REMARKS.

1. The diseases of London in the 16th century still prevail in unhealthy climates: not only the diseases and the manner of death have changed in this metropolis, but the frequency and fatality of the principal diseases have diminished.

2. The reported cases of fever, plague, cholera, and dysentery, constituted 4-10ths (396) of the diseases: they destroyed annually, on an average, 31 per 1,000 of the inhabitants; five times as many as are now carried off by consumption.

3. Fever, plague, and dysentery, were most fatal to adults; but they of course carried off a considerable number of children. Convulsions, and other diseases of infancy, did not decline till the 18th century. The diseases of adults first diminished in violence; and as the state of the city and medical knowledge improved, the diseases of infants decreased.

4. Small-pox attained its maximum mortality after inoculation was introduced. The annual deaths of small-pox registered 1760–79, were 2,323; in the next 20 years, 1780-99, they declined to 1,740: this disease, therefore, began to grow less fatal before vaccination was discovered; indicating, together with the diminution of fever, the general improvement of health then taking place. In 1771-80, not less than 5 in 1,000 died annually of small-pox; in 1801-10 the mortality sank to 2; and in 1831-5 to 0.83.

5. Measles became gradually more general in the 18th century; but in 1801-1810, after vaccination was introduced, twice as many died of measles as had died of this exanthem in 1771-80. If scarlet fever and measles, however, have somewhat increased in frequency, the mortality of the three diseases, small-pox, measles, scarlet fever, is only half as great (0022) as the mortality formerly occasioned by small-pox alone (005).

6. Fever, exclusively of the plague, has progressively subsided: since 1771, fever has declined nearly in the same ratio as small-pox. In the 3 latter periods of the table the deaths from fever decreased as 621 264: 114; from small-pox as 502 : 204: 83.

7. Cholera morbus was as fatal in 1660-79 as in 1831-5: in 1831-5

tions, three of which, 1801, 1811, and 1821, make the population of the liberties of London (97 parishes within, and 16 parishes without the walls,) 130,100, including a correction for seamen and strangers. Without correction, the population, in 1881, was 123,683. The enumeration of 1631 has, therefore, been made the basis of these calculations; as it is not probable the population, in the same space, ever exceeded 130,178. The deaths in the 97 +16 parishes during 31 years, 1616-46, amounted to 279,964; which diminished for the still-born, and divided by the population (130,178) of the intermediate year, give 6.68 as the annual rate of mortality. The fire disturbed the observations in 1666, so that it was more difficult to obtain an approximation to the mortality in the 20 years, 1660-79: but the enumerated deaths in the 10 years, 1670-79, were 94,644; in the 5 years, 1660–4, 483,000; in 1665, the epidemic year, 56,558; whence 237,349 were deduced as the total deaths in the 20 years. Reduced for the still-born, the annual rate of mortality was 8.85 per cent.; but, to avoid the risk of exaggeration, the rate of this period, including the plague year, 1665, has been stated in the table at 8 per

cent.

out of 1,000, but 1.35 are stated to have died of cholera; in 1660-79, the deaths from this disease were 1.48.*

8. Other inflammations besides inflammation of the lungs unquestionably prevailed in London before 1704, when the word found its way into the bills; but its present comparative frequency is not entirely due to a change of nomenclature. Fevers were the reigning diseases, and an impure atmosphere communicated their character to the inflammations; which are still relatively less frequent where fever and dysentery prevail. In Corfu, 1815-21, out of 325 deaths among our troops, 12 were attributed to inflammations, besides 10 to hepatitis; while 223 were ascribed to fever, plague, and dysentery. Sydenham classes pleurisy, bastard pneumonia, rheumatism, erysipelas, and quinsey, together, under the title "intercurrent fevers:" after distinguishing the idiopathic from the symptomatic disease, he says, "I conceive pleurisy to be only a fever occasioned by a peculiar inflammation of the blood, whereby nature throws off the peccant matter upon the pleura, and sometimes upon the lungs, whence a pneumonia arises." Fever, then, involved in its vortex the comparatively rare inflammations; inflammation (a vague term), now happening more frequently in a pure form, and proved by post mortem examinations to prevail very extensively, has apparently recovered, not only its rightful possessions, but several of the unappropriated, unknown diseases, particularly of children.

9. Consumption was exceedingly fatal when fevers and dysentery reigned it is now very fatal among the British troops in the West Indies. Its relative frequency increased down to 1810; in other words, fever and dysentery decreased more rapidly than consumption. The actual proportion of persons destroyed by this disease, as well as other forms of scrofula (rickets and evil), has, except in the anomalous period of 1771-80, progressively declined among the mass of the population in London. If asthma and tissick be added, the declension will be little less apparent.

10. Dropsy has been latterly proved to depend frequently on diseases of the heart and of the kidneys: its connection with agues and dysentery, and with diseases of the liver and spleen, is confirmed by the table.

Fatal Diseases at different Ages.

The diseases proving fatal in childhood, manhood, and old age, are not the same: hence, to determine the peculiar diseases the nature of the dangers we have to encounter at different periods of life, becomes a most important problem. Very few statistical observations exist, in which the deaths from each disease, at different

* Sydenham's Works, vol. i. pp. 218.433. "Cholera comes almost as constant at the close of summer, and towards the beginning of autumn, as swallows in the beginning of spring, and cuckows towards midsummer." He closes an accurate description by remarking, that it "often destroyed the patient in 24 hours." Dr. Craigie has demonstrated the antiquity and identity of cholera all over the world; before the last eruption, it had been epidemic in India. He cites a remarkable case from Morton. Edinburgh Journal, 1833.

ages, are enumerated. The observations of Dr. Heysham, at Carlisle when he collected the facts on which the Carlisle table is formed; the diseases of which 4,095 persons, assured in the Equitable Office, died; the bills of mortality of the Anglo-American population in Philadelphia, are, we believe, the only data of the kind yet published, either in Europe or America.*

Mr. Milne, in whose valuable work the Carlisle observations were published, justly remarks, that "the tables of Dr. Heysham had the advantage of being constructed by a skilful physician, capable of discriminating accurately between the different diseases; who either visited the patients himself, or had the means of procuring accurate reports from his medical friends." The arrangement of Cullen, which Dr. Heysham followed, is so artificial, as to render it very illsuited to statistical purposes, where it is desirous to bring facts together, not only allied in one fugitive point, but in their fixed anatomical or general characters. The arrangement adopted in the following tables is two-fold: fatal diseases are (1) arranged according to the organs they affected, (2) and according to their pathological nature. The arrangement, we admit, is imperfect; but some arrangement was necessary, and this brings together many interesting features.

In every case of death occurring in England or Wales, the sex, age, occupation, and disease are now registered, according to the provisions of the late Act for the Registration of Births and Deaths. The details of the measure admit of some improvement; when these are made, and the observations are reduced to tabular forms, they will exhibit the influence of the principal causes of sickness and death at every age, and in all the circumstances of the different localities, in the Island. They will, therefore, form important contributions to medical science; and lead, by a knowledge of the causes of sickness, to its diminution.

I. TABLE, which shows the Number of Deaths by each Disease, that took place in each of the under-mentioned Intervals of Age, at Carlisle, during 8 Years, commencing with 1779, and ending 1787, excepting 1780.

*Mortifications 3, rheumatism 6, gout 4, weakness of infancy 204, decay of age 226, dropsy 49, scrofula 3, cancer 5, unknown diseases 115, accidents 29, green sickness 1, discharge of blood 1, ulcer 3-649. All these diseases, except the two last, are classified in Table II.

II. Fatal Diseases observed in Carlisle, from 1779 to 1787, and registered by Dr. Heysham; arranged in Groups according to their Nature.

*Convulsions 10, epilepsy 4, insanity 2, asthma 27, chin-cough 19, influenza 1, fainting 6, teething 3, indigestion 12, colic 1, costiveness 1, rupture 1, jaundice 13, venereal disease 2, amenorrhea 1, difficult delivery 9, menorrhagia lochialis 3, diabetes 1, suppression of urine 1.-These will all be found in Table I.-Green sickness 1, age 15-20; and discharge of blood 1, age 40-30; are in neither.

The assurance offices obtain from the medical attendant a certificate of the disorder of which every person assured has died: the Tables III. and V. have been arranged from a recent publication of the Equitable Society, detailing the diseases fatal to 4,095 individuals during the 32 years, 1801-1832.