in children under two years of age. This statement was, I believe, first made by the distinguished Withering; but Dr. Nieuwenhuys, of Amsterdam, in an admirable paper on small-pox and scarlet fever, has repeated, within these late years, an almost similar opinion. He seems to have been led to this view by seeing cases in which infants had escaped the disease whose mothers were suffering from it, and were occasionally suckling these same children during the period of the disease. If this statement were true, it would convey one of the most curious facts in medicine. It is, however, one of those errors which occasionally will creep into the works of the ablest writers, if they give the history of their individual knowledge alone.

It happened to me that, in the first case of scarlet fever I ever saw in a puerperal woman, the infant at her breast died of the disease, and that another child of hers, under two years, took the malady and suffered from it in the malignant form. Here, then, were facts at once offered which showed that no rule such as that which has been suggested really obtains, or at least that such rule had its exceptions. I thought, therefore, that it would be interesting to follow out the subject, and, from a rigid analysis, to learn the fatality of scarlet fever in the early terms of existence.

In this direction I took, in the first place, my own reports of cases of the disease, and collected from the printed return-books of three friends who held parochial appointments (viz., the late Mr. Brown, of Saf

fron Walden, in Essex; Mr. Palmer, of Sheen; and Mr. Beresford, of Narborough, Leicestershire), the cases there reported from the year 1849 to 1853. To these I added statistics from the accounts of Messrs. Ryland and Parsons, who observed and noted the disease in Birmingham from the year 1832 to 1835. The result of this work gave me 431 cases of the disorder. Of these cases, 329 were in children under ten. In 242 cases under five, there were no less than fifteen in infants under two years of age. To pursue the question further, I next turned to the mortality tables of the Registrar-General. following is an epitome of this research:

The

"Out of a total of 12,962 deaths from scarlet fever in children under five years of age, occurring in the county of Kent in 1843, in London in 1845, 1846, and 1848, and in England in 1847, there were

Again, "in a total of 3,795 deaths in patients under five years, occurring in the London hospitals, in Manchester, and in Birmingham, in the year 1839, in twenty-four towns in 1840, and in London in

While it is thus clear, from indisputable evidence,

that the idea of an immunity from scarlet fever in the earliest period of life is founded in error, it comes out, also, from a more extended inquiry, that the mortality from scarlet fever is actually greatest in the period of infancy, if that be extended from one to five years. Thus, out of 31,744 cases of scarlet fever, occurring in Manchester in the year 1839, in Liverpool in 1839, in Birmingham in 1839, in twenty-four town districts in 1840, in London in 1842, 1843, 1844, 1845, 1846, 1848, and in England in 1847, the ages were

We gather from these details, as an exposition of our first inquiry, that scarlet fever attacks most frequently in the third and fourth years of life: that it declines rapidly after the fifth year, and is almost lost after the fortieth. At the same time it would be unfair to attribute to age any direct relationship to the cause of the malady: age cannot be looked upon either as predisposing or preventive. It is due to the non-recurrent character of the disease after one attack, and to extreme susceptibility to it of all who have not suffered, that the ratio of cases at different ages is so marked. Children of three or four, who are by that time permitted to run about, and are also susceptible to the disorder, are naturally more subject to exposure than infants on whom the mother's eye is constantly watchful; the former, therefore, suffer most. And for the reasons that the majority of cases take

place early in life, and that the disease is non-recurrent as a general rule, children over ten, and adults, are, to an extent proportionately large to the whole population, protected from the disease.

Leaving the question of age, I find that great differences of opinion have been offered on the point, whether sex exerts any influence on the occurrence of scarlet fever? The prevailing idea on this subject has been, and is, to the effect that females suffer most. Dr. Tweedie, whose opinion we all recognise, arguing on his own general experience, and on the results of an imperfect table, says, “females are more subject to the disease than males": with great candour, however, he repeats the opinion of Withering, "that, in children, the numbers of sufferers are equal in both sexes; but, amongst adults, females suffer most." Fothergill, in writing of the malignant attack of scarlet fever which visited London in 1749, says, " a greater number of girls have it than boys, more women than men." Rayer affords similar testimony; but Dr. Binns, in describing an epidemical scarlet fever which occurred in the Ackworth school, tries to show, by reference to a small but, as far as it goes, fair table of cases, that girls are less liable to the disease than boys.

The 431 cases in my own possession, and to which I have before drawn attention, show an equality between the sufferers of different sexes. I could not, however, consider so few cases as 431 worthy of note for any definite conclusion derivable from them.

Once more, therefore, I turned to the Registrar General's reports, and gathered what succeeds.

In 102,382 deaths from scarlet fever, occurring in England in the years 1838, 1839, 1840, 1841, 1842, 1847, and 1848, and in London in 1842, 1843, 1844, 1845, 1846, there were—

Amongst males, 51,660

females, 50,722

}

=

102,382 (938 males in excess.)

This calculation took in sufferers of every age, and left, at first sight, a fair inference on the mind, that males are, on the whole, more subject than females to scarlet fever. To understand the question fairly, however, it was necessary to go further; viz., to analyse a large number of cases, and find at what ages the deaths occurred.

34,744 cases of death from the disease, occurring in Manchester, Liverpool, and Birmingham, in the year 1849, in twenty-four towns in 1840, in London in 1842, 1843, 1844, 1845, 1846, and 1848, and in England in 1847, were therefore analysed. The relative number of deaths in both sexes, and in certain specified periods of life, were—