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£2000 in the Phenix through an agent at Edinburgh, and for £3000 in the North British Co. The agent of the Phonix, not knowing what prem. to charge, referred to the man. in Lond.; and the officers of the other co. told S. that they would take the risk, and charge the same prem. as the Phenix, and that S. might consider his mill insured. The risk was entered in their books, with a blank left for prem. The fire occurred before any conclusion was come to as to the prem. to be charged :-Held, by a divided Court, that the contract was incomplete, and that S. could not recover.

Where an agreement for ins. had been made on the 30th of March, and the prem. paid on that day, but the pol. was not made out until some days afterwards, and in the mean time the property was destroyed; but the pol., dated the same day as the prem. had been paid, was made out and delivered:-Held, that the pol. took effect by relation from the day of its date.-Lightbody v. North American Ins. Co. (N.Y.), 1840.

Where a co. offered by letter to insure on certain terms, and the insured replied accepting the terms and inclosing the prem., the contract was held to be consummated from date of mailing the acceptance, though property was destroyed before receipt of the same by the Co.-Taylor v. Merchants Fire Ins. Co. (U.S.), 1850.

After the approval of the application, and the payment or security of the prems., the applicant is insured, and can recover for his loss, although no pol. may have been made out.-Goodall v. New England Mut. Fire (N. H.), 1852.

A pol. was made out at the request of defendant, but he refused to receive it, or pay prem., or sign note :-Held, that there was no contract and no liability, and in action on prem. note against defendant the Co. could not recover.-Real Estate Mut. Ins. Co. v. Roeste (Mass.), 1854.

A contract arises when an overt act is done, intended to signify an acceptance of a proposition, whether such overt act comes to the knowledge of the proposer or not; and unless a proposition is withdrawn, it is considered as pending until accepted or rejected, provided the answer is given in reasonable time. The acceptance of a proposal to insure for the prem. offered is the completion of the negociation; and after the pol. has been forwarded to the agent of the Co. for delivery, the contract cannot be rescinded without the consent of the party insured.-Hallock v. Commercial Ins. Co. (N.J.), 1856. Where insured and his counsel, after a loss by fire, applied to the Sec. of the Co. for the pol., and he stated "that he had either sent the pol. to the insured by mail, or by private hand; he thought by the mail:"-Held, that such declaration was conclusive evidence against the Co., upon the question of the execution and legal delivery of the instrument; and they could not, upon the trial, repudiate the representation of their Sec. -Sussex County Mut. Ins. Co. v. Woodruff (N.J.), 1857.

Where an agreement of ins. was made between the parties by their agents on the 20th, and on the night of the same day the property was destroyed by fire; on the morning of the 21st the pol. was executed, delivered, and received in perfect accordance with the agreement, both parties being ignorant of the fire:-Held, to be a valid and binding contract. [COMMENCEMENT OF RISK.] [CONDITIONS OF INS.] [PREMIUMS.] CONSUMPTION (from the Lat. consumo, I waste away).-Emaciation, or wasting away of the body. This term is commonly applied to a diseased state of the lungs, attended by debility, cough, hectic fever, and purulent expectoration. It may be produced by a variety of causes; but hereditary disposition and scrofulous habit are leading causes which predispose to its most alarming form, namely, that which arises from tubercles in the lungs hence Tubercular Consumption; or sometimes Pulmonary Tubercle. Consumption is also termed Phthisis pulmonalis; and mesenteric consumption Marasmus. It is sometimes also designated Decline. In the early B. of Mort. it is usually designated Tissick-a corruption of Phthisic.

There is no disease which afflicts humanity in which the L. offices are more deeply concerned; hence we propose to treat the subject exhaustively-except that we shall not mention purely scientific medical treatises, whose name is legion.

It is certain that phthisis was known to the ancient Greeks. Hippocrates says "that the autumn is obnoxious to consumptive persons," to which Galen adds, in his commentary on this passage, "if it be dry, cold, and unequal." (See Haviland, On Climate, 1855, p. 18.)

In 1802 Dr. William Heberden, Sen., M. D., pub., Commentaries on the Hist. and Cure of Diseases, wherein, under "Phthisis Pulmonum," is an art. from which we draw the following:

A consumption appears by the Lond. B. of Mort. to be in that city the most destructive of all maladies to adults; 1 in 4 of those that grow up to manhood being reported to be carried off by this distemper. But all these cases must not be charged to the account of pulmonary consumption: because, whoever decline and waste away by any obscure, unnamed distemper, they are all charged to this article, though the lungs be not at all diseased. A consumption is a distemper which is most certainly derived from the parents, and yet rarely makes its appearance before puberty; between which and the age of 30 is the time of the greatest danger. In England we have very little apprehensions of the contagious nature of consumptions, of which in other countries they are fully persuaded.

Either this learned author, or his equally learned son, wrote further upon the subject; for we observe in Dr. Guy's Public Health (p. 21) the following passage: "Heberden

considered that Consumption was on the increase during all the last century. In his T. he renders it accountable for 3000 deaths at the beginning, 4000 in the middle, and 5000 at the end of the 18th century."

In 1808 Dr. William Woollcombe, of Plymouth, pub. Remarks on Different Diseases, particularly on the Increase of Consumption and the Influence of the Seasons on Mort. He calculated that the ann. mort. in England from C. alone amounted at that time to 55,000 persons!

In 1815 Dr. Thomas Young, M.D., pub. Practical and Historical Treatise on Consumptive Diseases. He sets out with this remark :-" Consumption is in almost all civilized countries the most extensively and inevitably fatal of diseases. Again :

The frequency of consumption in Gt. Brit. is usually such that it carries off one-fourth of its inhabitants; at Paris the mort. of consumption has been estimated at one-fifth, and at Vienna it is said to be one-sixth of the whole. But the mort. of Paris, and in the South of France, from consumption, have frequently amounted to one-fourth of the whole.

Dr. Young, however, wrote at a time when the name of phthisis or pulmonary consumption was extended to other pulmonary affections than those which have classed thereunder since the works of M. Laennec, Sir James Clark, and Dr. Lombard.

In 1821 there was pub. an English ed. of M. Laennec's great work [orig. pub. 1819], Treatise on the Diseases of the Chest, their Anatomical Characters, and Diagnosis by means of Acoustic Instruments; translated with Notes by John Forbes [2nd ed., with notes and life, 1827]. This work led to a more exact discrimination regarding, and classification of, chest diseases.

Mr. Marshall, in his Mort. of the Metropolis, pub. 1832, reviewing the causes of death as shown in the B. of Mort. during a period of 204 years, 1629-1831, says :-"Consumption, which forms so prominent a feature in the catalogue of diseases, may be regarded as remarkable for its uniformity, and more particularly if so viewed in relation to Asthma and Phthisis, with which it is blended from 1690 to 1700, and 1729 to 1739. Under CONSUMPTION, DEATHS FROM, we shall present to our readers the statistics which Mr. Marshall had before him.

In 1834 the mort. experience of the Equitable So. was pub. Out of a total of 4095 deaths which had occurred from 1 Jan. 1801 to 31st Dec. 1832, 339 were attributed to C. Of these 4 occurred between the ages 10-20; 23 between 20-30; 63 between 30-40; 83 between 40-50; 81 between 50-60; 66 between 60-70; 18 between 70-80; and I above 80. This gives 24'5 p.c. for the age 41-50; 24 p.c. for the age 51-60; and 25 p.c. above 60-that is 73'5 p.c. after 40, and 49 p.c. after 50. Prof. Christison, reviewing these figures in 1853, says :—“Great errors must have crept into the data supplying such results." The reasons which induced the learned Professor to take this view will appear when we come to review his labours (see 1853).

In 1835 Sir James Clark pub., Treatise on Pulmonary Consumption, and Inquiry into Tuberculous and Scrofulous Diseases in General. This work created much attention. The author furnishes the following estimate of the proportions of deaths from C. for the 121 years ending 1821 :

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The deaths from C. were to
all the deaths of the year (

*145

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*245 or 1 in 4

of the whole

General average for the 121 years,

and he added at the date of writing (1835), "It now appears to constitute mort." Sir James illustrates in various ways the influence of sex and age in the production of phthisis. Thus, in chapter 8, T. are given exhibiting the mort. from phthisis in persons above 15, in 7 cities in Europe and America, which show that in each city there is a pretty uniform decline in the ratio of deaths from phthisis from 20 years to extreme age (as has already been pointed out); and the facts furnished by the excepted city, Berlin, were at least a century old when used, having been furnished by Sussmilch. In Edin. the ratio was found to decline from 285 at 20 years, to 052 above 60 years; at Nottingham from 416 to 017 in the same period of time; Chester, from 245 to 054; at Carlisle, from *290 to 097; and at Paris, according to Louis, from 325 to 042; while the general average decline was from 285, or 28.5 p.c. at 20-30, to 078, or 7·80 p.c. above 60. De Morgan, in his Essay on Probabilities, pub. 1838, says:

The experience of any one índividual might lead him to say that it is no uncommon thing for three or four times as many persons to die of Consumption in one period of five years as in the previous period; but the experience of one large city will show that such is not the case. The B. of Mort. in Lond. showed the following results: the upper line denoting the last year of the 5 in question, and the lower line, the average number in every 1000 deaths which were caused by Consumption, or what was called such:

1732
135

1737
163

1742
165

1747
180

1752
187

1757
197

There is nothing like enormous fluctuation. The gradual increase of the number shows an increasing tendency to the complaints then described under the head Consumption, but cannot be called fluctuation, being itself regular.

The learned Professor overlooked the effect of increase of pop.

In 1838 there appeared in the Statis. Journ. [vol. i., p. 142], an extract from the Croonian Lectures of Dr. John Clendinning, M.D., On the Relative Frequency of Pulmonary Consumption and Diseases of the Heart, wherein is given the following:

Between May, 1821, and May, 1835, there have been recorded in the journals of the Marylebone Infirmary, under 18 principal heads of disease, 3753 deaths, exclusive of about 640 deaths from minor causes. Of the total, amounting to nearly 4400 deaths, 991 (viz. 542 males and 449 females) were deaths from phthisis (and mostly in the larger sense of the word, as used by Dr. Young), which gives a per-centage of 22 on the whole mort. of the 14 years.

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He adds, "For my part, I have no doubt at all that the greater part of the so-called consumptions in persons above 30 years of age has been, in reality, mere chronic catarrh, complicated with disease of the heart, and emphysema of the lungs.' In support of this view he gives the annexed T., compiled by his brother, Dr. G. Clendinning: Of 1044 deaths from phthisis occurring in the workhouse and infimary, jointly, of the parish of Marylebone, between May, 1821, and Dec., 1835, the distribution according to age was as follows:

He says further:

Per-centage proportion of each year.

No. of deaths from Phthisis.

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Totals

1044

100'0

According then to the above, and Sir James Clark's T., the distribution of phthisis according to age is nearly such as I have stated, viz. phthisis declines in frequency soon after puberty, and has been comparatively rare in middle life; when it is for the most part superseded, as I conceive, in frequency and fatality, by morbus cordis; and in extreme age it has disappeared altogether.

In 1838 Captain A. M. Tulloch read a paper before the Statis. So. of Lond., On the Sickness and Mort. among the Troops in the West Indies, prepared from Official Documents In part i. of this paper, embracing what is technically called the "windward and leeward command," out of 9975 cases of "diseases of lungs," admitted into hospital in 20 years, 1023 are attributed to Consumption, and of this number admitted, 580, or more than onehalf, died. The author says, "Not only is Consumption productive of great mort. in this command, but inflammation of the lungs and chronic catarrh are nearly twice as prevalent, and twice as fatal, as among troops in Brit., thus showing how little effect a mere increase of temperature has in modifying these diseases." In part ii. of the paper, embracing the "Jamaica command," out of a total of 4357 cases of diseases of the lungs treated in hospital during a period of 20 years, 661 were returned as C., and of these 315, or nearly one-half, died. The author says:

As an instance how much more prevalent Consumption is in this country than in Gt. Brit., it may be stated that out of an aggregate strength of 51,567 serving in Jamaica, 661 have been treated for that disease, being 13 p. 1000 ann.; while of 44,611 Dragoon Guards and Dragoons in the U.K., only 286 have been treated, or between 5 and 6 p. 1000 ann. This is the more remarkable as catarrhal affections and inflammations of the lungs are much less common than in this country.

In 1837 M. H. C. Lombard pub. in Strasbourg, Recherches Anatomiques sur l'Emphysème Pulmonaire; and in 1839, at Geneva, Tératologie: Cas d'obliteration presque Complète de l'Artère Pulmonaire. These works became speedily known in Gt. Brit., and have attracted much attention. The writer found, from inquiries made at Geneva, that one of the principal causes tending to produce phthisis was the inhalation of air in which mineral and other dusts were floating. He showed that among polishers, sculptors, stone-cutters, plasterers, watch-hand makers, and others of that class, the proportion of consumptive complaints was 177 in 1000-the general average number of such cases in all the professions in Geneva combined being 114. But yet he considered, on the whole, "that the influences which modify the system in general, such as a sedentary life, etc., etc., are more active in the production of phthisis than those acting locally upon the lungs, as dust, vapours, etc.; and if we reflect that the latter agents are never present independently of the former, their real activity, as causes of pulmonary tubercles, is at best but problematical." He showed that of 1000 deaths from C., the following causes contributed in the relative proportions named in the figure col.: Occupations with vegetable and mineral emanations

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Sudden movements of arms
Muscular exercise and active life

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176

116 89

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Workshop life

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Hot and dry air

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Stooping posture

2 animal; 3 vegetable.

122 ...

The order of the respective fatality of "dusts" he found to be as follows: I mineral;

In 1839 there was prepared by Captain [now Major] Tulloch, a Report, On the Sickness and Mort. among the Troops in the U.K. From an abstract of this document, prepared by Mr. J. W. C. Lever, and read before the Statis. So. in 1839 [vol. ii., p. 250], we draw the following details. The mort. of the Foot Guards during a period of 74 years under obs. was found to be 21'60 p. 1000, or nearly one-half higher than among the Dragoon Guards and Dragoons. The paper says:-"The principal diseases to which this high ratio of mort. is attributable are diseases of the lungs, amounting to 14'1 p. 1000 of the mean strength; whereas the mort. from diseases of the lungs among the Dragoon Guards and Dragoons amounts only to 77 p. 1000 of the mean strength. The ratio of deaths from all other diseases, or causes of death, is 7.5 p. 1000 in the Foot Guards, and 7.6 p. 1000 in the Dragoon Guards and Dragoons." It was shown that this high ratio of mort. did not arise from residence in the metropolis. Passing to the mort. of the combined troops, we find, under "Diseases of the Lungs," the following:

If the mort. in the Foot Guards, which must be considered an exception, be excluded from the comparison, the loss in the other corps by this class of diseases approximates so nearly that there is little difficulty in fixing an average:

In the Dragoon Guards and Dragoons it amounts ann. to

Household Cavalry

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West India Depôts

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Foot Guards

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Per 1000 of strength.

7'7

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8.1

9'6

216

As some part of the excess in the West India depôts may prob. be attributable to the climate of the
West Indies, which has a much greater tendency to produce Consumption than that of this country,
we may assume that the average mort. from diseases of the lungs throughout our army, exclusive of
the Foot Guards, is about 8 p. 1000 ann.
Of the fatal cases of disease of the lungs, nearly

four-fifths arise from Consumption, being as many as from all other causes of the army at home. The
highest estimates in civil life rate the mort. from this disease at one-seventh of the deaths at all ages; or,
if the obs. be confined to adults alone, it may possibly amount to one-fourth part, which, at the utmost,
is only half as high as among the troops.

We now reach a period from which the obs. on C., as indeed on all other diseases and causes of death, are destined to become the subject of much more exact and systematic investigation. In 1837 the Gen. Regis. Act came into operation. In 1839 the first Rep. of the Reg.-Gen. was pub. Dr. Farr's letters on the causes of death constitute a feature in these Reports, and from these we shall now have frequent occasion to quote. The attention of this learned man was speedily drawn to the subject of Consumption. In the first Rep. he tells us Consumption and Decline carried off more females than males, "in the ratio of 4135 to 3771." In the 2nd Rep. we find the following:

The higher mort. of English women by C. may be ascribed partly to the indoor life they lead, and partly to the compression, preventing the expansion of the chest, by costume. In both ways they are deprived of free draughts of vital air, and the altered blood deposits tuberculous matter with a fatal, unnatural facility. 31,090 English women died in one year of this incurable malady! Will not this impressive fact induce persons of rank and influence to set their countrywomen right in the article of dress, and lead them to abandon a practice which disfigures the body, strangles the chest, produces nervous or other disorders, and has an unquestionable tendency to implant an incurable hectic malady in the frame? Girls have no more need of artificial bones and bandages than boys.

There are in this same Rep., under "Diseases of Towns and of the open Country," some remarkable facts regarding the effect of density of pop. upon certain diseases. We give an abstract of so much of the T. as relates to C.

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It is here seen that in the districts with the least density, the deaths from C. were 375, and in those of most density 485 to 100,000 living; while other lung diseases caused 914 deaths in the most dense, against 659 in the least dense districts, out of the same numbers living.

It was further shown that in the entire metropolis, with a density of 26,900 persons to the square mile, and a pop. of 1,885,000, the deaths from Consumption and other diseases of the respiratory organs were 14,288; while in the counties of Cornwall, Devon, Somerset, and Wilts, with a density of 219 persons p. sq. mile, and a pop. of 1,743,000, the deaths from the same diseases were 8664. It is well known that in Cornwall - one of the 5 counties here named-an excessive mort. prevails among the miners. [MINERS, MORT. OF.]

In the 3rd Rep. of Reg.-Gen., embodying returns for 1839, Dr. Farr says:

At the adult age, when Consumption chiefly prevails, the numbers of men and women living are nearly equal, yet 31,453 females and 28,106 males died of this disease. The ann. rate of mort. by Consumption was-males 003722, females 004015; in 1838 it was-males 003783, females 004077, denoting a slight decrease, which was more obvious in other diseases of the class.

In this Report, also, the mort. from different diseases in Lond. and 24 other city districts with an aggregate pop. of 3,769,000, was contrasted with the mort. from the same diseases

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in counties containing a pop. of 3,559,000, chiefly engaged in agriculture. Dr. Farr says hereon:

The tendency to Consumption was increased 24 p.c., to typhus 55 p.c. in the town districts; but as the absolute mort. from Consumption is three times as great as from typhus in towns, and nearly four times (373) as great in the country, the excess of deaths by C., caused by the insalubrity of towns, is greater than the excess of deaths by typhus-a fact which has hitherto been overlooked. Thus 24,094 deaths from C. occurred in the country, 32,436 in the town districts: the excess amounted to 8342 deaths. These facts have an important bearing upon considerations which will occur later in this art. (see 1858).

In 1841 Major Tulloch read before the Statistical So. a paper : Comparison of the Sickness, Mort, and prevailing Diseases among Seamen and Soldiers, as shown by the Naval and Military Statistical Reports [vol. iv. p. 1]. Under "Diseases of the Lungs," is given the following table :

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Upon this the following obs. are offered: The attacks by this class of diseases have been nearly twice as numerous among the naval as among the military force employed in the Mediterranean, but the mort. has been only half as great. On investigating, however, the different forms of disease comprehended under this head, it will be found that inflammation of the lungs, pleurisy, spitting of blood, asthma, and difficulty of breathing, prevail to almost precisely the same extent in both services; and that the difference consists principally in catarrhal affections and consumption. Of the former nearly double the proportion have come under treatment in the naval force, but not a fourth part so many cases have terminated fatally, owing, it is believed, to a greater facility for invaliding those in whom this disease assumes a chronic or serious form. To the same circumstance is prob. to be attributed the smaller proportion of consumptive cases in the navy, in which only 5'1 p. 1000 have come under treatment ann., while among the military the proportion was 6'70 p. 1000. Even the former ratio, however, is sufficient to show that the climate of the Mediterranean is far from exerting any decided influence in retarding the development of consumption, when persons are constitutionally predisposed to it; since the proportion attached of the naval force there is quite as large as among the civil pop. at home.

It will perhaps be deemed a remarkable feature of the preceding T. that only about one-third of the consumptive cases among the sailors appear to have terminated fatally; but so many were sent home and lost sight of after their arrival, that the deaths inserted in the returns can by no means be assumed as a correct measure of the ultimate consequences of this disease. The author of the naval report most justly observes that "if all were genuine cases of phthisis, the mort. must unquestionably have been much greater than what is stated in the returns."

There seems, however, little doubt that either the sea air or the excitement produced by the voyage do sometimes operate very materially in alleviating the symptoms of this disease. Many soldiers sent home from Malta, with the apparent symptoms of confirmed phthisis, have arrived in this country in renovated health, and speedily returned to their duty; and so marked has been the improvement in several instances, that within the last year increased facilities have, at the special request of the medical officers, been afforded for sending home invalids of this class. Thus, while the faculty in this country are sending their consumptive patients to Malta, the medical officers in that island are sending soldiers labouring under the same disease to England; and as benefit is supposed to be derived from the change in both cases, it seems much more likely to arise from the influence of the voyage than mere change of residence, especially as the proportion of deaths among those labouring under consumption is remarkably low on ship-board.

Mr. Wilde, in his Rep. on the causes of death in Ireland in connexion with the Census of 1841, informs us that C. is by far the most fatal affection to which the inhabitants of Ireland are subject-being to the deaths from all causes 1 in 8.75.

In the Appendix to the 5th R. of Reg.-Gen., relating to the returns for 1841 [pub. 1843], Dr. Farr gives much interesting information regarding C. He says (p. 370):

Diseases of the respiratory organs were fatal to 92,183 persons in 1841. The mort. which they occasioned was nearly 6 in 1000 [of the living]; it was 5911 in a million, or 132 less than in 1840, when 6043 in a million died of pulmonary affections. Of the decrease of 132 to a million, 55 was in pneumonia, and 75 in phthisis. The mort. by these two diseases remained, nevertheless, excessively high.

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