III. TABLE of 4,095 Fatal Diseases happening among Persons assured by the Equitable Society, arranged according to the Parts affected.

IV. TABLE, showing the Annual Proportion of Deaths out of 10,000 living, at all Ages, produced by Diseases of different Organs, in Carlisle.

V. TABLE of 4,095 Fatal Diseases happening among Persons assured by the Equitable Society, arranged according to their Nature.

VI. Equitable Society..

Deaths out of 10,000 constantly living, at Four Periods of Life; distributed in Groups of fatal Diseases, (I.) according to the Nature, (II.) and Seat.

*Convulsion fits 8, epilepsy 19, suicide 29, asthma 74, angina pectoris 145, disease of the stomach and digestive organs 106, disease of liver 175, diabetes 8, bladder and disease of 128, child-birth 4-696. All these diseases are included in the section following.

Gout 38, mortification 46, cancer 43, atrophy 43, decay natural 566, dropsy 257.

VII. TABLE, showing the Annual Deaths by 10 Classes of Disease, out of 10,000 living at each Age, deduced from Dr. Heysham's Observations.

* Of the 134 deaths by eruptive fevers between the ages 0-20, 20-40, the deaths by small-pox were 84 and 1.

REMARKS.

1. Tables IV., VI., and VII. have been deduced from the four other tables; the absolute mortality was derived, in the same manner as the Carlisle table, from two enumerations of the living at different ages, and the deaths registered during 9 years (1779-1787) by Dr. Heysham; the deaths from each class of disease were ascertained by simple proportion. The rate of mortality amongst persons assured by the Equitable Society agrees nearly with that of Carlisle; so the same absolute mortality was applied to Table VI. as to Tables IV. and VII. The mortality of the class of persons from whom the assured were selected was certainly higher. The observations made in Philadelphia, to which we shall refer, were for the 2 years 1833-1835; the total deaths amounted to 10,106, and were published in annual bills by the Board of Health. The mortality in the 3 years, 1833-35, was 2.4 per cent.; the deaths in 5 years out of 100 born, 31.3.

2. Of a thousand persons living at Carlisle, fever annually destroyed 3.6; small-pox, 2.8; the entire class of eruptive fevers, 45 ; fever and eruptive fevers, 8.1. The two groups constituted 32.4 per cent. of the fatal diseases; in Philadelphia they amount only to 14, in London to 10.7 per cent.

3. The eruptive fevers at Carlisle and at Philadelphia were most fatal under the age of 20; but this does not justify the current belief of medical men, that children are more susceptible of those diseases which affect the organisation only once than adults. Admit that of 100 children born, 50 have small small-pox before the age of 10, 26 between the ages 10-20, 14 between 20-30, &c.; is it not evident in this case, that although the absolute number diminishes, the relative number attacked of those who have never had small-pox increases? One who has lived 30 years in the world without an attack of measles is, perhaps, protected by some idiosyncrasy; but, cæteris paribus, is not a person aged 30 as liable to an attack of measles as a child? Would not small-pox, introduced into a country where it had never been before, attack persons of all ages indiscriminately?

4. Of 1,615 deaths, Dr. Heysham ascribed only 20 to inflammation, and not one to an affection of the heart or large blood-vessels. This shows not so clearly that these diseases were uncommon, as that great

ignorance of morbid anatomy prevailed among the most accomplished physicians at the close of the last century. In Philadelphia 14-4, in London, 10-8 per cent. of the deaths are attributed to inflammation: after the age of 20, in the Equitable Society 12 per cent., in Philadelphia 14 per cent. of the fatal cases were inflammations.

5. Consumption and Scrofula at Carlisle and Philadelphia destroyed annually 3.4 per 1,000 of the inhabitants; and 3.8 per 1,000 of the persons aged 20 and upwards. One seventh part of the deaths were, consequently, from consumption; and above the age of 20, one fifth. 6. The violence of disease, Hippocrates somewhere says, is in proportion to the strength of the patient; and morbid anatomy proves that where there is great debility from age, or any other cause, inflammation runs through its course without manifesting distinctly its characteristic symptoms. The great number of deaths ascribed to natural decay, old age, and to weakness, are for this reason improperly considered examples of death without disease; although death sometimes does happen without any apparent organic cause.

7. What is the effect of the selection exercised by the assurance companies? What class of diseases does it exclude? In the first place, the eruptive fevers. Among 4,095 deaths in the Equitable Society, only 1 was of small-pox. The deaths from consumption, instead of making 20, only amounted to 8.3 per cent. of the deaths, or 10-3 if those who died of ruptured blood-vessel be added. But by way of compensation, the deaths from dropsy are 22; from apoplexy and palsy 37 per 1,000; instead of 11, 12, and 11, 106, the proportions dying of these two classes of disease in Carlisle and Philadelphia. The advantage to the assurance offices of applying tables founded on a city population in the last century, and including all the sick, to a class of persons in good health, and little liable to the eruptive fevers or consumption, is obvious. With some study, the selection of longlived or short-lived persons may be carried to a still greater extent.

8. In proportion as a population becomes civilised, and as its physical condition and mental life are ameliorated, the deaths from apoplexy appear to increase; while the fevers and plagues of the state of barbarism decrease in a much more rapid ratio. The persons assured by the Equitable Society represent the more intellectual order of people in this country; apoplexy is frequent among them; the numerous dropsies and inflammations mark their gastronomic excesses; the mortality from fever and erysipelas proves that they dwell in ill-ventilated houses, and crowded cities, with bad sewers.

9. Life, divided into 5 vicennial periods, is most secure in the second; the fatality of nearly all diseases increases afterwards in a geometrical progression. The observations in Philadelphia show that consumption is not an exception to this law.

10. One of the most important results presented in this paper is, that the character of diseases changes in a determined ratio at different periods of existence. The tables indicate not only the degree, but the kind of danger, we have to encounter at all ages: for example, in the second vicennial period (20-40), the deaths from consumption at Carlisle constituted 50, at Philadelphia 34, in the Equitable Society 26 per cent. of the deaths from all causes ; in the third vicennium

*

the nature of the danger has altered, for the deaths from consumption contribute but 23, 28, or 11 per cent. to the entire mortality. From tables of this description, the probability of death from cach class of diseases can be calculated at all ages. We will add one instance of their practical application. In the first period of life (0-20) the eruptive fevers, inflammations, scrofulous and dropsical effusions, are most to be dreaded; in Philadelphia two-fifths of the deaths were from affections of the brain and bowels. Who, with these facts before him, can fail to see the impropriety of giving children preparations of laudanum, spirits, or any food at first but the mother's bland milk? Cold often produces inflammation of the lungs in winter; but too much tenderness in this respect, and the accustoming of boys to a delicate diet, weaken the constitution. Between 20 and 40, consumption, inflammations, fevers, and epidemics, are the most deadly shafts of death, which, as Dr. Clark has shown, a judicious course of hygiene in this period may do much to disarm. The same class of diseases maintains the preponderance till 60; but, in the period following (60-80) dropsies and inflammations increase, while apoplexy gains a great ascendancy. After 65 a man should undertake nothing requiring great intellectual exertion, or sustained energy: warmth, temperance, tranquillity, may prolong his years to the close of a century; a rude breath of the atmosphere, a violent struggle, or a shock, will terminate his existence. The apoplexy of the aged can, with care, be averted for several years; but it is, perhaps, the natural death, the enthanasia of the intellectual: their blood remains pure, the solids firm to the last, when a fragile artery gives way within the head, the blood escapes, and by a gentle pressure dissolves sensibility at its source for ever. The life is no longer there, -the corporeal elements are given back to the universe!

Suggestions as to the Means of promoting Public Health in Great Britain.

1. If governments can do little by direct enactments for the diminution of sickness, it is, nevertheless, their duty to determine, by statistical enumerations, the actual state of health, and the extent to which it is deteriorated in different circumstances. Returns of the diseases and deaths in the army, the navy, and all bodies of men employed in the public service, should be made annually; and this, with the results of the general registration, would improve public health, by showing so distinctly the connection between diseases and their natural causes, that men would either avoid or obviate the evils destructive of health by some invention.

2. Almost all classes of the people of this country are profoundly ignorant of the physiological laws which regulate their own existence; health may consequently be improved by making a knowledge of the nature of the human organisation, and of the external agents by

Dr. Clark had this period, probably, in view when he estimated the proportion of deaths from tuberculous diseases, after excluding the deaths in infancy, at a third part of the total mortality in this country.