it orginates does not extend for more than three or four feet from the patient.

With respect to the structural lesions caused by the fever, they were found to consist in abundance or even excess of bile, and a pervious state of the biliary ducts, and more or less congestion of organs, with frequently extravasation of blood in various situations.

In the Fourth Chapter are detailed the principal Sequelæ of the Fever. These are thus summed up :-1. Ophthalmitis usually preceded by amaurotic symptoms. 2. Glandular swellings. 3. Boils and cutaneous eruptions. 4. Effusion into the knee-joint. 5. Swelled legs and ankles. 6. Pain in the feet, with and without swelling. 7. Paralysis of the deltoid and other muscles. 8. Sloughing of parts.

In the Treatment of this, as of every species of fever, the only general rule, which can be safely followed is that so correctly laid down by Cullen, and so urgently insisted on by Dr. Alison, viz. "to obviate the tendency to death;" with respect to the present epidemic there are, according to Dr. Cormack, three states most apt, either separately or conjointly, to cause death, and which, therefore, ought to be anxiously looked for, and, if possible, promptly corrected. They are

1st. Congestion of the mucous membrane of the stomach and intestines, terminating in effusion of blood and subsequent destruction of large portions of this tissue.

2nd. Congestion of one or more of the abdominal viscera, particularly of the liver and kidneys, disabling them from the performance of their secretive functions and thereby rendering the blood impure.

3rd. Debility and sinking.

The best means to prevent these evils are the cautious but steady use of purgatives, the determining of blood to the surface and extremities, and in some cases its abstraction. When the kidneys are not duly performing their functions, a small bleeding from the lumbar region by cupping, or even a dry cupping, in those in whom depletion would be hazardous, proves of great benefit. When there is debility and sinking, cordials must be administered; and, if this be combined with nausea or vomiting, they must be combined with sedatives.

With respect to the abstraction of blood, Dr. Cormack mentions that few of his patients bore the loss of more than ten ounces, and several became affected with vertigo and faintness, after two or three only had flowed. Some who, whilst the blood was flowing, declared themselves quite relieved from the head-ache, within half an hour after the arm was bound up were found to be suffering just as much as ever. He found that the most severe headaches were always far more effectually and uniformly relieved by the combined operation of a purgative, a pediluvium, and the constant application of cold to the head and the back of the neck. In several cases of pulmonary inflammation, Dr. Cormack found all the symptoms disappear under the use of antimony and morphia combined; or the liberal use of morphia and ipecacuan lozenges. These remedies, when used along with fomentations, sinapisms, or blisters, are safe, and generally efficient substitutes for local bleeding, in thoracic complications.

In a word, he conceives that the cerebral, pulmonary, and abdominal complications, in which it is proper to abstract blood, are extremely rare, and that in very many instances it is a most hazardous practice. In some of the more severe cases of abdominal pain, and extreme tenderness on pressure, the patients have been well brought through simply by the diligent use of copious warm poultices and fomentations. Enlarged and tender spleens have often done well with this simple treatment.

With respect to the application of cold to the surface, cold water to the head was, in general, found to be quite sufficient to allay the headache. In some instances, muriate of ammonia and other evaporating lotions were used. The aspersion of the arms and chest with cold water had the effect of calming several restless and irritable patients.

Medicines which act on the kidneys, when the urine was very scanty and scalding, and pain complained of in the loins, have proved serviceable -those used were the nitrate of potash, spirit of nitrous æther, and other diuretics. Warm fomentations to the loins, cupping, &c. act well in exciting the kidneys to renewed secretion, probably by preventing or moderating the congestion of these organs. Whenever alarming head symptoms occurred, associated with suppression of urine, he always directed attention to the kidneys.

We must here close our analysis of Dr. Cormack's monograph, in which will be found many and valuable practical remarks.

THE FIFTH ANNUAL REPORT OF THE REGISTRAR-General of BIRTHS, DEATHS, AND MARRIAGES IN ENGLAND. 8vo. pp. 324. London, 1843.

SINCE the first appearance of these Reports we felt it our bounden duty earnestly to recommend their attentive perusal to the members of the medical profession. The vast fund of valuable and practical precepts contained in them, whilst they evince the great skill and high scientific attainments of the gentlemen engaged in this department, cannot fail to prove of incalculable benefit not merely to those to whom the prevention and treatment of disease are more immediately committed, but to the public generally. Every page of the Report satisfies us that a steady advance is making towards the attainment of a more perfect system of registration, and that the attention of the Registrar-General is intently directed to the best means of removing all difficulties. From the very first appearance of these Reports, an obvious improvement was perceptible in every succeeding In none of these Reports, however, is this progressive improvement more decided or marked than in the present. It contains the Report of the Registrar-General, and the returns on which this report is founded, the marriages births and deaths in four years-the present state of mortality, both over the whole country, and in different districts and different towns-the mortality at different ages-the mode of construction No. LXXXI.

F

of Life-Tables-the principles on which they are constructed-their uses and mode of application for various purposes.

To this is added an Appendix, containing Mr. Farr's Letter to the Registrar-General, with accompanying Papers and Tables. The first Paper commences with the Construction of Life-Tables, in which he employs the differential method. Then we have a Paper headed Public Health, containing details of the zymotic and sporadic diseases which prevailed during the year 1841, and an elaborate account of the deaths by different causes in the four years 1838-41. Then an Abstract of the Causes of Death registered in the year 1841 in the towns and the open country, with an elaborate detail of the causes of the high mortality in town districts. Next follows an account of the causes of the mortality at different periods of life, &c. &c. Having now presented a summary of the contents of this excellent volume, we proceed to our analysis of those contents.

The present volume commences with a General Abstract of the Births, Deaths, and Marriages registered in England, during the year 1841. In order to show the progress of registration, and the changing state of the population, the Births, Deaths, and Marriages of the preceding years are subjoined:

The Registrar-General seems determined to make the future series of his annual abstracts to terminate on December 31st, instead of June 30th as was heretofore done. The Marriages in 1841 were 1 in 130, the Births 1 in 31, the Deaths 1 in 46 of the population; the average of the two preceding years having been of Marriages 1 in 127, Births 1 in 31, Deaths 1 in 45. The Marriages diminished slightly in number every year; from 123,166 in 1839 to 122,496 in 1841; from 1 in 126 in 1839 to 1 in 128 in 1840, and 1 in 130 in 1841. Thus in the three years 1625, 1597, 1574 males in 100,000 were married, or less by 51 in 1841 than in 1839; whilst in the same three years 1553, 1526, and 1504 women in 100,000 were married; or less by 49 in the year 1841 than in 1831. In several cases the fluctuation in the number of marriages was observed to coincide with the depression or prosperity of industry or trade, and indicates with considerable accuracy the view which the people took of their own circumstances, and the greater or less immediate facility for providing for the support of families. The great good sense displayed by the working classes in England with respect to marrying cannot be too much recommended. Would that the same prudence and the same caution were observed among the corresponding classes in Ireland, among whom marriages are contracted with such precipitancy, and such little thought respecting the means of supporting their young families, that but for the well-known and truly proverbial devotedness and affection of the poor Irish peasant for his offspring, one might be disposed to think that in the affair of matrimony the principle which guided these wretched people was, solamen miseris socios habuisse malorum.”

The greatest number of marriages (36,542) occur in Autumn, and the

smallest number (25,174) in Winter: the difference between these extremes is 11,368, and the four seasons stand in the following order :

:

"The marriages in Winter (25,174) are to those in Spring (31,559) very nearly as the marriages in Summer (29,502) are to the marriages in Autumn (36,542): and the marriages in Winter are to those in Summer, as the marriages in Spring to the marriages in Autumn." It will be at once evident that the latter of these proportions is included in the former, and directly inferrible from it by an alternation of ratios, and therefore need not have been stated. In fact its being stated involves a tautology. The marriages in the four quarters are thus in geometrical proportion nearly; whence the marriages in any three being given, the number of marriages in the other quarter can be deduced from them by the common rule of three within a few hundreds; or, as the terms are nearly in arithmetical proportion also, by adding two terms and subtracting the third. The regularity in the numbers registered in each of the three years indicates the operation of constant causes, or such as fluctuate only in the same way as those which adjust the proportion of marriages to the population. In order to distinguish the number of persons in the community who marry from the mere number of marriages, the Registrar-General had an abstract made of the number of widows and widowers re-married in the last half year of 1841. Of 65,498 women married, 5888, or 9 in 100, were widows; of the same number of men 8476, or 13 in 100, were widowers. The average annual number of marriages in the three years 1839, 1840, 1841, was 122,777; and it would follow that 106,975 men, and 111,765 women, or 218,740 persons marry every year.

The proportion of re-marriages is greatest in the metropolis, and in the North-Western, Western, and York Divisions, where the mortality is highest.

There were married under the age of twenty-one 5362 men, and 16,285 women; the proportion of minors (4.38 per cent. of the men, and 13.29 per cent. of the women) is below the averages of preceding years.

Births. In 1841, 512,158 births were registered; in 1840, 502,303; and in 1839, 492,574; this increase, therefore, was 9855 in 1840, and 9729 in 1839; or 19,584 in two years. If the births had increased at the same rate as the population, the increase would have been about 14,000 in the two years: the excess of 5584 over this number may, I think, be fairly ascribed to the greater efficiency of this branch of registration. The births registered were to the deaths in 1841 as 149 to 100, or as 3 to 2. This proportion falls very far short of the ascertained annual increase of the population in the ten years 1831-1841. The greatest number of births is registered in the Winter quarter: the smallest in the Summer.

Illegitimate Births.-From the Registers of Births it would appear that 1 in 16 of the children born in England is not born in wedlock. The

Registrar-General sees no grounds for supposing that less than 64 in 1000 English children are illegitimate. The proportion in France is 71 in 1000. In the Fourth Annual Report it was shewed that the proportion of boys to girls born in England was 10,486 to 10,000-the proportion of boys has been ascertained by several to be greatest among legitimate children. In France, for instance, the boys are to the girls born as 106.4 to 100; but among illegitimate children the proportion is 104.4 to 100. The present return gives a result quite the reverse; of the legitimate births the boys are to the girls as 105.4 to 100; of illegitimate births the boys are as 108 to 100.

Deaths.-The deaths in the year ending June 30th, 1841, amounted to 355,655; in the year ending Dec. 31st, 1841, to 343,847; so that, although the two series of abstracts comprise the Winter and Spring quarters of 1841, the difference in the sums of the annual deaths is 11,808. On comparing the deaths in 1840 and 1841, there will be found a decrease of 15,787. The deaths were more numerous (99,069) in the Winter of 1841 than in the Winter of any preceding year, but in the Spring the decline commenced, which reduced the mortality in the following quarters below the mean mortality of the four years. Up to the year 1843 the deaths in the Summer quarter rose regularly from 72,791 to 80,822, in the Autumn from 80,833 to 89,630; the deaths in Winter except in 1839, when they were below the average number. The deaths in the four Winter quarters were 385,764, in the four Summer quarters 305,333; the deaths in the Springs 355,248, in the Autumns 338,662. With respect to the table, which is here given, and which shews the influence of the seasons very distinctly, before it is applied it requires correction for the different duration of the seasons, and for the increase of population. The four Winter quarters comprised 361 days, the Spring quarters 364 days, the Summers 368 days, and the Autumns 368 days; the population increased at the rate of 1.334 per cent. annually. If the quarters had contained the same number of days, and the population had been stationary, the deaths would have been nearly as follows:

Four Winters (365 days) 391,059 Quarterly averages (91 days) 97,765 Four Springs

دو

Four Summers

356,565
302,827

Four Autumns,,

89,141

75,707

83,639

86,563

By observing the great excess of deaths in Winter in the above summary the fatal effects of cold are seen in a striking light. The average corrected number of deaths in the seasons would be

Winter.
97,765

Spring.
89,141

Summer.
75,707

Autumn.
83,639

By transposing the Autumn and Summer terms, the law is discovered, which has regulated the mortality of the seasons, thus