veins 556 10. Clinical Lecture of Sir B. Brodie on Abscesses

557

NORTHERN HOSPITAL, LIVERPOOL.

11. Successful Amputation during Spreading Traumatic Gangrene 12. Diagnosis of Ascites and Ovarian Dropsy, by Percussion

ST. MARYLEBONE INFIRMARY.

13. Diuretics in Phthisis, Chronic Catarrh, &c. . .

KING'S COLLEGE HOSPITAL.

14. Mr. Fergusson on the Circular and Flap Operations.

Spirit of the British and American Periodicals, &c.

559

560

3. Hypochondriasis

4. The Art of Percussion

1. What hard work Percussion is

2. The Hammer

3. The Gamut

4. The Sense of Resistance

5. How to Map out an Organ

5. Midwifery in China

1. Parturition

2. Illustrative Cases

3. After Treatment of Parturient Women

4. Remedy for Prolapsus Ani

6. Observations on the Incipient Stage of Cancerous Affections of the Womb. By Dr. Montgomery.

7. Case of Accidental Poisoning by Arseniuretted Hydrogen. By Dr. O'Reilly 8. Cases illustrative of Disease seated in the Cerebellum. By W. Jackson, Esq. 570 9. Case of Closure of the Os-Uteri which required an Operation. By T. R. Pugh, Esq..

573

10. Case of Aneurysm of the Arch of the Aorta pressing upon the Left Bronchus, &c. By Robert Spittal, M.D.

12. Moveable Calculus, the size of a Pistol-bullet, traversing the Trachea and Bronchia. By. Mr. Ewart

580

13. Case of Abscess behind the Mamma. By Mr. Henry James Johnson 14. Opening Mammary Abscesses and Buboes by Seton. By Mr. Henry James Johnson

15. Case of Fatal Hemorrhage from the Extraction of a Tooth. By David Hay,

M.D.

582

16. Abstract of a Paper on Opium-smoking in China. By G. H. Smith, Esq. 1. Mode of Preparing the Opium for Smoking

3. Description of a Smoking-shop

4 Effects of the Opium on the Smoker

5. Influence of the Habit on the Health, vigour, and conformation of the Chinese

6. Note by Dr. Johnson

17. A Suggestion for the Cure of Cholera. By Lieut. H. Congreve

18. Observations on the Mineral Springs of Harrogate. By Dr. Bennett
19. A Pentaglot Dictionary of the Terms employed in Anatomy, Physiology,

THE

Medico-Chirurgical Review.

No. LXXII.

[No. 32 OF A DECENNIAL SERIES.]

JANUARY 1, TO APRIL 1, 1842.

THIRD ANNUAL REPORT OF THE REGISTRAR-GENERAL OF Births, DEATHS, AND MARRIAGES, IN ENGLAND, WITH APPENDICES. Presented to both Houses of Parliament by Command of Her Majesty. London, 1841.

THESE Reports are so calculated to do good service to medicine, that we have done, and shall do our best for their dissemination. The body of facts that they contain must ultimately be of eminent utility. Nor is their application limited to a barren system of statistics, interesting to few and affecting the well-being of none. They bear upon the public health and contain the data for legislation in regard to it. They merit the close attention of medical men, not only as such, but as citizens.

The volume opens with a Report from the Registrar-General himself to Lord Normanby, containing a general abstract of the Number of Births, Deaths, and Marriages registered during the year ending June 30, 1840. The following statement will show the numbers registered in the year ending June 30, 1840, compared with those of the preceding years:

1837-38.

480,540

399,712

331,007

335,956

121,083

111,481

There is thus an increase in the number of Births registered in the year ending June 30, 1840, over those in 1838-9, of 21,049; over those in 1837-8, of 101,877:

In the number of Deaths registered in the year ending June 30, 1840, over those in 1838-9, of 19,094; over those in 1837-8, of 14,145:

In the number of Marriages registered in the year ending June 30, 1840, over those in 1838-9, of 3,246; over those in 1837-8, of 12,848.

The increase in the number of registered Births results from a continuance of that successful operation of the new law, which began to appear after the former half of the first year of registration.

In each of the last three years the proportion of Male and Female Births has been very nearly the same.

The Registrar-General remarks:

"The increase of deaths compared with those of the two preceding years is less than it appears to be. It must be remembered that the first year's regisNo. 88.

1

tration could not comprise the deaths of the whole year, which, including those registered subsequently, amounted to 338,660. The real increase, therefore, over the registered deaths which occurred in the year 1837-8, is 11,441. It must also be borne in mind that the population of England and Wales, was shewn by the Censuses of 1821 and 1831, to have increased from 1821 to 1831 at the rate of 16 per cent.; and if it be assumed (as is probable) that this rate of increase has continued to the present time, the population in the years 1838-9 and 1839-40 will probably have increased to the amount of from 220,000 to 240,000 yearly. If the lowest of these numbers be taken, and the mortality be estimated at the lowest rate consistent with probability, namely, one in 50, there will in each of these years, at the same rate of mortality, have been at least 4,400 more deaths than in the year preceding. This number, therefore (being the probable increase at the same rate of mortality) must be deducted; and the remaining numbers, which indicate increased mortality, will, for the year 1839-40 as compared with 1837-8, be about 7000; compared with 1838-9, about 14,700. Yet this increase is great; and inasmuch as there is reason to believe that it is not merely an apparent increase, arising, like that of births, from the improved efficiency of a registration which, at the commencement, was very defective (for the very efficient registration of deaths, even in the first year, left no such room for improvement), but that there has really been an increased mortality to that amount, a circumstance so serious demands attention and inquiry, with a view to ascertain the nature of the increase, and especially whether it has been sudden or progressive, general or local, and whether affecting equally or unequally all ages and both sexes." 4.

The proportion of male to female deaths in each of the three years has been nearly the same, as appears from the following numbers :

The increase has been principally in the deaths of children, for more than half the excess over the deaths of 1838-9, and more than three-fourths of the excess over those of 1837-8, consisted of the deaths of children under years of age.

5

This increase of mortality has been confined to certain situations, others exhibiting a decrease.

Thus there has been a progressive decrease of mortality from 1837-8, in the metropolis and in Devonshire; and a progressive increase from 1837-8, in divisions 15, 18, 19, 20, 21 and 25, comprising the counties of Derby, Leicester, Northampton, Nottingham, Rutland and the northern parts of Lincolnshire; the counties of Chester, Salop, and Stafford except the mining parts of the two latter; Lancashire, south of Morecambe Bay, except Liverpool and Manchester; the West Riding of Yorkshire, except the northern parts thereof and Leeds; the City, Ainsty, and East Riding of York, Monmouthshire, Herefordshire, and Wales.

The counties in which there has been the greatest increase of mortality, compared with that of 1838-9, are Lancashire, Nottinghamshire, West Riding of Yorkshire, Leicestershire, Cheshire, Gloucestershire, Northumberland, Durham, Derbyshire, and North Wales, the combined increase of which alone amounts to 15,231, out of the total increase of 19,097.

The prevalence of such increased mortality in those counties which com

prise the largest proportion of manufacturing population, naturally suggests that the cause may probably be found in circumstances to which the mannfacturing classes have been peculiarly exposed. But a further examination shews that not only has the increase varied very much within those counties, but that there has even been a decreased mortality in some of those districts which are peculiarly the seats of manufacture. Such has been the case in Manchester and Salford, Ashton, Oldham, Stockport and Leeds. Therefore, though manufacturing distress cannot be excluded from among the possible causes of increased mortality, care must be taken not to assign such mortality to this one cause in an undue degree.

It appears that this increased mortality is attributable chiefly to the prevalence of epidemics, especially of typhus and scarlet fever, and that the districts of Chorley, Leigh, Wigan, Burnley and Blackburn in Lancashire; Macclesfield, Dewsbury, Pontefract, Nottingham, Bingham, Ashby-de-la-Zouch, Bangor, and Beaumaris, are those in which these diseases have been most fatal.

The number of marriages would seem to have augmented in some slight degree. The counties in which early marriages prevail are "Hertford, Bedford, Cambridge, Huntingdon, Northampton, Leicester, and Essex." The same, with the addition of Wiltshire, are the eight counties in which, in the succeeding year, are the largest proportion of men married under the age of 21. The least matrimonial counties are Hampshire, Devonshire, Herefordshire, Shropshire, East and North Riding of Yorkshire, Durham, Cumberland, and Westmoreland.

From the writing test on marriage, the counties at the minimum and maximum of the educational scale would appear to retain their respective positions-the Metropolis and Cumberland standing at the head, Bedford and Monmouth at the bottom of the list.

An analysis of 10,019 marriages makes the average age of marrying in men 27.4 years, and in women 25 5 years.

A Table shews the proportion of deaths at different ages out of 1,000 registered deaths for each division and for the whole of England and Wales. The deaths of children (taking the mean of both sexes) under one year of age, which everywhere constitute so large a portion of the whole mortality, sometimes exceeding even a fourth, appear to have been comparatively most numerous in the mining districts of Staffordshire and Shropshire; the south of Lincolnshire, Huntingdonshire, and Cambridgeshire; the manufacturing parts of Lancashire and Yorkshire; in Manchester, Liverpool, and Leeds; in Norfolk and Suffolk; and in the division comprising the north of Lincolnshire, Rutland, Derbyshire, Nottinghamshire, Leicestershire, and Northamptonshire; in all which divisions the proportion has ranged from 238 to 293. In Birmingham the proportion has been a little less, and much less in the Metropolis. The smallest proportion of deaths under that age has been in Devonshire, Dorsetshire, Wiltshire, Bedfordshire, Lancashire north of Morecambe Bay, Westmoreland, Cumberland, Northumberland, and Durham (excepting the mining parts of each); the North Riding of Yorkshire; Herefordshire, Monmouthshire, and Wales; in all of which the number has ranged from 168 to 186.

These results have been most similar to those of the preceding year for

the whole of England and Wales; for the Metropolis, Liverpool, Leeds, Dorsetshire, and Wiltshire; the district comprising the southern part of Lincolnshire, with Huntingdonshire and Cambridgeshire; the district comprising the remaining part of Lincolnshire, with the counties of Rutland, Nottingham, Derby, Leicester, and Northampton; the mining parts of Northumberland and Durham; the northern counties; and for Herefordshire, Monmouthshire, and Wales. The principal differences elicited by comparison have been in Birmingham, Devonshire, Cornwall, Norfolk, and Suffolk, Staffordshire, Shropshire (excepting the mining parts), and Cheshire and Lancashire (except Liverpool and Manchester) south of Morecambe Bay.

The proportion of deaths at advanced ages has been greatest in Devonshire, Dorsetshire, Wiltshire, Cornwall, in the counties north of Yorkshire, and in Norfolk and Suffolk. It has been least in Liverpool, Manchester, Leeds, Birmingham, and the mining districts of Staffordshire, and Shropshire.

Such is the substance of the Report of the Registrar-General. The Tables on which it is founded follow, and these are succeeded by an Appendix on the causes of death in England and Wales, by Mr. Farr.

ON THE CAUSES OF DEATH IN ENGLAND AND WALES.

The deaths in the year 1839, were not so numerous by 3,550 as those in 1838, but, in consequence of the better registration, the number of cases in which the causes were specified scarcely differed in the two years.

In 1838 the causes of 330,559 deaths were stated.

The mortality was lower than in 1838, the diminution being 2.4 per cent. among males, and 2.6 per cent. among females, or exactly 2 per cent. in the two sexes. The Winter of 1838 was extremely cold, the mean temperature of January being eight degrees, and that of February six degrees below that of the corresponding months in 1839.

The number of deaths from the class of epidemic, endemic, and contagious diseases, was 65,343; and the mean rate of mortality per 1,000 by the class was 4.25; in 1839 it was 4.52. The decrease was in small-pox and typhus, 16,268 persons having died of small-pox in 1838, and 9,131 in 1839; 18,775 of typhus in 1838, and 15,666 in 1839. On the other hand, 6,514 children died of measles, and 5,802 of scarlatina, in 1838; while 10,937 died of measles, and 10,325 of scarlatina, in 1839. Hooping-cough declined. Croup, thrush, diarrhoea, dysentery, cholera, influenza, and erysipelas remained stationary; none of them assumed the epidemic form. Ague rose from 44 to 95. In 1838, 16 males and 8 females died of hydrophobia; in 1839, 11 males and 4 females perished in the same way. Out of a population of 100,000 of each sex, 432 males and 418 females died of the epidemic class of diseases; but when the comparison is instituted between the deaths alone, the proportions are reversed; in 100,000 deaths of males 19,368, and in 100,000 deaths of females, 20,189 were from the same class of diseases.