eases is attempted to be explained, the writer enters at some length, resting his conclusions mainly upon the older writers, when these diseases were so rife in London, as to divert attention from pure inflammations, and he observes

"The early medical observers have directed attention to the analogies zymotic diseases have with combustion, fermentation, putrefaction, and poisoning. These analogies have been, to a certain extent, confirmed by the researches of modern chemistry; and Liebig has been led by the study of organic transformations— fermentation, putrefaction, decay-to develope a theory invented by the greatest practical physicians to explain the phenomena of zymotic diseases.

"Liebig observes, that physicians had referred formerly to fermentation merely by way of illustration;' from which it is evident that he had not had time to consult the English medical classics on this head, or he would have discovered, not, indeed, an anticipation of his own admirable generalizations, but a theory very similar to his own- -the basis of their pathology-founded upon enlarged views, and well calculated to prepare the way for his researches and the researches of other chemists." 204.

And again

"The three great contemporaries, Sydenham, Morton, and Willis, lived in London when plague and epidemic diseases prevailed; and much as they differed, or were mistaken on some points, all announced more or less clearly the zymotic hypothesis. They were not, it must be borne in mind, mere chemiatric theorists; they had studied diseased action as assiduously, and with as much sagacity, as modern chemists have studied fermentation; Willis was a great anatomist; Sydenham and Morton have left original pathological delineations, which have never been surpassed, and laid down plans of treatment which are still followed.

'Liebig, Dumas, and the chemists of this country, will, we sanguinely hope, not rest satisfied with what has been done, but continue to prosecute their labours with ardour and success; and, from the study of the series of transformations of nitrogenous compounds, proceed to investigate the transformations of the blood, tissues, and secretions which accompany the production of varioline, typhine, and the other zymotic principles." 205.

This part of the volume concludes with a note in reply to some observations on the "Report of a Sub-Committee of the Royal College of Physicians in Edinburgh." Mr. Farr very justly remarks.

"There is nothing perhaps in which it would be more difficult to get all medical men to agree than in any one classification of diseases; and though this is partly due to the imperfect state, it cannot be entirely ascribed to the uncertainty, of medical science, for it really arises from the utility, not to say the necessity, of considering the facts in different combinations, according to the object in view. The nosology which was given in the first Report, and of which the present is an extension, has been received quite as favourably as was anticipated: it has been employed, with some modifications, for statistical purposes in this country and abroad. In the present revision I have endeavoured to profit by the friendly criticism of the medical press, and the suggestions with which I have been favoured by members of the profession, who naturally take an interest in a national system of registration." 206.

Into the critique however or the reply we deem it unnecessary to enter, nor indeed will our space permit further notice than to observe that, we think Mr. Farr rightly says he has to thank Dr. Allison and his

colleagues for affording him an opportunity of "giving some explanations and answering some objections against the statistical nosology, which could not perhaps have otherwise been conveniently given or answered here." From this explanation we extract the following statement of the principle of registration adopted.

"The plan in England has been to recommend medical practitioners to return the causes of death under specific names; to distinguish, where they can, all the diseases which are recognised as distinct in the present state of science; to return in general terms the diseases which are imperfectly known, and not to assign any cause without satisfactory evidence of the accuracy of their information. To promote uniformity in the nomenclature, a list of the diseases which are considered distinct in the standard medical works of the day, has been drawn up, and recommended for adoption, if the medical informant should consider that the names there given express the cause of death with sufficient accuracy. In the present stage of registration, however, these causes are referred, in the published abstracts, to a much smaller number of heads; comprising the diseases of frequent occurrence, or diseases which it appears interesting, under one point of view or other, to consider apart." 215.

An abstract is given with the tabular returns-showing the state of the public health in 1840. We confess we are at a loss to know why a Report of the Registrar-General published late in 1842 should only furnish an abstract of the public health for the year 1840-or why an analysis and statement is not furnished for 1841, more especially as this volume includes tables of mortality to the 21st of May, 1842, and Major Graham in his report, dated August 8th, 1842, states that,

"To ascertain the state of the public health down to the latest time, I have directed to be prepared a quarterly table of the mortality in 114 of the principal districts (including nearly all the large towns) of England; showing the average quarterly deaths, and the number of deaths registered in the quarter immediately preceding the publication." 19.

Showing that the latest intelligence was considered desirable.

Questions of public health are among the most important that can engage the attention of the medical philosopher-nor is their interest in any sense confined to these limits-inquiries into the causes, physical, political and moral, influencing and determining the public health, are worthy of general attention and study-nay, interest all-the poor by their physical well-being-rate-payers by their pockets-governments by policy-and the enlightened by philanthropy.

The abstract before us shows that there is much yet to be done before a complete registration can be attained. In the year 1840, the supposed causes of 351,757 deaths were stated, leaving 7,804 deaths in which the causes were not stated.

"The mortality by all causes was higher in 1840 than in 1838, and considerably higher than in 1839. Out of 1,000,000 living in 1839, only 21,856 died; while in 1840, out of the same number living, 21,856-and 1,022 more perished. Upon referring to the deaths by different classes of causes, it will be perceived that 626 of the excess (1,022) arose in the epidemic class of diseases; the remaining excess being distributed over all the classes, except that of the violent deaths, which diminished somewhat in each of the two last years.

"The deaths from Small-pox fell from 16,268 in 1838, to 9,131 in 1839, and 10,434 in 1840; the deaths from Typhus fell from 18,775 to 15,666 and 17,177.

From both diseases the mortality was less in 1840 than in 1838, but greater than in 1839. Hooping-cough progressively declined from 9,107 deaths, to 8,165 and to 6,132." 218.

Scarlatina, it appears, was the reigning epidemic of the year 1840. The deaths from it in the three years were

The epidemic was most destructive in the North-western, North-midland, York, Welsh, and Northern Divisions. The epidemic had not terminated at the close of the statistical year.

"The deaths by Diarrhea, Cholera, Influenza, and Ague, increased to a considerable extent; though not so as to assume the epidemic form, or to present anything very remarkable.

"The deaths from Hydrophobia in the three years were 24, 15, 12; and therefore not half so numerous in 1840 as in 1838.

"The mortality by the diseases of the Nervous System was nearly the same in the three years, viz., 003365, and 003255, and 003302. The mortality by Cephalitis and Paralysis was slightly higher in 1840 than in the two preceding years.

"The mortality by the diseases of the Respiratory Organs was 6 in 1,000; or in each of the three years '006149, 005989, and 006043. The deaths ascribed to Consumption in each of the three years were 59,025, 59,559, and 59,923; and the mortality was ‘003996, ‘003939, and '003897. The mortality from this disease declined very slightly. About 4 in 1000 persons died annually of Consumption, and about one-fifth or one-sixth part of the total deaths was by this disease.

"The mortality of diseases of the Digestive Organs was '001307, 001373, and 001465. The increase was chiefly in Enteritis.

"The mortality by diseases of the Urinary Organs was 000112, 000101, and 000110, in the three years. The deaths by Stone (and Gravel) were 320, 299, and 303: the mortality 000022, 000020, and 000020. About 1 in 50,000 persons die of stone annually. It will be interesting to see whether the mortality be reduced in future years by the discoveries of surgery. The mortality by Diabetes is to that by Stone as nearly two to three.

"The deaths in Childbed were 2,811, 2,915, and 2,989 in the three years. The mortality increased from 000190 to 000193, and 000195. To about 187 children born alive, one mother died. The proportion of mothers who perish at this important period is unquestionably excessive; and must suggest to every humane person the inquiry whether the education of the nurses who attend the poor in labour may not be improved?

"The number of deaths ascribed to Rheumatism and to diseases of the joints was 962, and 1,170 in 1840.

"If we except Debility,' under which head are included, 'premature births' -Dropsy' was the most fatal of the diseases of uncertain or variable seat.' The deaths ascribed to dropsy were 12,342, 12,251, and 13,261 in the three years; the annual rate of mortality 000836, 000810, and 000863. It is scarcely necessary to add, that according to the present views of pathologists, Heart Disease, or Nephria, would in the majority of cases be considered the primary affections. So difficult, nevertheless, appears to be the diagnosis practically, that nearly as many cases of simple Dropsy' are registered in the London Hospitals as out of doors in private practice.' 218.

An interesting table is given of the relative mortality by different causes in the three years 1838-40. The greatest number occur in the following classes.

There are three other large classes in which the information is more vague and probably less to be depended upon, viz.

Diseases of uncertain seat

Old age

..

48,396

36,793

Deaths ascribed to external causes, cold, violence 11,922

only.. 20,186 to be accounted for by the remaining

six classes enumerated.

And of this 20,000, the causes are not ascertained in nearly 8,000. We take our leave of this volume, which we may safely affirm, from its very moderate bulk, contains more valuable information, and affords more abundant materials for thought and enquiry of the most useful kind, than a very large proportion of the books which issue each season from the press could yield, were they all put together, and winnowed of their chaff. With this opinion we need not say that we strongly recommend it to the study of the profession generally, whom it behoves more especially to be well informed, on all subjects touching the public health, and heartily do we concur in the hope expressed by the Registrar-General at the conclusion of his Report.

" I hope that the registrars and informants will not fail to see the necessity of attending to the classification of fatal diseases, which has been framed for their use with much labour and after careful consideration; and I also trust that the members of the medical profession, who have hitherto given their aid, will cordially assist in carrying out this national registration of the causes of death; as they alone are enabled to give a correct statement of the nature of the fatal diseases; and to them, more than to the members of any other profession, must be apparent the vast importance of thus collecting accurate materials for advancing the science of vital statistics." 24.

LXXVIII.

EE

AN EXAMINATION OF THE MEDICAL REGULATIONS COMMONLY CALLED THE MEDICAL BOON, &c. &c. dated July 16th, 1842. By MADRAS MEDICAL OFFICERS. London, 1843.

MANY a good cause has been sadly damaged by injudicious advocacy. It is a recognised rule with all right-minded and prudent men, when they would make an impression upon their superiors, to eschew the slightest approach to disrespect. The authors of this silly pamphlet would seem to be guided by a very different principle. They rely, not upon strong facts, but strong language, to carry the points at issue between themselves, and their honourable masters. The foolish instinct of insubordination and disrespect is so strong in them that it breaks out even in the motto upon their title-page, by which they would insinuate that the masters whose salt they have eaten, and are still eating, for aught we know to the contrary, are upon a par of honesty with the highland freebooter, Rob Roy. The next time they are inclined to discuss matters that have at least a claim to be considered in a temperate and gentlemanly spirit, we would recommend to their attention for a motto a distich quite as suitable and a little older than the verse of the venerable Wordsworth

"Ah wud some power the giftie gie us

To see oursels as others see us!"

The production we are now very reluctantly constrained to notice, has originated in a sentiment of alarm among those whom it chiefly concerns, lest the Marquis of Tweeddale should fill up vacancies in the grade of superintending surgeons, not after "the good old" seniority plan, but upon the newly-acknowledged principle of qualification for the office. Does not this look awfully like a vivid consciousness of demerit upon the part of the Medical Repealers? Why otherwise should the very idea of merit, and not mere length of service, excite such apprehensions, unless there was a consciousness of their liability to be brought to a balance in which they might be found wanting? Admitting that the authors of this pamphlet have some just cause of complaint, let us see how they acquit themselves. They thus introduce themselves to our attention :—

"A NUMBER of Madras Medical Officers having examined, with much care, the new Medical Regulations commonly called the Medical Boon '-are of opinion-1st. That the enactments of these regulations are at variance with those principles of strict honour, and integrity of purpose, which hitherto have always formed a distinguishing feature of that Court's orders, on all questions relating to the army; and, 2ndly. That they are so defective in those attributes of wisdom and correct judgment which have ever characterised its awards in all matters of the kind submitted for its decision, that we are forced, almost in spite of our conviction to the contrary, to adopt the opinion, that absolute purity of motive did not actuate the framers, nor preside at the council table at which these orders were passed."

Further on, we have these officers thus decorously expressing themselves :

"That order, as emanating from a body of sensible, well-informed, and edu