the mortality in the latter year being 12,646. The year following the mortality increased enormously, becoming wellnigh doubled, the number of deaths from the malady being 23,711. In 1859 the number fell to 19,310; and in 1860 it became as low as 9305. Prior to 1855 deaths from scarlatina, cynanche maligna, and diphtheria were not separated in the Registrar-General's report. Whether the detailed reports of the Registrar-General will show an increase of the mortality in the whole of England from scarlatina, during 1861 and 1862, as great as occurred in London, cannot be predicted. It is certain, however, that the activity of scarlet fever was great in several parts of the kingdom. The deaths from cynanche maligna in 1855 amounted to 199; in 1858, to 1770; in 1860 the mortality from the disease had decreased to 376. The mortality from measles was largely augmented in 1858, and there was a steady increase in the number of deaths from the disease in the two subsequent years. The deaths registered from diphtheria in 1855 numbered 186; in 1859, 9587; in 1860, the mortality from this disease had decreased to 5212. The mortality from whooping-cough, in 1860, was the lowest since 1852; and the mortality from small-pox had declined from 6460 in 1858 to 2749 in 1860. The reduced rate of mortality throughout England which occurred in 1860 was chiefly due, Dr. Farr states, to the decline of the number of deaths from scarlatina, diphtheria, and diarrhoea. A decrease also in the mortality from small-pox, erysipelas, and cholera contributed to the favourable results. The most noteworthy fact in the epidemiology of the metropolis during the twelve months was the remarkable outbreak of typhus. In 1858, 1859, and 1860, typhus had become so rare a disease in London, that the question of converting the Fever Hospital to other uses was seriously entertained. In 1861 typhus again became epidemic; and since January, 1862, the number of admissions to the Fever Hospital for typhus has exceeded that at any period of the history of the hospital. Dr. Murchison attributes this epidemic to the artificial scarcity produced by the system of strikes, which had for some time previously disorganized the labour market, and the condensation of population caused by the arrival of labourers in the metropolis from the country in search of work.* The mortality from continued fever in London, doubtless owing to the outbreaks of typhus, was in excess of that of any like period since 1848. Indeed, the total mortality of the winter, spring, and summer quarters of 1862 (2839) from this disease was alone in excess of that of any year since 1848. The true source of this excess of mortality would not have been rightly understood except by the careful nosological and etiological distinction of the forms of continued fever insisted upon by Dr. Murchison. The mortality from scarlatina was but a little below that from continued fever during the twelve months,the total mortality from the former malady being 3437; from the latter, 3463. Next in order of mortality was whooping-cough. Continued fever, scarlatina, and whooping-cough were the chief epidemic * See Dr. Murchison's recently published treatise on the Continued Fevers of Great Britain (p. 52), for an account of this epidemic. affections of the period under observation in the metropolis. The mortality from continued fever increased to a maximum in the second quarter of 1862. The mortality from scarlatina was at its maximum in the last quarter of 1861, then decreased throughout the two succeeding quarters, but largely increased again in the summer quarter of 1862. The mortality from whooping-cough was greatest in the first quarter of 1862. Diphtheria was still largely fatal, having occasioned 625 deaths. Mr. Radcliffe detailed the history of the outbreak of typhus at Preston, in Lancashire, to the date of reading the report: he dwelt also at some length on epizootic diseases, brought together the chief accessible information on epiphytics, and terminated his report by a brief analysis of the principal contributions to epidemiological literature in Great Britain during 1861-62. The chief diseases prevalent among domesticated animals were epizootic pleuro-pneumonia, and the vesicular disease of the mouth and feet. Scores of sheep suffered and were lost from filario in the bronchial tubes and abomasum; there were several local but very fatal outbreaks of influenza among horses; and an outbreak of variola ovina occurred in Wiltshire. The history of the latter outbreak, which occasioned great alarm at the time, will be imperfect until the official reports are published. There was no special disease among plants during the year. ART. 13.-The Epidemics of Yellow Fever in Bermuda. By Deputy-Inspector Dr. SMART, R.N. (Proceedings of the Epidemiological Society, March 2, 1863.) Without going further back than the close of last century, it appears that the dates of the successive outbreaks of fever there have been 1796, 1812, 1818, and 1819, 1837, 1843, 1853, and 1856. The following are the principal conclusions drawn by Dr. Smart from his extended researches:-1. That in the best recorded yellow fever epidemics of Bermuda there has been generally a coincidence of the same disease on the American coasts. 2. That on such occasions there has been an epidemic constitution, manifested by the prevalence of catarrhal affections in the spring, and of gastric affections in the early summer-these yielding to fever, which, at its climax in the autumn, assumed the type of yellow fever with black vomit in a greater or less proportion of the attacks. 3. That during these epidemic seasons comparative immunity has usually favoured the native population, and those of the European residents dwelling under good sanitary conditions. 4. That the most intense manifestations of the disease have arisen in crowded barracks and convict-hulks, especially when the healthy and sick have been kept together. 5. That inasmuch as in the worst instances recorded it has been found that removal from infected localities has been always followed by an almost complete exemption of those not already infected, by amelioration of the state of the attacked, and lastly by an early extinction of the epidemic character of the fever, it is therefore just to consider the essential causes of the disease to operate, under ordinary circumstances, by material local agencies, rather than by those of person. 6. That sanitary measures are the means to be relied on upon the approach of the epidemic constitution in any locality. 7. That, in the event of an epidemic outbreak, the same measures are highly valuable, but the only measure of certain value then is removal from the locality, and, in the case of crowded communities, as in barracks, ships, &c., immediate dispersion into wider space of all persons within the range of the noxious local agencies. 8. That, although the direct proof of personal contagion be still wanting, there are ample reasons for concluding that the highest degree of local infection has been generated in the hospitals, naval, military, and convict, so that the malady has been propagated among the attendants as well as among the sick. 9. That with regard to hospital arrangements for the treatment of yellow fever, owing to the peculiar predisposition arising from the debility of ill health, yellow fever hospitals should be distinct and special, and under sanitary cordon; and that, considering the disadvantages of the climate of Bermuda, the minimum of space, even when perfect ventilation can be maintained, should not be less than 1500 cubic feet per man in fever wards. After alluding to the terrible mortality from this fever in several ships of the West India squadron in 1861, during the passage to Halifax, and after their arrival there, Dr. Smart remarks: "I must confess that such results, placed side by side with those of immediate removal of men from infected localities, as exhibited in Bermuda experience, have raised a doubt in my mind whether equal losses of life would have been incurred by the immediate removal of the crews from their ships into some suitable quarantine establishment in the West Indies." ART. 14.-On Recent Typhus in Lancashire. (Lancet, February 14, 1863.) Since the great typhus-epidemic in Lancashire at the time of the Irish famine in 1847-48, there has been scarcely any of this disease in the cotton towns. In 1862, however, positive maculated typhus has made its appearance. The disease has been most prevalent at Preston, and next at Manchester. Several cases have been met with in Chorley, a town not far from Preston, and more recently at Accrington; and scattered attacks, still of true typhus, appear to have been observed at Salford and Blackburn. As the chief interest centres in Manchester and Preston, Dr. Buchanan confines his remarks to the outbreaks in these towns. He visited Preston late in October, under the directions of the Privy Council. The earliest case of distinct typhus he could trace had occurred on July 7th, in a four-roomed cottage, 17, Castle-street, at some distance from the centre of the town. It was not known that the first patient had been exposed to contagion. In this cottage eight persons had crowded by night into a room whose utmost cubic capacity was 800 feet. They were dirty, under-fed, and the boy who first felt ill had also been much exposed to the weather. The boy was removed to the hospital, and returned home on his convalescence. In the last week of August six other persons were attacked in this house. They were removed and the house was closed. Meanwhile, new cases of typhus had occurred in another part of the town, apparently without communication with the former. These were in a district that was afterwards subjected to the chief violence of the epidemic. The locality consisted of very confined and dirty courts, lying low, near the canal, and densely inhabited. At the end of August a third neighbourhood, distant from either of the other two, became affected with typhus. A fourth outbreak, apparently unconnected with the rest, was seen in another central part of the town in the middle of September. By the end of this month cases had occurred in five out of six wards into which the town is divided. The general progress of the outbreak in the town may be estimated from the following return of reported cases of typhus:Cases occurring in July, 2; August, 8; September, 23; October (five weeks), 109; November, 89; December, 38; week ending January 3rd, 13-a third more than in the previous week, and double the number occurring in the week ending December 20th; week ending January 10th, 15; and since then a still further increase, though not to any great extent. At the time of Dr. Buchanan's visit, at the end of October, the House of Recovery (fever hospital), which was constructed for forty patients, contained fifty-two cases of typhus. Afterwards there were upwards of sixty inmates at one time. In some wards the space for each bed fell short of 600 cubic feet, and the air was here very foul. At the beginning of November a wooden building was erected in contiguity to the House, capable of containing sixty patients, with a space of 1500 cubic feet to each. This building was put up in ten days; but there was a lamentable delay before the patients were removed into it at the end of December. In the meanwhile, upwards of twenty persons in attendance on the sick had caught the fever, the medical officer and the master of the House of Recovery being among the number. It deserves mention, for the sake of those who refuse to acknowledge an epidemic influence that does not show itself on the general death-rate, that in the September quarter of 1862 the mortality from all causes in Preston was very markedly below the average, 464 deaths only being registered, against 607 in the corresponding quarter of 1861. This subsidence was entirely among children under six years, and resulted, there is reason to believe, from the greater care bestowed by mothers on their infants during the time of industrial depression. The following returns from the parish fever hospital will indicate the progress of the outbreak of typhus in Manchester. In July, 7 cases of the disease were admitted; in August, 8; September, 12; October, 20; November, 25; December, 17. From December 29th to January 13th, not one case; but on the last-named day, two cases, and since then a few who had contracted the fever in adjoining wards of the workhouse. Scattered cases of typhus have probably occurred in Manchester from time to time, but very rarely since 1847-48. The earliest instance of true typhus in the Infirmary occurred at the end of May, and two cases were admitted in June. At present there is very little typhus in Manchester; but it would be premature to reckon on the complete subsidence of the disease. Dr. Buchanan refers to his recent report to the Privy Council, "On the Health of the Operatives in the Cotton Towns of Lancashire affected by the Prevailing Distress," for a detailed account of the circumstances contributing to the outbreaks of typhus in Preston and Manchester and other towns. He is at a loss to explain why the typhus influence should have fallen chiefly on Preston. Manchester was exposed to the danger of imported typhus. The limita tion of the fever to these towns chiefly was to be ascribed to the strict removal of cases to hospital; the maintenance of a high standard of relief, increasing almost every month; the liberal distribution of bedding and clothing as the winter has advanced; and the almost unprecedented mildness of the weather since November. November, which was the coldest month since the distress began, witnessed the maximum of typhus cases both in Preston and Manchester. ART. 15.-Further Observations on Typhus and Typhoid Fevers, as seen in Dublin, especially the united form they assumed during the first half of the year 1862. By Dr. HENRY KENNEDY, Physician to Sir Patrick Dun's Hospital, Dublin. (Dublin Quarterly Journal of Medical Science, August, 1862.) About two years ago Dr. Kennedy endeavoured to show that typhus and typhoid fever were the result of a common poison: on the present occasion he publishes the results of his additional experience, giving the details of forty cases illustrative of the types of fever prevailing in Dublin during the last two years. These cases present examples "of typhus in both young and old ;-of typhus without spots; of typhoid with none, with one or two, or with an extensive crop of them ;-of typhus with the brain wonderfully free;--cases of typhoid, but more numerous, the same;-of both typhus and typhoid in which the state of the tongue and parts about were identical from sordes;-many cases of either type with the chest not engaged at all, or so slightly as not to call for treatment;-instances of both types with and without tympany;-cases of either kind entirely free from hæmorrhage; a freedom remarkable when compared with former years;-and lastly, the modified types of fever which the present year has disclosed." |