Page images
PDF
EPUB

the following statistics on deaths from C. appear: winter, 1872; spring, 1971; summer, 1745; autumn, 1914. The order of fatality in the years above quoted would therefore be :

1838. 1840.

"

1853.

[blocks in formation]

2, Winter;

[merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small]

3, Summer;

3, Winter;
3, Summer;
3, Winter;

4, Autumn.

4, Autumn.

[blocks in formation]

So far, therefore, as seasons are concerned, the above T. prove that spring-i.e., April, May, Juneis the most inimical quarter to phthisical patients; and that prob. autumn-Oct., Nov., Dec.-the least so. In Lond., at least, if not throughout England generally, the spring is undoubtedly the most obnoxious to consumptive cases; and this statement is in accordance with the experience of those physicians who have opportunities of seeing the rise, progress, and end of many hundreds of phthisical cases during the year. Dr. Richard Quain observes" that the cold easterly wind of spring completes the work which the winter had left undone."

In the Investigation Report of the Standard L., pub. in 1855, there is contained, "An Analysis of a Retrospect of the Emerged Risks of the Standard Assu. Co., from 5th Nov. 1850, to 5th Nov. 1855." The entire number of deaths was 423—of which 60 were attributed to C.:

C., the most important of all causes of death in their relation to assu., has occasioned an increase from 29 to 60 from one period to the other-that is, from 110 to 15'6 p.c. The causes of this increase are two in number. For first, the bus. of the Co. increasing in a geometrical ratio during the last ten years, throws into the newer period a larger proportion of those causes of death which operate chiefly in the early years of assu. life; among which causes C. stands pre-eminent; and, secondly, the spread of the practice of assuring has apparently extended to an earlier period of life, as shown by the much larger proportion of deaths from C. under 35 years of age (24 instead of 8) in the latter than in the earlier quinquennium. No improvement has taken place in the survivancy of the assured who have died of this disease. The 60 survived on an average only 5'7 years instead of 326, their average expectation of life-being a trifle more than a sixth of the natural term. In the last quinquennium it was exactly a sixth; so that it is prob. that the Co. must count on a loss of five-sixths of the expectation of life in the case of every assured person who dies of C. There is no class of cases therefore as to which so much care in selection is necessary.

In 1855 Herr Hopf, the then Manager of the Gotha Life Assu. Bank, communicated to the Assu. Mag. a paper on the results of the operations of that asso. during the first 25 years of its existence, 1829-53, "particularly with respect to the mort. amongst the lives assured." The total deaths in the period had been 4519; of these the deaths from "chronic diseases of the respiratory organs" amounted to 698. Consumption must be assumed to account for the far greater portion of these ; 23 of the deaths occurred between the ages of 15-30; 163 between 31-40; 239 between 41-50; 181 between 51-60; 84 between 61-70; 8 between 71-87. The "intensity" of this class in relation to the total deaths was 15-45; being slightly exceeded by "common fevers," which were the most prevalent cause of death in this inst. The "intensity” of diseases of the respiratory organs at different periods of life was as follows: age, 15-30, 28 40 p.c.; age 31-40, 26'21 p.c.; age 41-50, 2151 p.c.; age 51-60, 13.73 p.c.; age 61-70, 8.10 p.c.; age 71-87, 227 p.c. This high per-centage (which did not include influenza) has been much commented upon by subsequent writers.

In 1856 Dr. Brinton, M.D., pub. his useful little book, On the Medical Selection of Lives for Assurance, wherein occurs the following passage [we quote from 3rd ed. 1861]: Of all the hereditary complaints, pulmonary tubercle or Consumption is that which has the most important relation to L. assu. Careful inquiry entitles me to conjecture that the mort. from this disease, among lives properly selected, does not exceed one-tenth of its average share in the general mort. of the whole pop., as shown by the Reg.-Gen. returns. [Dr. Brinton says in a note, "I base this statement chiefly on my own experience as physician to a large assu. so."] And though much of this difference is ascribable to the class from which such lives are taken, and to the personal examination itself, yet much of it must also be attributed to the care which is usually exercised in inquiring into the hist. of this disease in the family of proposers for assu.

There is no tabular information as yet collected that affords satisfactory grounds for any exact estimate as to the frequency of hereditary Consumption. Accurately to diagnose the disease is often so difficult, that it is by no means every observer on whose statements we can rely. For example, nobody who is conversant with the details of sickness and death among the poor can suppose that in the many thousand infants ann. regis. as dying of Consumption, the statement is always (or even generally) based on a careful examination of the chest during life by an accomplished auscultator, much less by dissection after death. Mere inquiries of unprofessional persons respecting other members of their family affected with this disease are accompanied with a still greater (though somewhat kindred) vagueness. Some suppose C. and Decline to be quite distinct; and answer with a negative your question about the former, because they have heard the latter referred to. Others speak of asthma, bronchitis, pleurisy, and inflammation of the chest, in perfect ignorance that these terms may, and often do, conceal the primary tubercular disease on which they immediately depend. The latency of the predisposition already referred to involves us in another and equally serious difficulty. If we only search amongst the fathers and mothers of our cases, we shall certainly overlook a great many well-marked instances of transmission. But the disease itself is so frequent a cause of death as to produce about 1 death in 7, or 15 p.c. of the whole mort. Hence, enlarging the sphere of our inquiries in any given family soon increases the chances of our meeting with this disease to a degree that makes it all but impossible for us not to detect it in some relative. For example, let us suppose the person who is the subject of our inquiry can afford no information respecting his father and mother, and the two brothers and sisters, as well as the father and mother, of each of these parents. Here, within this circle of closest consanguinity, are to persons, viz. 2 parents, 4 uncles and aunts, and 4 grandparents, of whom on an average 1 will have died of C. Hence, except in numbers exceeding this average, mere deaths by Consumption afford no very safe conclusion.

My own inquiries among hospital patients decidedly consumptive, within this circle of relationship, are summed up by the statement that 90 p.c. had lost some one of the above relatives by what appeared to be the same disorder: and that instead of 1 out of 10 (the average mort.), about 3 had thus died.

The author is of opinion that, notwithstanding this strong hereditary tendency of the

disease, "we have no right to condemn a person on the mere suspicion which a single instance in his family can afford.” He then offers some "practical rules" which he thinks may guide in the selection :

There is an impression (which is favoured by some well-known facts in the physiology of generation) that the tendency to phthisis is more likely to be transmitted by a mother than by a father thus diseased. Other things being equal, it may be so. But such preponderance is often outweighed by a strong and predominant likeness of the offspring to either of these parents. For such an external likeness may well be supposed associated with an equal similarity of constitution; especially where it involves the framework of the thoracic cavity in which the disease chiefly shows itself. Hence, though the father of our subject of inquiry may have died of decline, still if he himself takes strongly after his mother, this resemblance to the healthier branch of his ancestry goes far to nullify the injurious suspicions which his father's death might otherwise have excited.

Where, in add. to a consumptive father or mother, you find a consumptive brother or sister, you will do better to decline the life. The influence of a consumptive grandfather or grandmother, in add. to a father or mother, is rather less decisive; because you will observe it is more dilute.

Where the father and mother have both died of C. there can be still less doubt. In the preceding cases the prob. of a consumptive tendency have been merely accumulated; but in this case they are multiplied-so multiplied that (as is well known) such unhappy unions sometimes end a family, by the successive deaths of every one of the offspring with this dreadful disease.

Where neither father nor mother have died of C., and where the deaths, collaterally and upwards, within the above limits, are equally free from disease, it will often be very hard to say what influence the deaths of brothers and sisters should have. You had better, I think, allow for numbers; and, for example: not permit 1 or even 2 deaths by C., out of 10 brothers or sisters, to decide you against an individual otherwise healthy. And, besides allowing for likeness (or the reverse) between the deceased relative and the subject of examination, you must recollect the influence of intemperance in the male, and of the few dangerous years that immediately follow puberty in the unmarried female. It will also be well to inquire at what ages consumptive brothers or sisters have died. Where they have all died, for instance, at or under the age of 25, and your subject of inquiry has already attained the age of 40, his danger has greatly diminished.

Indeed, in all cases, this diminution of the risk of C. with advancing age must be systematically allowed for. This decrease is such that at 40 half the danger is over; at 50 three-fourths in the male, and fourfifths in the female; at 60 but one-fourteenth remains, even in the male, in whom we may regard the liability throughout as about one-fourth greater than in the female (5 to 4).

In 1857 Dr. Stephen H. Ward, M.D., Medical Examiner to the London Board of Life Asso. of Scotland, pub. a little book: On the Medical Estimate of Life for Life Assu. The author says:

The prominent position which C. occupies in the mort. T. of this country is due far more to its undoubted and constant hereditary transmission than to any peculiarities of climate. It is evident, consequently, that the marked existence of this disease, in any great family, gravely affects the value of life of the survivors. To non-professional men it seems a hard matter to decline a life, otherwise of first-class character, simply because strumous disease has carried off certain relatives of the present or past generation. It is nevertheless a sound principle of action in L. assu.; and the medical advisers of offices now make it a pretty general rule to recommend the rejection of a life when so many as two immediate relatives have died of C.

It must be borne in mind that the existence of the strumous diathesis is shown not only by pulmonary phthisis, but also by diseased joints, curvature of the spine, certain eruptions, as lepra and psoriasis, glandular swellings, etc.

In the 21st R. of Reg.-Gen. (returns for 1858), Dr. Farr says, under "Causes of Death":

The constitutional class, which includes, with a few others, dropsy, cancer, and the tubercular diseases, though doubtless subject to a great extent to human arrangements, will be modified chiefly by processes that are necessarily gradual, and less by the fluctuations of heat and cold. The deaths referred to it were 82,416; and they discover little difference in amount from those of former years. It may be remarked that supposing the pop. of Lond. is now rather more than double that of the Welsh division, the rate of mort. which they suffer from phthisis was nearly the same in 1858, though the two divisions are widely different in important circumstances. But other pulmonary diseases, bronchitis, pneumonia, asthma, etc., were more than three times as fatal in Lond. as in Wales. Though N. Wales and South agree in their ann. average rate of mort. (2 p.c.), yet in 1858 N. Wales contrasted favourably with the southern portion of the Principality as regards the mort. from phthisis, and still more favourably as regards that from other pulmonary complaints.

In 1858 the Royal Commission appointed to inquire into the sanitary condition of the Brit. Army, the state of the hospitals, etc., pub. its Report. This was a most valuable and important document. It disclosed a frightful state of things, and showed that whatever the primary cause of the great mort. of the army might be, the immediate cause of it was the prevalence of C. to an extent quite unprecedented, and quite unknown in connexion with any other series of obs. in the entire range of V. Statistics. Without any corresponding increase of deaths from other causes, those from diseases of the respiratory organs, taking all branches of the army, amounted to about 60 p. c. of the deaths from all causes. The Commissioners, finding that C. was the great scourge of the army, entered upon a consideration of the prob. causes of this state of things, and came to the conclusion that it must be attributed mainly to the overcrowding of the barracks, in which consideration the absence of proper ventilation was comprehended.

In 1858 Mr. F. G. P. Neison read before the Brit. Asso. Meeting at Leeds a paper: On Phthisis in the Army. His object was to combat at least to some extent the conclusions of the Commissioners as set forth in the R. just passed under review. He says: If it be true that the increasing density of pop., particularly in the sense in which it is understood in regard to barracks' sleeping accommodation, has a tendency to augment diseases of the lungs more than all other diseases, then it is evident that districts in which the sleeping accommodation differs so widely must show a marked difference in the ratio of deaths taking place from phthisical causes. No doubt the results of the influence of a uniformly and generally increased density of pop. in a district which is not, in any considerable portion of it, highly intensified in its overcrowding, would be unfairly compared with the results of a district or section of pop. which is thoroughly overcrowded. Although, therefore, there is no one district of the kingdom in which there is a uniform

system of overcrowding, still there are many in which the overcrowding of large portions of them is such that, if the hypothesis be of any value, there must be at least a slightly augmented ratio of deaths from C. compared with the general ratio of increase from all causes. Let us see how far this is in agreement with recorded facts.

He then enters upon the inquiry indicated. We do not propose to follow him, but must rest content with his own statement of his conclusions:

A careful examination of the results given in this abstract leads to a conclusion quite at variance with the hypothesis of the Commissioners. In fact in the densest districts, the mort. from diseases of the lungs is relatively to the deaths from all diseases much less than in the more thinly pop. districtsIn Lond. the deaths are... In England and Wales

[ocr errors]
[ocr errors]

...

...

44'8 p.c. 46'5 p.c. And in the residue of the country, after deducting the districts enumerated in Abstract C. 52'1 p.c. It will be seen that the effect of density and overcrowding is not to intensify pulmonary disease so much as the class of zymotic diseases.

In 1859 Mr. James T. Hammick, of the Gen. Regis. Office, read a paper before the Social Science Congress (meeting at Bradford), On the Relation between Density of Pop. and Mort. from Consumption. This paper was in fact a reply to Mr. Neison's paper just noticed-and we think a very complete and overwhelming one. The author remarks: It is proper to observe, however, that density of pop. does not of necessity imply overcrowding, although the latter may commonly be inferred wherever the degree of density is considerable. Overcrowding is of two kinds (1) on the superficial area; and (2) in cubic space-and either kind may exist independently of the other. In the country, where there is no surface overcrowding, a labourer's cottage may be so crowded by its inmates that disease may break out; while, as in the case of model lodging-houses and many well-ordered public inst., it is quite possible, by a suitable construction of buildings, to have a dense surface pop. living healthily because occupying a large cubical space. The distinction is highly important, but statistical data for estimating the separate effect of each kind of overcrowding are unfortunately wanting. We must therefore be content to be guided in the formation of general conclusions by such materials as exist.

He then proceeds to invite the attention of his readers to a comparison of the deaths from phthisis and other diseases of the respiratory system in the healthiest parts of England with those in London, Lancashire, and the country generally; and also to the influence of density of pop. on these diseases at different periods of life:

In default of a better standard of vitality, it will be convenient to employ for the purpose of comparison the mort. in the districts in which the sanitary conditions appear least unfavourable. The Reg.-Gen. has found in 63 districts, containing about a million of pop., the ann. mort. ranging on an average of 10 years from 15 to 17 in 1000. In these healthy, but not model districts, the inhabitants are scattered, and generally follow agricultural pursuits-but many sources of insalubrity exist in and about their dwellings. The density of pop. is 135 persons to a square mile, and the "proximity" or nearness of person to person is, on an average, 163 yards.

Here is the T. resulting:

[blocks in formation]

In the metropolis, owing to special circumstances, which will presently be adverted to, the deaths from phthisis are greatly reduced; yet we find that 286 persons in 100,000 die ann. as compared with 237 in the healthy districts; while from other diseases of the respiratory organs the Lond. rate of mort, was more than double that of the healthy districts. In Lancashire, where the aggregation of the inhabitants upon the surface of the soil is much denser than in any other county, Middlesex excepted, and where, if anywhere, the influence of density of pop. upon these diseases must be felt, the deaths from phthisis were 340, and from other pectoral diseases 364 p. 100,000-a mort. in excess of that of the healthy districts by 43 and 118 p.c. respectively. In the whole of England the deaths from phthisis were 18 p.c., and from other lung diseases 60 p.c. in excess of the healthy districts.

Again we are told, “Consumption is fatal to persons at all ages, from infancy to advanced life, but it is especially fatal at the soldiers' ages, between 15 and 35, when developed by the influences likely to call scrofulous diseases into action.' The following T. shows the comparative mort. at these ages, divided into three periods of 10 years, in the localities under consideration.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small]

85

It is thus seen that at the 3 periods of age, the excess of mort. in Lancashire was 25 p.c. at the first period, 19 p.c. at the second, and 47 at the third; and that the excess of deaths from other lung diseases in Lancashire was 35 p.c. in the first decennial period of age, 91 p.c. in the second, and 191 p.c. in the third.

The results for Lond. are exceptional, but they are precisely such as might be expected. At the earlier periods of age-15 to 35-the death-rate from phthisis was actually below that of the healthy districts, in the period between 15 and 25 in a very marked degree. The explanation of this fact is to be found in circumstances peculiar to the metropolis, where less than half the adult pop. consists of natives, the remainder being immigrants. The resolution to leave their homes in the country, "to go to Lond." for the purpose of seeking employment, is rarely taken by the sickly. At the census of 1851 there were not far short of 220,000 domestic servants of both sexes in Lond.; with this class good health is an essential qualification. The pop., therefore, is recruited from a select class of persons usually in the enjoyment of robust health, and not likely, for a time at least, to augment the mort. from pulmonary disease. Another circumstance which undoubtedly contributes to diminish the deaths from C. at the earlier ages is the removal of young and unmarried persons, when they become afflicted with tubercular disease, to their homes in the country, where they die.

At the more advanced ages-from 35 to 45-when the immigrants, having become settled as Lond. residents, succumb under the influences which develop C., the T. exhibits a widely different result; for the deaths in the metropolis are raised to 493 p. 100,000 living as compared with 330 in the healthy districts.

Looking at these facts-and they might have been greatly multiplied-I think there is no avoiding the conclusion that density of pop. exercises a powerful influence in producing a high tubercular mort. No doubt overcrowding in dwellings and of dwellings is only one cause of many which contribute to this result; but the fact that it is a cause cannot be too frequently brought under notice, or too urgently pressed upon the attention of those who may help to remedy an evil which is not only a fertile source of disease, but also indecency and crime.

Again :

I cannot subscribe to Mr. Neison's theory that because increased density of pop. exhibits statistically
a more moderate increase of mort. from pulmonary diseases than from diseases of the zymotic class,
that therefore an excessive mort. from the former class of diseases cannot be due to overcrowding.
My object has been simply to investigate the relation which exists between populousness and one
important class of diseases, without extending the inquiry to the whole range of human maladies.
It may be said, and with considerable truth, that much of the excessive mort. from C. in towns is
attributable to the influence of occupations. But is it not true that-except in the trades which induce
pectoral complaints by the direct application of local irritants to the lungs-the insalubrity of the
occupation arises from the vitiated atmosphere breathed by large numbers of persons in crowded and
ill-ventilated workrooms: one of the worst forms of overcrowding? In the army, however, the
enormous mort. from phthisis was traced to occupation; but deficient cubic space and defective
ventilation went hand in hand in barracks, and the results are known to the world.

Finally:

Consumption must not be looked upon as a disease peculiar to our climate, and therefore not admitting of mitigation or prevention, but as a disease often clearly traceable to the impure air of closely-packed dwellings, crowded workshops, workrooms, and factories. As most of the predisposing causes of fever are also those of pulmonary disease, every effort we make to banish the one will help to rid us of the other. Let the towns be rendered healthy by a careful attention to the known means of preserving public health; let landlords and public cos. erect improved dwellings for the working classes; let employers, if influenced only by enlightened selfishness, see that their workpeople are not crowded together in ill-conditioned workrooms and factories; let parks and playgrounds be provided; let out-door games and athletic exercises be encouraged; let barracks, workhouses, and other public institutions be constructed and regulated in such a manner as to insure ample space for every inmate;-and it is not too much to say that the results of these beneficial arrangements would be the saving of prob. a third part of the lives now sacrificed to this terrible class of diseases, which numbers about 100,000 victims in England every year.

Dr. Farr says, in 22nd R. of Reg.-Gen.-returns for 1859:

Tuberculous diseases, including phthisis or C., the most fatal of all, increased from the year 1850 to 1853, and since that year have again decreased, and most decidedly if we take the increase of pop. More than 3 in a 1000 of the pop. died of these diseases, which caused 15 out of every into account. 100 deaths. Phthisis was the cause of 12 out of the 15 deaths.

In a paper by Mr. H. W. Porter, B. A., read before the Inst. of Act. in 1860, On some Considerations suggested by the Ann. Report of the Reg.-Gen., being an Inquiry into the Question as to how far the Inordinate Mort. in this Country, exhibited by those Reports, is Controllable by Human Agency [vol. ix. Assu. Mag.], there occurs the following passage: It will not, perhaps, be considered that I am asserting too much when I say that the mort. under this head is, in a great measure, produced by causes which are more or less under human control; and the classification of the occupations followed by those who fall a prey to C., which it will come within the province of the Reg.-Gen. to make, will serve, in course of time, to point out in what direction public attention must be turned, with the view to ascertain what may be the influence of the unhealthy nature of certain occupations and of peculiar local influences upon the duration of life, and to show our legislators how it is within their power to ameliorate the unhappy condition, in respect to health and longevity, which may by such means be made apparent, and possibly, moreover, to place in the hands of the medical profession the means of grappling with a disease which is the great terror of their country, and which has hitherto defied all human skill, and entirely baffled medical

science.

In a later or continuation paper on the same subject, Mr. Porter offers the following obs., which have a practical value in relation to L. ins. :

One great cause of the maintenance of the high rate of mort. from phthisis is, no doubt, the intermarriage of persons in whom the hereditary taint of this disease exists. There is a theory put forth by Walker, that if one parent be afflicted with pulmonic disease, it is an even chance that any one child that may be the result of the marriage of two persons so situated should derive the organs of the chest from the parent so afflicted; and it has been suggested that this theory might account for the very capricious selection that this disease makes in the different members of the same family for its attacks.

Be this as it may, we know perfectly well that the hereditary transmission of this malady is an undoubted fact; and assu. cos., whose experience is so large on such points, very generally feel called

upon to reject applicants for L. assu., whose apparent health may be undoubted, when several cases of phthisis have occurred among the members of the family. Some cos. indeed think that it is safer to reject the case when the father or mother, or even one brother or sister, has died from this disease, if the applicant be young-say under 45.

In Walker's work on Intermarriage another theory is broached, viz. that under certain restrictions, the male gives to the progeny the external or locomotive organs, and the female the internal or vital organs. Arguing from the analogy of breeding among animals, this is more than a mere theory; and the fact is well known to breeders of stock. So much, indeed, do certain known laws with respect to propagation prevail, and so thoroughly have they been made the subject of scientific investigation, that a cattle breeder can produce, within certain limits, almost any class of animal he desires.

If we recognize the truth of this second theory, the necessity for extreme caution, on the part of the L. assu. cos. in accepting the lives of individuals whose mothers have died from any hereditary disease, becomes clearly apparent. Still arguing from what has been proved to be the case with respect to animals, assu. cos. might, with reason, carry their inquiries into the family hist. of lives proposed for assu. much further than they have yet thought of doing. It would, perhaps, startle a person desirous of assu. his life, to ask him whether his mother had been married previously to her marriage with his father, and if so, whether her former husband died of phthisis; and yet this would not be by any means a ridiculous inquiry.

Mr. Porter, with a view of following up certain branches of the inquiry upon which he had entered, applied to the authorities of the Brompton Hospital for C. and Diseases of the Chest. From the returns so obtained, he deduced (inter alia) the following conclusions:

The result of the medical inquiry based upon the facts recorded in the above cases showed that there was a greater liability to phthisis in males than in females. I mention this, as the result is stated to be not in accordance with the opinion entertained on this subject by writers of authority in this country, or on the Continent.

The intensity of the disease, judging from the hospital statistics, appears to be between the ages of 25 and 35 for males, and at ages a little younger for females.

The question of the contagious nature or otherwise of phthisis, as bearing upon the production of this disease, is not an unimportant one. The difference of opinion, however, on this point appears to be very great, and the evidence on the subject to be very contradictory. As long, however, as the question admits of a doubt, it would certainly be well to be on the safe side, and at all events to avoid needless exposure to contagion. The medical report of the hospital contains the results of a most interesting investigation into the question of the hereditary predisposition to phthisis.

With reference to the transmission of the disease, we learn from the report that it has been observed that one or more of several children of the same individuals may exhibit traces of the disease of their parents, and yet the other children of the family, though not apparently diseased themselves, may, on becoming parents, transmit to their offspring the elements of the disease, which only requires some exciting cause for its development, Thus a diseased parent in one generation will have offspring to all appearance healthy, and in the next generation apparently healthy parents will be found to have diseased children.

The result of the inquiry of the medical officers of the Brompton Hospital, as to the proportion of cases on the books in which hereditary taint could be traced, showed that out of 1010 cases, comprising 669 males and 341 females, 122 males and 124 females, forming 18 and 36 p.c. respectively of the whole, or 24 p.c. of males and females combined, were born of phthisical parents; or, in other words, 1 in every 4 patients, nearly, of the 1010 cases under obs., was traced to be hereditarily predisposed to the disease. It appears, too, that females are more likely to inherit the disease than males, in the proportion of 2 to 1.

With a view to show how very large is the comparative proportion of those who appear to inherit phthisis from their parents-and accordingly to show how peculiarly severe the power of the hereditary transmission of this disease is-a comparison was instituted with the similar power in cases of insanity, which is also known to be, unhappily, too frequently transmitted through successive generations; and the result was, that 11'9 p.c. males and 13.4 p.c. females-or combined 124 p.c. of the cases under obs. -were born of insane parents. The prob., therefore, of the hereditary transmission of phthisis, as compared with that of insanity, is, taking both sexes together, as 2 to 1; and while the prob. of inheriting phthisis, as just shown, is twice as great among females as among males, that of a similar transmission of insanity only 1p.c. greater.

Again :

As regards the hereditary transmission of phthisis, another investigation of the statistics of the Hospital for Consumption at Brompton showed, that where one parent only was affected with pulmonary disease, the fathers being so affected transmitted their disease to their sons in 63 out of 106 cases, being 59'4 p.c. of the whole number obs. ; to their daughters in 47 cases only out of 108, being 434 p.c.: while the mothers, being phthisical, transmitted the disease to their sons in 43 cases, being 406 p.c.; and to their daughters in 61 cases, being 564 p.c. of the cases under obs. Judging therefore from these figures, it would prob. appear, if a large number of cases were regis., that the power of transmission of disease by phthisical fathers to their sons, and by phthisical mothers to their daughters, is about the same. Very similar-in fact almost identical-results are shown by a similar comparison of the statistics of insanity.

We shall all agree with the author of the paper under review that:

The information which is the result of such inquiries as these cannot but be of great interest to those connected with the bus. of L. assu., and of the highest importance to the cos. themselves, if they wish, not as a matter of course, to reject applicants for L. assu. in whom an hereditary taint is suspected; in fact if they desire to act upon the principles which are the result of actual inquiries, instead of treating the cases brought before them in an arbitrary and unscientific manner, as they are now very much obliged to do.

Under OCCUPATIONS, INFLUENCE OF, other facts deduced from Mr. Porter's papers, and bearing upon Consumption, will be dealt with.

In 1860 Dr. James Begbie, M.D., pub. in a pamph. form his 3rd Rep. On the Causes of Death in the Scottish Widows' Fund L. Assu. So. from Jan. 1853, to Jan. 1860. Out of a total of 975 deaths during the septennium, 66 were attributed to C., being at the rate of 634 p.c. of the deaths, and showing a slight increase over that of the Report of 1853. Of these 66 deaths-of which 58 were males and 8 females-9 occurred between ages 20 and 30; 16 between 30 and 40; 22 between 40 and 50; 16 between 50 and 60. The learned compiler of the Rep. says:

No great improvement can be expected in the average survivancy of our C. risks, except by a rigid

« PreviousContinue »