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Looking Back. FROM THE LANCET, SATURDAY, Jan. 7th, 1832.
124
LOOKING BACK.-BRITISH MEDICAL BENEVOLENT FUND.
also 5 per cent. below the respective quinquennial Compared with the average in the previous averages. five years, there has been in each county group a fairly uniform fall in the general death-rate of each sex. According to the experience of 1908, which is confirmed by that of former years, the mortality in the urban area exceeds that in the rural at each of the several stages of life. This is especially true respecting children under the age of 10 years and adults at ages from 35 to 65, the greatest differ-ences being observed among children below the fifth year. On the other hand, the rates of 1903-08 agree with those of recent previous years in showing excess of mortality in the rural districts among young adults of both sexes-in men at ages 20-25, and in women at ages 15-35. This feature has been strongly marked in the case of young adults dying from pulmonary tuberculosis. There is nothing remarkable in the records of mortality from the more familiar infectious diseases, especially in those of children, in the year under notice, the mortality from small-pox, measles, whooping-cough, scarlet fever, and diphtheria being in each case below the average. From a sanitary point of view the fluctuations of mortality from enteric fever are regarded as of exceptional importance. The English death-rate from this disease was equal to 75 per 1,000,000 persons living at all ages and of both sexes, a rate which, with the exception of that for 1907, is the lowest on record, and is below the average for the quinquennium immediately preceding by 13 per 1,000,000. Among males the deathrate was equal to 94 per 1,000,000 of that sex and among females to 56 per 1,000,000. During the 40 years that have elapsed since the disease was first differentiated in these reports enteric fever mortality has fallen to less than a fifth of its former amount-namely, from a rate of 390 per 1,000,000 in 1869 to a rate of 75 per 1,000,000 in 1908. According to the experience of recent years the mortality from enteric fever is found to vary according as a given area contains a large or a small proportion of urban inhabitants. Taking both sexes together, urban mortality from this disease in 1903-07 exceeded rural mortality by 46 The excess was 55 per cent. among males and per cent. only 35 per cent. among females. From the experience of 1908 it would appear that urban and rural areas have shared almost equally in the saving of life that is represented by the fall in the death-rate. In the urban areas the decrease has been greatest among females ; in the rural it was shared equally by each sex. Both in the year 1908 and in the previous quinquennium the male rates of mortality from enteric fever exceeded the female rates at all periods of .life above the age of 15 years. As in the previous year the highest mortality in both sexes was observed between the ages of 25 and 35 years. From an interesting table we learn that among registration counties with populations exceeding 100,000 the highest crude rates of enteric fever mortality were 146 in Durham, 136 in Norfolk, 133 in Cumberland, 131 in Monmouthshire, 125 in Lancashire, and 105 in the West Riding of Yorkshire. In the county of Durham mortality was excessive in the districts of Sedgefield, Auckland, Lanchester, Easington, Houghton-le-Spring, and Chester-le-Street. The greater part of the county of Durham is included in the " northern area of high enteric fever mortality " which has in recent years become noteworthy in these reports. In this area the mean death-rate from enteric fever in the year under notice was 187 per 1,000,000, against an average rate of 169 per 1,000,000 in the previous five years. In the districts of Auckland, Easington, and Houghton-le-Spring the rates in 1908 exceeded 300 per 1,000,000. The high rate in Norfolk was due to excessive mortality in the city of Norwich, and that in Cumberland to an epidemic in the borough of Workington. In Lancashire several districts still showed high rates, while in the West Riding of Yorkshire the contiguous districts of Pontefract, Hemsworth, Barnsley, and Rotherham experienced a mortality greatly in excess of that in the remainder of the county. (To be continued.)
being
Looking Back. FROM
THE LANCET, SATURDAY, Jan. 7th,
CASE OF CHOLERA AT SUNDERLAND, WITH AN ANALYSIS OF THE BLOOD, TAKEN FROM THE PATIENT. BY WM. REID CLANNY, M.D., &c., 8underZand. &c. To the Editor of THE LANCET. SIR,-Agreeably with your request, I send you a case of Cholera, attended by Mr. Embleton of Sunderland, and also the results of my analysis of the blood. (The case was that of Elliot Todd, aged 33, who was attacked on December 12th at 2 o’clock A.M., and died at 7 P.M. the same day.) ANALYSIS OF THE BLOOD.
This blood, on applying the tongue to it, had no taste, nor any particular smell. I also tasted it again, sometime after it had been drawn. I afterwards tasted the colouring matter, the coagulated albumen, and the fibrin, but in them I found no taste, nor any smell. It contained no gases of any description ; was black as tar. I followed the plan which I have taken the liberty of recommending my professional brethren to pursue in the investigation of typhus and other diseases, and which I intend henceforth, for many reasons, to pursue. I shall give the results of an analysis of the blood of one of our sailors which was taken in October last. This blood contained one cubic inch of carbonic acid in the 16 ozs. which were taken. The
tioned
that at Sutton Dr. T. Colcott Fox is associated in the treatment with, and assisted by, Dr. H. G. Adamson and Dr. H. G. Critchley.
Elliot Todd.
Sailor.
Water
..................
Albumen, coagulated
.........
Colouring matter ............ Free carbon Fibrin dried ...... Muriates of soda and potassa, carbonate of soda and animal extraction ...............
pressed and
...............
756 121 59 32 18
14
......
644 31 253 66 6
......
0
......
......
......
......
1000
1000
I think it will be readily understood that as I did not see this case, it will be out of my power to make any comment upon it. The results of the analysis are most instructive, and by the medical philosopher must be regarded with astonishment. The blood in this .case possesses only two ounces of serum, which was like serum of healthy blood in I am, yours, &c., appearance. W. REID CLANNY. Sunderland, Dec. 31, 1831.
BRITISH
treatment
THE LANCET COMMISSION ON RINGWORM.-In the reports of our inquiry into the prevalence and of ringworm in the metropolis it ought to have been men-
1832.
MEDICAL BENEVOLENT
FUND.
meeting of the committee 20 cases were amounting to E18Z made to 17 of the applicants, two cases being passed over and one postponed for further inquiry. Appended is an abstract of the cases AT the December
considered and grants assisted :Widow, aged 66
years, of M.R.C.S., L.S.A. Practically unprovided for at recent death of husband, and children only able to give very and slight irregular assistance. Voted £12. M.D. Edin., aged 68 years. Used to have a large practice in Scotland but lost his savings by becoming security for relations. Now suffers from an incurable complaint. Voted £10, in two instalments, with leave to apply again in six months. Daughter, aged 54 years, of late M.R.C.S., L.S.A. Has exhausted small capital in the attempt to support herself by keeping a lodging house and is now penniless and in arrears with her rent. Voted ,c12. Widow, aged 38 years, of late M.D. R.U.I. Quite unprovided for at husband’s death about a year ago and is endeavouring to obtain a post to which she can take her only child, aged 9 months. Voted BIO. Widow, aged 64 years, of L.R.C.P., L.R.C.S.Edin. Permanently incapacitated by the results of rheumatism and dependent on a sister who is a teacher. Xo children. Voted ,c12. M.R.C.S., aged 81 years. Practised for 44 years in one place in the South-west of England, but was obliged to give up on account of the infirmities of age. Only income a small Poor-law superannuation allowance. Children unable to help. Voted B12. Widow, aged 74 years, of M.R.C.S., L.S.A., whose capital was
LOOKING BACK.-BRITISH MEDICAL BENEVOLENT FUND.
also 5 per cent. below the respective quinquennial Compared with the average in the previous averages. five years, there has been in each county group a fairly uniform fall in the general death-rate of each sex. According to the experience of 1908, which is confirmed by that of former years, the mortality in the urban area exceeds that in the rural at each of the several stages of life. This is especially true respecting children under the age of 10 years and adults at ages from 35 to 65, the greatest differ-ences being observed among children below the fifth year. On the other hand, the rates of 1903-08 agree with those of recent previous years in showing excess of mortality in the rural districts among young adults of both sexes-in men at ages 20-25, and in women at ages 15-35. This feature has been strongly marked in the case of young adults dying from pulmonary tuberculosis. There is nothing remarkable in the records of mortality from the more familiar infectious diseases, especially in those of children, in the year under notice, the mortality from small-pox, measles, whooping-cough, scarlet fever, and diphtheria being in each case below the average. From a sanitary point of view the fluctuations of mortality from enteric fever are regarded as of exceptional importance. The English death-rate from this disease was equal to 75 per 1,000,000 persons living at all ages and of both sexes, a rate which, with the exception of that for 1907, is the lowest on record, and is below the average for the quinquennium immediately preceding by 13 per 1,000,000. Among males the deathrate was equal to 94 per 1,000,000 of that sex and among females to 56 per 1,000,000. During the 40 years that have elapsed since the disease was first differentiated in these reports enteric fever mortality has fallen to less than a fifth of its former amount-namely, from a rate of 390 per 1,000,000 in 1869 to a rate of 75 per 1,000,000 in 1908. According to the experience of recent years the mortality from enteric fever is found to vary according as a given area contains a large or a small proportion of urban inhabitants. Taking both sexes together, urban mortality from this disease in 1903-07 exceeded rural mortality by 46 The excess was 55 per cent. among males and per cent. only 35 per cent. among females. From the experience of 1908 it would appear that urban and rural areas have shared almost equally in the saving of life that is represented by the fall in the death-rate. In the urban areas the decrease has been greatest among females ; in the rural it was shared equally by each sex. Both in the year 1908 and in the previous quinquennium the male rates of mortality from enteric fever exceeded the female rates at all periods of .life above the age of 15 years. As in the previous year the highest mortality in both sexes was observed between the ages of 25 and 35 years. From an interesting table we learn that among registration counties with populations exceeding 100,000 the highest crude rates of enteric fever mortality were 146 in Durham, 136 in Norfolk, 133 in Cumberland, 131 in Monmouthshire, 125 in Lancashire, and 105 in the West Riding of Yorkshire. In the county of Durham mortality was excessive in the districts of Sedgefield, Auckland, Lanchester, Easington, Houghton-le-Spring, and Chester-le-Street. The greater part of the county of Durham is included in the " northern area of high enteric fever mortality " which has in recent years become noteworthy in these reports. In this area the mean death-rate from enteric fever in the year under notice was 187 per 1,000,000, against an average rate of 169 per 1,000,000 in the previous five years. In the districts of Auckland, Easington, and Houghton-le-Spring the rates in 1908 exceeded 300 per 1,000,000. The high rate in Norfolk was due to excessive mortality in the city of Norwich, and that in Cumberland to an epidemic in the borough of Workington. In Lancashire several districts still showed high rates, while in the West Riding of Yorkshire the contiguous districts of Pontefract, Hemsworth, Barnsley, and Rotherham experienced a mortality greatly in excess of that in the remainder of the county. (To be continued.)
being
Looking Back. FROM
THE LANCET, SATURDAY, Jan. 7th,
CASE OF CHOLERA AT SUNDERLAND, WITH AN ANALYSIS OF THE BLOOD, TAKEN FROM THE PATIENT. BY WM. REID CLANNY, M.D., &c., 8underZand. &c. To the Editor of THE LANCET. SIR,-Agreeably with your request, I send you a case of Cholera, attended by Mr. Embleton of Sunderland, and also the results of my analysis of the blood. (The case was that of Elliot Todd, aged 33, who was attacked on December 12th at 2 o’clock A.M., and died at 7 P.M. the same day.) ANALYSIS OF THE BLOOD.
This blood, on applying the tongue to it, had no taste, nor any particular smell. I also tasted it again, sometime after it had been drawn. I afterwards tasted the colouring matter, the coagulated albumen, and the fibrin, but in them I found no taste, nor any smell. It contained no gases of any description ; was black as tar. I followed the plan which I have taken the liberty of recommending my professional brethren to pursue in the investigation of typhus and other diseases, and which I intend henceforth, for many reasons, to pursue. I shall give the results of an analysis of the blood of one of our sailors which was taken in October last. This blood contained one cubic inch of carbonic acid in the 16 ozs. which were taken. The
tioned
that at Sutton Dr. T. Colcott Fox is associated in the treatment with, and assisted by, Dr. H. G. Adamson and Dr. H. G. Critchley.
Elliot Todd.
Sailor.
Water
..................
Albumen, coagulated
.........
Colouring matter ............ Free carbon Fibrin dried ...... Muriates of soda and potassa, carbonate of soda and animal extraction ...............
pressed and
...............
756 121 59 32 18
14
......
644 31 253 66 6
......
0
......
......
......
......
1000
1000
I think it will be readily understood that as I did not see this case, it will be out of my power to make any comment upon it. The results of the analysis are most instructive, and by the medical philosopher must be regarded with astonishment. The blood in this .case possesses only two ounces of serum, which was like serum of healthy blood in I am, yours, &c., appearance. W. REID CLANNY. Sunderland, Dec. 31, 1831.
BRITISH
treatment
THE LANCET COMMISSION ON RINGWORM.-In the reports of our inquiry into the prevalence and of ringworm in the metropolis it ought to have been men-
1832.
MEDICAL BENEVOLENT
FUND.
meeting of the committee 20 cases were amounting to E18Z made to 17 of the applicants, two cases being passed over and one postponed for further inquiry. Appended is an abstract of the cases AT the December
considered and grants assisted :Widow, aged 66
years, of M.R.C.S., L.S.A. Practically unprovided for at recent death of husband, and children only able to give very and slight irregular assistance. Voted £12. M.D. Edin., aged 68 years. Used to have a large practice in Scotland but lost his savings by becoming security for relations. Now suffers from an incurable complaint. Voted £10, in two instalments, with leave to apply again in six months. Daughter, aged 54 years, of late M.R.C.S., L.S.A. Has exhausted small capital in the attempt to support herself by keeping a lodging house and is now penniless and in arrears with her rent. Voted ,c12. Widow, aged 38 years, of late M.D. R.U.I. Quite unprovided for at husband’s death about a year ago and is endeavouring to obtain a post to which she can take her only child, aged 9 months. Voted BIO. Widow, aged 64 years, of L.R.C.P., L.R.C.S.Edin. Permanently incapacitated by the results of rheumatism and dependent on a sister who is a teacher. Xo children. Voted ,c12. M.R.C.S., aged 81 years. Practised for 44 years in one place in the South-west of England, but was obliged to give up on account of the infirmities of age. Only income a small Poor-law superannuation allowance. Children unable to help. Voted B12. Widow, aged 74 years, of M.R.C.S., L.S.A., whose capital was