THE

BRITISH AND FOREIGN

MEDICAL REVIEW,

FOR JANUARY, 1846.

PART FIRST.

Analytical and Critical Reviews.

ART. I.

1. The Sixth Annual Report of the Registrar-General of Births, Deaths, and Marriages, in England, 1845.

2. Contributions to Vital Statistics: being a Development of the Rate of Mortality and the Laws of Sickness; from original and extensive Data, procured from Friendly Societies, showing the Instability of Friendly Societies," Odd Fellows," "Rechabites," &c., with an Inquiry into the Influence of Locality on Health. By F. G. P. NEISON, F.L.S., &c., Actuary to the Medical Invalid and General Life Office. Read before the Statistical Society, March 17, 1845.

3. Facts connected with the Social and Sanitary Condition of the Working Classes in the City of Dublin, with Tables of Sickness, Medical Attendance, Deaths, Expectation of Life, &c. &c.; together with some Gleanings from the Census Returns of 1841. By THOMAS WILLIS, F.S.S. Dublin, 1845.

4. On the Duration of Life among the Families of the Peerage and Baronetage of the United Kingdom. By WILLIAM A. GUY, M.B. Cantab., &c., &c. (Extracted from the Journal of the Statistical Society for March 1845.)

It is always an agreeable task to pass under review a periodical publication which bears on the face of it evidence of a continual striving after progress and improvement. This pleasure is provided for us year by year in the Reports of the Registrar-General. The one which is now before us is the largest, and, in many respects, the most interesting and important of the six which have issued from Somerset House. It contains, in addition to the usual Report and detailed abstracts of births, deaths, and marriages in England and Wales, a series of foreign official returns, of which the greater part was procured for the Registrar-General by the Earl of

XLI.-XXI.

1

Aberdeen (at the instance of Sir James Graham,) through the Foreign or British Ministers, and the remainder from Dr. Elliott of Stockholm, M. Hoffman of Berlin, and M. Moreau de Jonnes of Paris. Returns have been obtained from Sweden, Norway, Denmark, Russia, Austria, Prussia, Saxony, Hanover, Frankfort, Bavaria, Wurtemburg, Netherlands, Belgium, France, Portugal, and the United States of America. We shall presently have occasion to notice some of the results obtained from these sources.

After the abstracts for England and the several continental returns, which together occupy 500 closely-printed octavo pages, we are favored with a series of very valuable dissertations by Mr. Farr, headed respectively “Public Health," "Summary of results deduced from the English Life Table," "On the properties and applications of the New Life Table, and an account of some improvements in its form," "The annual mortality and the mean age at death," English Joint-Life Table," "Life Insurance," &c. &c. These dissertations occupy upwards of 150 pages, and abound in tables, which must be of the first importance to the actuary.

These tables are not of a nature to admit of analysis in this place; we must, therefore, content ourselves with this reference to them, reserving only certain parts of the essays, that entitled "the annual mortality, and the mean age at death," among the number, for criticism in connexion with Mr. Neison's valuable "Contributions to Vital Statistics." We cannot, however, refrain from pointing, in passing, to the valuable table at p. 655 of the Report, which, for the first time, presents us with the mean age at death of the inhabitants of England living at every age, and contains other useful columns. Some interesting applications of this table will be found at p. 661 of the 8vo edition of the Report.

There were registered, in England and Wales, in the year 1842, 118,825 marriages, 517,739 births, and 349,519 deaths, being an excess of births over deaths of 168,220. Taking the average of four years, 1839-1842, 1 person in 130 was married, 1 in 45 died, and 1 child was born to 31 persons living. The marriages have decreased during that period from 1 in 126 to 1 in 136, the births have increased up to 1841, and the deaths were highest in 1840, and lowest in 1841. The years 1841 and 1842 have exhibited little difference in the relative number either of births or deaths: 1 in 64 of the male population, and 1 in 66 of the female population married annually; there was 1 birth to 15 males and to 16 females living; and the mortality of males was 1 in 44, and of females 1 in 47, or, to be more accurate, 2.294 and 2·124 per cent.

An interesting comparison is instituted between the marriages, births, and deaths in England and the four principal European states: France, Prussia, Austria, and Russia. It appears that during the last few years to which the returns refer, there have been fewer marriages in England than in any of the larger European states. While in England there is only 1 marriage in 131 persons living, there is 1 in 124 in Austria, 1 in 121 in France, 1 in 113 in Prussia, and 1 in 99 in Russia. The births, as might be anticipated, are also in defect in England. The relative numbers being as follows: England 1 birth in 35 persons living, Prussia 1 in 27, Austria 1 in 26, Russia 1 in 23, France alone presenting the equal ratio of 1 in 35, a conclusive proof that in France there are fewer children to a marriage than in England.

The number of illegitimate children registered in England and Wales in 1842 was 34,796; of these a somewhat larger proportion were males than in the case of legitimate births, for it appears that while among legitimate children there were 20 boys to 19 girls born alive, among illegitimate children there were 21 to 20. In all England there were 6-7 illegitimate births in 100 births, and it is not a little remarkable that nearly all the large towns stand below this average. The highest proportion anywhere observed is 18 per cent., the lowest somewhat above 1 per cent. The proportion of illegitimate children varies not less remarkably in different nations, for while Sardinia has so low a proportion as 2 in a 100, Bavaria has no less than 20 in the 100. Of 13 European states England takes the fourth place in regard to continence. The returns for the continental states confirm the well-known fact of the high mortality of illegitimate children. Thus, in Saxony, while 464 in 10,000 legitimate children were still-born, 616 in the same number of illegitimate children were stillbirths. The deaths during the first year in Saxony, Sweden, and Stockholm respectively, were 26, 16, and 26 per cent. of legitimate to 34, 27, and 40 illegitimate.

It now only remains to speak of the mortality of England, as compared with the continental states. The average annual mortality of the English population in the five years, 1838-42 was 2.209 per cent., or nearly 1 in 45; but in 1842 it was 2.167, or nearly 1 in 46. This is a more favorable rate of mortality than that which prevails in the chief European states. In France it is 1 in 42, in Prussia 1 in 38, in Austria 1 in 33, and in Russia 1 in 28.

The result of the registration for 1842, then, as compared with former years, and the movement of the English population as compared with that of the principal states of Europe, appears on the whole to be satisfactory. It is clear that we possess advantages which it is our duty and our interest to improve to the utmost. It will not do to compare ourselves only with our neighbours; we must take a much higher standard than that which any continental state affords, and be satisfied for the whole country with nothing short of the rate of mortality of its most favoured divisions. In the South-western and South-eastern divisions the mortality is stated at 1 in 52, and in no less than four counties (Sussex, Dorsetshire, Devonshire, and North Wales,) it is as low as 1 in 54. The time will, we trust, arrive when the entire country shall boast as low a mortality. In the mean while let it be our standard of excellence.

We have still to notice a valuable return of violent deaths and suicides registered in 1840. They amount to no less than 10,881, of which 900 were cases of suicide, and 65 were murders. If we take the instrument or means of death employed by suicides, the following will be the order of their frequency: hanging, strangling, and suffocation, 381; poisons 161; wounds 129; drowning 107; gun-shot wounds 45; leaps from heights 18; unascertained 60. Of the cases of suicides by poison 26 were by arsenic, 19 by opium, 3 by oxalic acid, and 113 by other poisons. Among the accidental deaths the following are deserving of notice: overdose of opium or laudanum, given or taken by mistake, 39; oil of vitriol, given or taken by mistake, 15; drinking boiling water (children,) 23; making in all 77 accidental deaths from these three causes.

Having now given our usual abstract of the Registrar-General's Report, as far as it refers to the number of births, deaths, and marriages, we proceed to present our readers with some account of the other works which stand at the head of the present article, especially of the very valuable and highly interesting publication of Mr. Neison.

We have already introduced Mr. Neison to our readers in an article on the "Vital Statistics of England and Wales ;"* and we then took occasion to express our dissent from the extreme views which he had adopted. We regret that he has imposed the same duty upon us on the present occasion; but ere we enter upon the discharge of it, we must express the strong sense we entertain of the value of Mr. Neison's labours. His facts and calculations may be implicitly relied on, though his conclusions are sometimes open to objection; and his liberality in stimulating and rewarding his contributors by prizes from his own purse must not pass without notice. The "contributions" too, consisting, to so great an extent, of tables, must have been published at great cost, and with little hope of a pecuniary return; so that on the whole, Mr. Neison has placed all who may profit by his labours under many and great obligations. The members of friendly societies, "Odd Fellows," "Rechabites," &c. must own themselves, in a peculiar manner, his debtors; and they will do well to listen to Mr. Neison's warning, ere it be too late.

The "contributions" consist of two parts, of which the first treats of the duration of life among different classes, and the second of the prevalence of sickness among the members of benefit societies.

The first part comprises several life-tables, which Mr. Neison uses as the foundations on which to build his deductions. By throwing his facts into this form he has obtained by far the most satisfactory data, and has avoided the error which he himself pointed out in an essay formerly referred to, of instituting comparisons from which an essential element (the ages of the living,) was omitted. On the superiority of life-tables to all other data for determining the sanitary state of nations, or classes of persons, Mr. Farr makes some very just observations. In the chapter of the Report,' headed "the annual mortality" and "the mean age at death," he proves satisfactorily that the mean age of the living has always been esteemed by the highest authorities as a necessary element in every just comparison of class with class and country with country; and he demonstrates the necessity of taking this circumstance into account, by comparing the expectation of life, as calculated from the ages both of the living and the dying, with the average age at death, and the number of living out of which one death takes place annually. From this comparison it results that there is a much nearer correspondence between the expectation of life and the mortality, than between the expectation of life and the average age at death. Thus, if we compare England, France, and Sweden, we find that they hold the same relation to each other in regard both to the expectation of life and the mortality, the order being England, France, Sweden; but in respect of the average age at death the three countries occupy a different position: France having the highest average age at death, Sweden holding the second rank, while England stands at the bottom of the scale. So also if we compare England, Surrey, the Metro

British and Foreign Medical Review, No. XXXV, p. 198.

polis, and Liverpool, there is the same correspondence between the expectation of life, as shown by the life-tables, and the mortality, while the mean age at death in England and the Metropolis is precisely the same, viz., 29 years, though the expectation of life for the former is 41 years, and for the latter only 37 years.

The necessity of employing life-tables as our tests of the sanitary condition of different classes, and of the inhabitants of different localities, is further illustrated by the anomalous results obtained by employing only the mean age at death. According to this latter method, Greenwich is the healthiest district of the Metropolis, for the obvious reason, that there is an accumulation of old men at Greenwich Hospital, who, dying at advanced ages, make the mean age at death high. By using the same onesided test, Rotherhithe is made to appear more healthy than Islington, Marylebone, and Pancras ; and Whitechapel takes a more favorable sanitary position than St. James's district and the city of London.

In adopting the life-table, therefore, as his test of the sanitary condition of the classes which he makes the subjects of comparison, Mr. Neison has made choice of the only perfectly unobjectionable standard; and we shall willingly admit that his facts and tests are unexceptionable, though, as we have already hinted, we shall not be quite so easily satisfied with his arguments.

"a

Mr. Neison first provides himself with a standard of comparison in the shape of a life-table of England and Wales, founded on the census for 1841, compared with the deaths as given in the 2d, 3d, 4th, and 5th Reports of the Registrar-General. Our readers may recollect that Mr. Farr's life-table was calculated on the mortality of the year 1841 alone; it is evident, therefore, that the average employed by Mr. Neison must form " broader and more satisfactory basis on which to found a measure of the duration of life in this country." On comparing the two life-tables with each other, Mr. Neison's table will be found to give a higher expectation, both for males and females, throughout the whole of life. At 60 years of age the difference amounts for the male to one year, and for the female to somewhat more than a year. It is somewhat singular that the difference between Mr. Neison's table and the Carlisle table, is, taking one period of life with another, still less than that which exists between the two tables just compared.

A standard of comparison thus obtained, our author proceeds to develope his views, and to reveal his scepticism with regard to the "supposed influence of locality on the duration of life;" and he justly observes that hitherto no public means have been employed to solve this question.

"For the progress of vital statistics it unfortunately happens, that the public records of this country are kept with very little regard to method or unity of plan. The Report of the Census may certainly in itself be regarded as a very complete document; and perhaps no other country possesses such excellent mortuary registers; yet for almost every purpose of exact calculation, both documents are nearly useless. No two things should have been more intimately related in design and classification, thau the census of the people and the registration of deaths. Still they seem to have been compiled without any regard to each other. For example, if it were required to compare any two counties in England--a manufacturing with an agricultural county-an inland with a coasting county-in order to determine the relative value of life in the respective populations, it cannot at the