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 UC-NRLF 
 
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MJSae HEAtTH LIBRAR 
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 
 MRS. PRUDENCE W. KOFOID 
 
REMARKS 
 
 ON THE 
 
 FREQUENCY AND FATALITY 
 
 of 
 
 DIFFERENT DISEASES, 
 
 &c. 
 
REMARKS 
 
 OX THE 
 
 FREQUENCY AND FATALITY 
 
 OF 
 
 DIFFERENT DISEASES, 
 
 PARTICULARLY 
 
 ON THE PROGRESSIVE 
 
 INCREASE OF CONSUMPTION: 
 
 WITH 
 
 OBSERVATIONS 
 
 ON THE 
 
 INFLUENCE OF THE SEASONS 
 
 ON 
 
 MORTALITY. 
 
 BY WILLIAM WOOLLCOMBE, M. D. 
 
 LONDON : 
 
 PRINTED FOR tOVGMAN, HURST, REES, AND ORME, 
 PATERNOSTER ROW J 
 
 AND REES AND CURTIS, PLYMOUTH. 
 1808. 
 
Printed by C. S tower, 
 Paternoftc? Row, Londo% 
 
>7" 
 
 PREFACE. 
 
 IN submitting to the Public the result 
 of his own inquiries concerning some 
 points of Statistical Medicine, the design 
 of the Author will be accomplished, if it 
 shall be found that some useful addition 
 has been made to the stock of authentic 
 materials, some useful suggestions offered, 
 conducive to the more successful investi- 
 gation of subjects, which he deems of 
 importance, of questions in which he 
 thinks the interest of the Public intimately 
 concerned. 
 
 x 
 
 IM375I79 
 
11 
 
 Of the Tables, which constitute the? 
 essential part of the following pages, the 
 first five ha/e been formed from materials 
 afforded by the register of the medical 
 cases occurring at the Public Dispensary 
 at Plymouth, in a period of seven years 
 from the establishment of the Institution. 
 In framing them the object has been, to 
 exhibit the proportionate prevalence of 
 different diseases, and the absolute and re- 
 lative mortality resulting from them ; as 
 well as to afford grounds for instituting a 
 comparison between the prevalence of 
 diseases in different districts at the same 
 period, and in the same district at different 
 periods. 
 
 The space of time which they include, 
 may perhaps be deemed too limited, to 
 admit of the deduction of general conclu- 
 sions with much confidence in their vali- 
 dity; yet their coincidence, in many in- 
 
Ill 
 
 stances, with observations derived frona 
 more extended experience, may afford a 
 presumption of their not being altogether 
 unworthy of attention. Many deficiencies 
 in their construction, which cannot be 
 referred to this source of imperfection, will 
 readily be noticed. To account for these 
 in a general way it may be sufficient to 
 observe, that the register of the cases was 
 not made with any reference to the use to 
 which it has been now applied. Its pri- 
 mary object was merely to keep in the 
 view of the Physician the number and 
 character of the cases immediately under 
 his care; and to furnish the means of 
 annually informing the Subscribers to the 
 Institution of the extent to which their 
 charity had been applied, and of the degree 
 of benefit resulting from it. This will 
 account for the deficiency observable at 
 the end of the first Table, where the total 
 number is made up by the addition of a, 
 
11 
 
 Of the Tables, which constitute the* 
 essential part of the following pages, the 
 first five ha/e been formed from materials 
 afforded by the register of the medical 
 cases occurring at the Public Dispensary 
 at Plymouth, in a period of seven years 
 from the establishment of the Institution. 
 In framing them the object has been, to 
 exhibit the proportionate prevalence of 
 different diseases, anrl the absolute and re- 
 lative mortality resulting from them ; as 
 well as to afford grounds for instituting a 
 comparison between the prevalence of 
 diseases in different districts at the same 
 period, and in the same district at different 
 periods. 
 
 The space of time which they include, 
 may perhaps be deemed too limited, to 
 admit of the deduction of general conclu- 
 sions with much confidence in their vali- 
 dity; yet their coincidence, in many in- 
 
Ill 
 
 stances, with observations derived from 
 more extended experience, may afford a 
 presumption of their not being altogether 
 unworthy of attention. Many deficiencies 
 in their construction, which cannot be 
 referred to this source of imperfection, will 
 readily be noticed. To account for these 
 in a general way it may be suificicnt to 
 observe, that the register of the cases was 
 not made with any reference to the use to 
 which it has been now applied. Its pri- 
 mary object was merely to keep in the 
 view of the Physician the number and 
 character of the cases immediately under 
 his care ; and to furnish the means of 
 annually informing the Subscribers to the 
 Institution of the extent to which their 
 charity had been applied, and of the degree 
 of benefit resulting from it. This will 
 account for the deficiency observable at 
 the end of the first Table, where the total 
 number is made up by the addition of ^ 
 
IV 
 
 considerable portion of cases, to which no. 
 distinctive appellations of disease have 
 been assigned. 
 
 It will not be denied, that the inferences 
 of the relation of diseases to each other, 
 and the proportion of any one distemper 
 to the whole number, must be affected by 
 this omission ; yet the conclusions relating 
 to the diseases of most importance, either 
 as to their prevalence or their consequences, 
 are comparatively little influenced by it ; 
 since the omission of assigning names must 
 generally have occurred in slight and 
 unimportant disorders, with the exception 
 of a few cases, where it may purposely 
 have arisen from the obscurity in which 
 the nature of the distemper was involved. 
 Many of the cases unnamed may, with 
 certainty, be referred to the class of erup- 
 tive diseases, and are so marked in the 
 register; the omission, in this instance, 
 
y 
 
 arising from the uncertainty prevailing at 
 the moment, as to the proper head to 
 which they should be referred, according 
 to the arrangement of Dr. Willan, whose 
 nomenclature has been otherwise ad- 
 hered to. 
 
 A strict adherence to nosological accu- 
 racy has not been aimed at. In general 
 the names of diseases adopted are those 
 assigned by Dr. Cullen ; in some instances 
 they correspond with those employed by 
 Sauvages. Where any term is used in a 
 different or unusual sense, it is signified in 
 a note subjoined. The inattention and 
 irregularity in attendance of patients at 
 Dispensaries, render precision in ascertain- 
 ing their complaints often impracticable. 
 
 The valuable work of Dr. Heberden, 
 on the increase and decrease of diseases, 
 having in great measure suggested the 
 
formation of these Tables, a comparison 
 of the inferences deducible from them 
 with his observations, naturally became a 
 primary object. And if the following 
 pages be found to contain any confirma- 
 tion of the conclusions of that Author, 
 they may derive from this circumstance a 
 collateral claim to that attention, of which 
 independently they might not be deemed 
 deserving. 
 
 Several facts, and many grounds of 
 comparison, have also been derived from 
 Dr. Willan's Reports on the Diseases in 
 London ; a work abounding in useful and 
 accurate information, and enriched with 
 the practical observations of a discrimi- 
 nating and enlightened mind. 
 
 On two subjects the inquiry has been 
 carried far beyond the limits of mere com^ 
 
 parison. The desire of ascertaining with 
 
Vll 
 
 more precision', than seems hitherto to 
 have been attained, the extent of the 
 prevalence of consumption, occasioned in 
 the investigation of that point a minute- 
 ness, which will be excused by those who 
 are impressed with the importance of the 
 question. The inquiry into the influence 
 of the seasons on disease and mortality, 
 was also deemed sufficiently interesting to 
 justify a more detailed examination of the 
 evidence on which it rests. If the popular 
 opinion on this point be erroneous, the 
 error is not merely speculative, but of 
 practical influence on the inhabitants of 
 this country, Every attempt therefore to 
 correct it may expect a favourable recep- 
 tion, and an attentive consideration. 
 
TABLE I. 
 
 OF THS 
 
 CASES OF PATIENTS 
 
 ADMITTED AT THE 
 
 PLYMOUTH PUBLIC DISPENSARY, 
 
 FROM NOVEMBER IS, 1798, 
 TO AUGUST 31, 1805. 
 
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 NOTES ON TABLE I 
 
 9. Apoplexla Hydroeephalica. — By the adop- 
 tion of this appellation for the hydrocephalus 
 acutus, vel internus, of the earlier authors, it is 
 not intended to subscribe to the propriety of 
 its application. For this species of inflamma- 
 tion of the brain, peculiarised by its termina- 
 tion in effusion, some distinctive name seems 
 wanting. Is hydrocephalus admissible ? 
 
 13. Asthenia. — Sauvages Nos. Meth.'cl. 6. 
 gen. 21. Seeal so observations refcrrible to 
 this title in Willan's Reports on the Diseases in 
 London, p. 52. 
 
 17, 18. Ca/igo comece, Caligo lent is. — The 
 first species includes those cases of obscuration 
 of the transparent cornea, which are the fre- 
 
16 
 
 quent consequences of ophthalmia, and are dis- 
 tinguished by the terms macula, leucoma, &c. 
 The second comprehends cataract. 
 
 19. Cancer scroti.— Tt\k case occurred in a 
 chimney-sweeper of advanced age ; the ul- 
 cerated part was of small extent, and was re- 
 moved by excision. 
 
 21. Catarrhus epidemicus. — Influenza. 
 
 24. Chorea. — This has been said to be a fre- 
 quent disease in England. In Scotland it is of 
 rare occurrence. The number of cases in the 
 present instance has a tendency to confirm the 
 former observation. In one of these instances 
 the disease had its origin distinctly in terror, 
 in a boy of eleven years of age, in whom it 
 first occurred during Lord Duncan's action with 
 the Dutch fleet. In some of these cases evi- 
 dent benefit appeared to be derived from the 
 continued use of nitrat of silver, which has 
 almost invariably disappointed my hopes in 
 epilepsy. This might reasonably be expected 
 from a due consideration of the nature of the 
 two diseases, and of the probable mode of 
 operation of the medicine. 
 
 39. Dysuria — To account for the fatal cases? 
 in this instance it may be mentioned, that 
 
17 
 
 under this title are included diseases of the 
 bladder, arising from different causes. See 
 Cullen Nos. Meth. gen. 124, sp. 5 & 6. 
 
 47. Febris. — Under no title in the list is the 
 arrangement so liable to exception as in this, 
 to which so considerable a number of cases has 
 been referred ; and in the contemplation of it 
 was made the previous remark, that nosological 
 accuracy had not been aimed at. A large 
 proportion of these cases consists of such, as 
 by reporters are frequently styled "acute dis- 
 eases of children;" a vague and unsatisfactory 
 title, but possibly warranted by the imperfect 
 st^ %t i of our knowledge of their complaints. 
 To these must be added the slighter febrile 
 affections of adults, arising from cold, or other 
 causes ; and those cases, in which the symp- 
 toms of fever, being the chief object of prac- 
 tice, were principally regarded, the primary 
 disease being at the time of admission doubtful 
 or obscure. 
 
 48. Gangmna. — Mortification of the toes 
 and feet. Pott's Works, &c. 
 
 49. Gastrodynia. — Perhaps these cases should 
 in strictness have been referred to dyspepsia ; 
 but the symptom by which they are here charac- 
 
 D 
 
18 
 
 terized is often so predominant/ as to entitle 
 them to a distinctive appellation. In many 
 instances of this most pertinacious complaint, 
 which occurs almost exclusively in females, the 
 pain of the stomach has entirely arisen from an 
 inordinate use of tea, and has ceased on dis- 
 continuing this beverage. 
 
 60. Hydarthrus. — Diseaseof the knee-joint- 
 white swelling. 
 
 62. Ilydromeira. — Sauvages. Gen. 289, sp. 2. 
 Ilvdrometra gravidarum. 
 
 65. Hysteralgia. — Sauvages. Gen. 209, sp. 6. 
 
 '5. Mclama. — Of the four cases here set 
 down, two are not strictly referrible to the 
 genus melsena, the characteristic haemorrhage 
 not having in those cases occurred. They are 
 so associated, in defect of a more appropriate 
 situation, because the disease in those instances 
 was deemed to consist in that condition of the 
 vessels of the system of the vena portarum, 
 Vfhich precedes the haemorrhage in melasna, 
 They were the cases also which terminated 
 fatally. 
 
 SO. Oedema pucrperale. — White — Try e — Wil- 
 lan, 321 — Hull on Phlegmatia dolens. 
 
 2 
 
19- 
 
 S8. Pkurodyne. — The reference of so many 
 cases to this title of Sauvages, which Cullen has 
 not thought entitled to a generic distinction, 
 is another instance of no very strict attention 
 to nosological precision. It is designed in this 
 place to include some cases, which ought per- 
 haps to have been referred to rheumatism, to 
 which Cullen assigns all the species of Sau- 
 vages; some, which were sequels of pneumonic 
 inflammation ; and others, in which neither the 
 precise seat, nor nature of the complaint, was 
 easily to be ascertained. 
 
 91. Pompholyx.- — In a recent case of this 
 kind, which has subsisted many months, the 
 vesications have occupied in succession almost 
 every part of the surface ; chiefly the breasts 
 at first ; latterly the belly, thighs, and feet. 
 That the stomach, uterus, ovaria, and urinary 
 bladder, have also participated in the disease, 
 has been rendered highly probable by the oc- 
 currence of disordered function of those 'or- 
 gans. The disease supervened a sudden sup- 
 pression of the menstrual discharge, which has 
 not been restored. Sometimes blood, some- 
 times a watery fluid, is thrown up from the 
 stomach. A considerable and painful tumour 
 has taken place in the left hypogastrium ; and 
 no urine has been discharged during seveia! 
 
29 
 
 weeks without the aid of the catheter. In 
 some few instances of this disease, described 
 under the name of chronic pemphigus, there 
 has been suspected to subsist a connexion with 
 disorder of the uterine functions, in the oppo- 
 site conditions of menorrhagia and amenorrhea. 
 
 98. Purpura. — Phaenigmus petechialis, Sauv. 
 308 — Haemorrhsea, Adair Dissert. Inaug. d« 
 Hasmorrhgea petechial^ Edin. 1789 — Petechias 
 sine febre — Purpura, Willan's Reports, p. 90. 
 
 105. Scarlatina. — The identity of scarlatina 
 anginosa and cynanche maligna, being ad- 
 mitted, there can be little hesitation in classing 
 the disease with the exanthemata, rather than 
 with the phlegmasia? ; and consequently of em- 
 ploying scarlatina, rather than cynanche, as the 
 generic term. 
 
 108. Stomacace. — Sauvages. Gen. 241, sp. 1. 
 
 1J3. Tetanus. — In a recent case of this dis- 
 ease, the event was favourable. In the history 
 of it the following circumstances seemed 
 worthy of attention. The disease arose from 
 severe contusion pf the fore-finger, commenc- 
 ing about four weeks after the infliction of the 
 injury. At tjie expiration of another week, 
 
21 
 
 when assistance was first applied for, there was 
 no external wound, but the last joint was con- 
 siderably enlarged. From the amputation of 
 the finger some degree of alleviation of the 
 symptoms was the immediate consequence. 
 From the combined and continued use of 
 wine, bark, and affusion of cold water, decided 
 benefit was judged to be derived. From the 
 application of tincture of tobacco to the ex- 
 ternal fauces, the rigidity of the muscles was 
 for a time evidently diminished, and pain mi- 
 tigated. From opium, in doses from one to 
 three hundred drops, and to the extent of two 
 ounces and a half of the tincture, in seventy- 
 two hours, no benefit was apparently derived ; 
 and its effect in producing distressing dysuria 
 could not be doubted. From the use of di- 
 gitalis, by which the frequency of the pulse 
 was reduced, some advantage seemed to be 
 gained. The active treatment of the com- 
 plaint occupied three weeks : the recovery was 
 complete. The patient was a strong man, 
 about twenty-five years of age. In the con- 
 duct of the case the narrator was assisted by 
 the judicious advice of his friend and colleague, 
 Dr. Remmett, Physician Extraordinary to the 
 Institution in which it occurred. 
 
 114. Trichiasis. — "Estdirectiociliorum versus 
 oculi bulbum." Plenck. de Morbis Oculorum. 
 
TABLE II. 
 
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 CONTAINED IN TABLE I. 
 
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 IN WHICH FATAL EVENTS OCCURRED, 
 
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 RELATIVELY TO EACH OTHER* 
 
33 
 
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TABLE IV. 
 
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 ARRANGED IN THE ORDER OF THEIR FATALITY, 
 
 RELATIVELY TO THE NUMBER OF CASES Or E.'.CII DIS- 
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37 
 
 
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39 
 
 TABLE V. 
 
 OF THE 
 
 / 
 
 PROPORTION OF FATAL CASES, 
 
 IN EACH OF THE SEVEN YEARS, 
 
 FROM NOVEMBER 13, 1799, 
 TO AUGUST 31, 1805. 
 
 
 
 
 
 Vears. 
 
 Fatal Cases. 
 
 Total Cases. 
 
 Proportion. 
 
 1799 
 
 36 
 
 459 
 
 1 in 12.5 
 
 1800 
 
 44 
 
 738 
 
 1 in 16.5 
 
 1801 
 
 52 
 
 800 
 
 1 in 15.4 
 
 1802 
 
 54 
 
 697 
 
 1 in 12.8 
 
 1803 
 
 42 
 
 610 
 
 1 in 14.5 
 
 1805 
 
 50 
 
 592 
 
 1 in 11.8 
 
 1806 
 
 43 
 
 513 
 
 1 in 12 
 
 7 
 
 321 
 
 4409 
 
 1 in 13.7 
 
PART I. 
 
 OF THE 
 
 FREQUENCY AND FATALITY 
 
 OF 
 
 DIFFERENT DISEASES, 
 
 PARTICULARLY OF THE 
 
 PROGRESSIVE INCREASE OF CONSUMPTION 
 
 G 
 
43 
 
 PART I. 
 
 In subjoining a few remarks to the 
 preceding tables, it is not intended to 
 enter into a regular or detailed examina- 
 tion of their correspondence with, or 
 variation from, similar documents; but 
 merely to advert to some leading particu- 
 lars somewhat more fully, than could con- 
 veniently be done in the notes attached to 
 the tables themselves. 
 
 In considering the prevalence of dis- 
 eases, it will be obvious that those which, 
 in an extensive sense of the term, may be 
 classed under the title of pulmonary dis- 
 orders, claim the first attention, no less 
 from their number, than from their fa- 
 tality. 
 
44 
 
 Whether the proportion of these com* 
 plaints be notwithstanding less in this*, 
 than in other parts of the island, as from 
 the reputed mildness of our western air 
 might naturally be expected, a deficiency 
 of adequate information precludes any 
 attempt to determine. But an inspection 
 of these tables will, it is feared, afford 
 little or no ground to impeach the cor- 
 rectness of those statements, in which the 
 mortality, occasioned by the chief of this 
 class of diseases, has been estimated at a 
 rate so high, as almost to exceed belief, 
 and to cast a shade of suspicion on the 
 credibility of any conclusions deduced 
 from them. If however the facts, here- 
 after adduced, should be found inconsistent 
 with a claim to any considerable exemp- 
 tion from the ravages of pulmonic dis- 
 tempers, it will scarcely be denied, that 
 much less extensive, than from local con- 
 siderations might have been expected, has 
 been the prevalence of another disease, the 
 destructive influence of which has of late 
 
 * The south-west part of Devonshire, in thv vicinity of 
 Plymouth, 
 
been an object of much and fortunate at- 
 tention in several populous towns in the 
 kingdom. 
 
 The predominance of Pulmonary 
 Complaints will be evident from an 
 inspection of the first and second tables. 
 The proportion of cases of this description, 
 extensively taken, will be found to be to 
 the whole as l to 5 ; and if the cases re- 
 ferred to the heads catarrhus, influenza, 
 and pleurodyne, be excluded, the propor- 
 tion resulting from the remainder, viz, 
 asthma, dyspnea, haemoptysis, pertussis, 
 phthisis, and pneumonia, will- be as 1 to 
 0-7. If influenza be excluded, on account 
 of its occasional and uncertain occurrence, 
 and pleurodyne for the reasons which may 
 be collected from the note on that title in 
 the first table; while, on the contrary, 
 catarrh is retained, because the cases of 
 this complaint, admitted at a dispensary, 
 are likely to be of the severer kind, and 
 bordering upon a more formidable disease ; 
 the relation subsisting between pulmo- 
 nary, and all other complaints collectively, 
 may then be stated as 1 to 5-4. 
 
46 
 
 The importance of pulmonic complaints, 
 thus evinced by their proportionate pre- 
 valence, is still more forcibly demonstrated 
 by contemplating their proportional fata- 
 lity. From the third table it may be col- 
 lected, that this proportion is as 1 to 2-5, 
 From the result of his extensive practice, 
 public and private, mentioned in his Re- 
 ports on the Diseases in London, in con- 
 firmation of the conclusions deducible from 
 the bills of mortality, Dr. Willan states 
 the relative fatality of pulmonic distem- 
 pers, exclusively of hooping-cough, and 
 cough succeeding measles, to have been 
 about l to 3. If the deaths from those 
 sources had not been excluded, the sub- 
 sisting relation would then have been prer 
 cisely similar to that just stated. On an 
 average of six years, the proportion de- 
 duced from the bills of mortality is as 1 
 to 3-1, which is probably less than it 
 ought to be, owing, as it may be sus- 
 pected, to an error, diminishing the deaths 
 from pleurisy. From the very trifling 
 number of deaths attributed to this disease, 
 it seems probable, that cases of pneumonia 
 are verv commonly classed with fevers. 
 
47 
 
 In considering the prevalence and ra- 
 vages of pulmonary disorders, in general 
 our attention is irresistibly directed to 
 
 the FREQUENCY AND FATALITY OF PUL- 
 MONARY Consumption. 
 
 The relative occurrence of phthisis ap- 
 pears, from the first table, to be as 1 to 
 22-27 ; and on an average of three years, 
 in Dr. Willan's practice, it is found to 
 have been as 1 to 29. Of its relative oc- 
 currence in other places data are wanting, 
 on which to institute a comparison ; but 
 of its relative fatality the following in- 
 stances have been collected. From a due 
 consideration of these it will too certainly 
 appear that no exaggeration can be as- 
 cribed to that article in the bills of mor- 
 tality, which records the desolating effects 
 of this insidious disease, the baleful in- 
 fluence of which is probably extending 
 in constant progression over the British 
 islands, and countervailing that gradual 
 diminution of the portion of human afflic- 
 tion arising from disease, which, we have 
 reason to hope, is otherwise effecting by 
 
48 
 
 the combined operation of various causes; 
 among which the happy discoveries in 
 preventive medicine, that mark the close 
 of the past century, claim a distinguished 
 share *-. 
 
 * May not the discovery of the cow-pock, if it should 
 ultimate'}' effect the extermination of the sinall-pox, which it 
 mav do when the prejudices of mankind shall permit, be 
 w loomed rather on account of the influence here ascribed 
 to it in diminishing human suffering, than on account of 
 its effect in diminishing human mortality ? Since disease 
 is one of the appointed checks to excessive population, end 
 the plan of Providence in the creation of human life re- 
 quires the termination of the existence of one-third of its 
 creatures, before they have attained the age of two years, 
 it may be doubted whether the annihilation of so efficient 
 an instrument as small-pox can be admitted, without the 
 substitution of some other equally destructive malady*. 
 The substituted malady may indeed be productive of less 
 collateral affliction, than the loathsome distemper whose 
 place it supplies. But granting that no direct substitute 
 should arise, it will not follow that disease in general will 
 be deprived of its accustomed share in checking popula- 
 tion ; and if it be not, the only difference will be in the 
 proportion of victims submitted to other disorders. The 
 infant rescued from small-pox, may be rescued only to 
 perish in childhood by measles or scarlatina, or be pre- 
 served to swell the list of youthful victims to the insatiate 
 maw of consumption. Yet in estimating the afflictive 
 effects of a disease on mankind, its absolute fatality may 
 
4Q 
 
 The following table consists of two 
 parts. In the first part are selected, from 
 the bills of mortality, the absolute and re- 
 lative numbers of deaths from consump- 
 tion, at different periods, in the course of 
 the last century and half; in the second 
 part are collected a few instances, casually 
 obtained, of similar mortality in different 
 places in the kingdom, during the latter 
 part of the past century. 
 
 be a very subordinate consideration, as might be exem.- 
 .plified in the instance of cancer. Much depends on 
 the condition and relations of the persons obnoxious to it. 
 The mortality from consumption and small-pox being 
 supposed equal, and inoculation yet undiscovered, if su- 
 perior power were to propose the annihilation of one or 
 other of these distempers, no competent judge of their 
 effects, actuated by benevolent motives, would hesitate, I 
 presume, to solicit the extermination of the former. This 
 speculation on its influence on population is totally foreign 
 from the question of the merits and advantages of vac- 
 cination, which, in my estimation, are placed beyond all 
 cavil. Perhaps to the speculation itself it may be quite 
 sufficient to oppose the reply, a little altered, of the Prin. 
 cess to Rasselas, " How the world is to be cfe. peopled Is 
 not my care, and needs not be vour's." 
 
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S3 
 
 ' From the first part of the preceding 
 table it appears, that the absolute and re- 
 lative mortality from consumption has been 
 regularly increasing during the last cen- 
 tury ; though it seems to have been con- 
 siderably less in its relative proportion at 
 the commencement of this period, than it 
 had been fifty years before. Dr. Heberden 
 has stated this augmentation, in a gross 
 way, by the following figures, the total 
 mortalitv in each instance being 21,000, 
 
 Deaths from Consumption. 
 At the beginning of the 18th century, 3000 —■ 1 to 7. 
 At the middle of the 18th century, . 4000 = 1 to 5. 25* 
 At the end of the 18th century, , 5000 = 1 to 4. 2> 
 
 If he is correct in his statement of the 
 proportion in the first period, there must 
 have been a great decrease in deaths from 
 consumption in the first years of the cen- 
 tury, since the relation in the last five 
 years of the preceding century is, as stated 
 in the table, l to 5. 8. On the contrary, 
 in stating the proportion in the third pe- 
 riod as 1 to 4. 2, he is not supported by 
 the average of the last ten years of the 
 
34 
 
 century, which makes it as i to 3. S. As 
 there is much reason to believe that the 
 general mortality has for some time been 
 on the decrease, relatively to the increas- 
 ing population of the country, it admits of 
 a question, whether the number of deaths 
 from consumption, which, relatively to 
 the deaths from all other causes, is with- 
 out doubt very considerably augmented, 
 is in reality increased, relatively to the 
 population of the country. In other 
 words, dees a larger proportion of the in- 
 habitants of this island fall a victim to this 
 disease at present, than did at the close of 
 the seventeenth century*? 
 
 * Many arguments might be mentioned, which would 
 a priori have rendered probable the extension of this dis- 
 rate. Of this fort is the argument drawn from hereditary 
 disposition, which, if admitted, must be allowed to have 
 considerable influence. In an opulent and flourishing 
 country, where population is on the increase, many 
 weakly children will be reared, who, in a less improved 
 state of society, must have perished in early infancy ; and 
 consequently there will be a larger proportion of adults 
 obnoxious to a disease of this description. In such a 
 country a much larger proportion of the people will be 
 occupied in sedentary employments, in manufactories sub- 
 servient to the arts of luxury and refinement- The altera- 
 
55 
 
 That consumption has for some time 
 been, and still is, an increasing disease in 
 this island, is presumed from the increased 
 relation of deaths from this disease to the 
 whole mortality at the present period, 
 contrasted with the relation it bore at dif- 
 ferent periods in the last century and half, 
 as exhibited in the bills of mortality. As- 
 suming the variation in this relation to be 
 a just measure of the absolute increase and 
 decrease of the disease, it will appear from 
 an inspection of the first part of the sixth 
 table, that at the close of the seventeenth 
 century the consumptive mortality was 
 less than it had been in the middle of that 
 century, by nearly one- sixth part ; that in 
 the middle of the eighteenth century it 
 had somewhat increased, but was still 
 considerably less than it had been an hun- 
 dred years before ; but that at the close of 
 this century its increase had been so great, 
 as not only to equal the mortality in the 
 
 tion in diet and clothing affords arguments of an equivocal 
 nature. How long this may be the case in the latter 
 instance is perhaps not doubtful. The female costume of 
 Greece is indeed elegant, but our climate is not- Attican, 
 
56 
 
 first period, but to exceed it by nearly one- 
 fifth. The relations of the mortality at 
 these four periods, or half centuries, in the 
 succession above stated, correspond to the 
 following numbers, 48, 58, 54, 38. 
 
 To the assumption of this increase of 
 the relative mortality, as a measure of the 
 real increase of consumptive mortality, 
 two objections occur. First, it may be 
 said, that the increase of consumption 
 within the bills of mortality is no proof 
 of its general increase in the kingdom at 
 large, since this may be attributed to the 
 operation of local causes ; and, secondly, 
 it may be stated, that an increase in the 
 proportion of mortality from one disease 
 to the whole mortality, is no proof of its 
 absolute increase ; since the apparent aug- 
 mentation in the former mav have arisen 
 from a real reduction of the latter. 
 
 Each of these objections is entitled to 
 attention. 
 
 To the first it maj be. replied, that al- 
 
57 
 
 though the ratios of consumptive morta- 
 lity in a crowded metropolis may not at 
 any period be a measure of relation justly 
 applicable to the kingdom at large, yet 
 that those ratios may justly be compared 
 with each other at different periods ; and, 
 that from the comparison may be formed 
 a scale of variation, which may be justly 
 applied as a measure of increase and de- 
 crease to the w T hole kingdom, unless any 
 material change can be supposed to have 
 taken place in the local circumstances of 
 the metropolis within the period. It is 
 not, however, obvious that any such change 
 has taken place in regard to London. The 
 Improvement of the city, after the great 
 fire in J 060, certainly tended greatly to 
 the increase of its salubrity, and might, 
 perhaps, contribute to the relative decrease 
 of consumptive mortality which is ob- 
 served after that period, although its known 
 influence in putting a stop to the preva- 
 lence of plague, and in mitigating the 
 ravages of other contagious distempers, 
 by which the sum of the general mortality 
 must have been diminished, would rather 
 
58 
 
 lead to a different conclusion. But what 
 local change of circumstances has occurred 
 in London in the la^t thirty years, to which, 
 with any plausibility, can be attributed the 
 great increase of consumptive mortality 
 within that period? Great as the addi- 
 tion to its population has been, equally 
 great has been the extension of its build- 
 ings ; and there is little reason to believe 
 that the inhabitants are now more crowded 
 than they were formerly. On the con- 
 trary, the local improvement of the me- 
 tropolis is believed, by the most compe- 
 tent judges, to have contributed largely to 
 its general salubrity ; and it seems highly 
 improbable that to the same local circum- 
 stances should be owing an increase of 
 mortality from one disease, and a diminu- 
 tion from all others. Such a consequence 
 might indeed seem to be involved in the 
 rapid increase of the population of the 
 metropolis, because the emigration from 
 the country, by which this increase is 
 made, takes place chiefly at that period of 
 life, which is deemed most liable to the 
 invasion of phthisical disease. This cir- 
 
59 
 
 cumstance may perhaps account for the 
 greater proportion of phthisical mortality 
 in London, compared with the countrv, 
 and otiier towns of less magnitude ; but 
 cannot be allowed to have any influence 
 on the relations subsisting in London at 
 different periods, because the metropolis 
 must at all times have drawn its recruits 
 from the country under similar circum- 
 stances, 
 
 But the relative increase of consump- 
 tive mortality of late years rests not on the 
 sole evidence of the London bills of mor- 
 tality. It is confirmed by two instances 
 in the second part of the sixth table, the 
 cases of Holvcross and Ackworth. In 
 the instance of tlolycross the increase is 
 so great and so rapid, that it is difficult to 
 believe that some mistake has not been 
 committed in the numbers, although the 
 unusual accuracy with which the record of 
 that parish was kept by Mr. Gorsuch 
 during thirty years, is adverse to such a 
 supposition. If it be correct, it proves 
 
Co 
 
 that the mortality from consumption was 
 nearly doubled in the space Of ten years 
 in a small parish, in which, during that 
 period, very little variation occurred, either 
 in the population, or in the general mor- 
 tality. In the other instance of Ack- 
 worth, the increase, in the space of ten 
 years, amounted to one-eighth; an in- 
 crease of a very serious nature, if the short 
 space of time included in the observation, 
 be considered, as well as the period itself, 
 which was from l£5; to 1767, at which 
 time no great increase had begun to take 
 place in London. The period of vast in- 
 crease at Holyeross was from 1 7G0 to 
 1770, from which latter year maybe dated 
 the augmentation in the London bills. 
 
 The second objection which, it was 
 observed might be stated against the pre- 
 sumption of absolute increase of consump- 
 tive mortality from its relative increase at 
 different periods, is grounded on the dif- 
 ficulty of ascertaining whether this in- 
 crease may net be apparent only, and 
 
61 
 
 arising from a decrease in the general 
 mortality. 
 
 If, for example, the inhabitants of this 
 country "had, in the year 1700, been six: 
 millions, the proportion of mortality one 
 ,in forty, and the proportion of consump- 
 tive mortality one to six, the total deaths 
 would have been 150, 000, and those from 
 the disease under consideration 25,000, 
 If in the year 1800 the inhabitants had 
 been the same in number, and the deaths 
 from consumption had been known to 
 have increased relatively one-third, or to 
 be in the ratio of one to four, stiil might 
 there have been no increase in the absolute 
 fatality of consumption ; but a reduction 
 of the general mortality might have taken 
 place in the same proportion, so as to have 
 become as one to sixty ; in which case the 
 total mortality would be 100,000, and the 
 consumptive mortality still 25,000*. This 
 
 * These, and subsequent statements of a similar nature, 
 may be more readily comprehended by referring to the 
 following calculations, founded on the assumed relations 
 pf mortality : — 
 
62 
 
 objection is therefore not without weight, 
 and shews that, in order to establish a 
 relative increase of mortality from any efts- 
 ease to be a just measure of its absolute 
 augmentation, we must ascertain the pro- 
 portion of deaths to the inhabitants of 
 the country at the particular periods be- 
 tween which a comparison is instituted. 
 As this proportion is not, and cannot be 
 ascertained with precision, we must be 
 satisfied with such an approximation to 
 the truth as can be derived from the im- 
 perfect evidence found in those authors, 
 who have treated of that branch of poli- 
 
 Population. 
 
 Proportion of _. . ,. Tr »«*«= 
 
 fcpuUtioa. Mortality to „55?, t:.e <_ r.=urr. ; r.. e ft* 
 
 Pr.m.lariV.n. Morta.. ;. to the total C 
 
 Mortality. tton. 
 
 — 6 = 31.250 
 -4- 4 = 46,875 
 «£. 6 = C7.777 
 
 — 4 = 41.66G 
 
 — 6 = 25.000 
 '•4- 4 *= 37,500 
 
 — 6 = 18,518 
 
 — 4 = 27,777 
 -f- C = 16,666 
 -4-4 =^25. 
 
 U ,000,000 ~ 40 = 275 3 000 . . -^- S = 55,6CQ 
 
 60 = 100,000 
 
63 
 
 tical economy, with which this question 
 
 ii connected *. 
 
 * Writers on political economy have in rain endea- 
 voured to ascertain with precision the relations of mor- 
 tality to population in the same country at different pe« 
 ri>>ds. The collected information on this subject, recently 
 obtained bv the returns to Parliament in answer to the 
 question- proposed in the Population Act, has also proved 
 insufficient to establish with any degree of accuracy the 
 subsisting mortality in this kingdom at the present period; 
 much ie-o to contrast it with the relations which have pre- 
 vailed at antecedent periods. If the actual return of 
 burials from the abstract of the parochial registers were 
 complete, the annual average of deaths during the last six 
 years of the past century would be found to be, to the 
 population of the kingdom, as one to forty-seven. But 
 these returns are confessedly incomplete from various 
 causes, among which may be mentioned, a total absence of 
 returns from some parishes ; known, and reasonably pre- 
 sumed, omissions in those registers from which returns 
 have been made ; and a deficiency of any return of burials 
 occurring in places of interment, belonging to different 
 societies of dissenters from the established church. Of 
 the additions, which ought to be made to the sum of re- 
 corded burials on account of these deficiencies, there are 
 no data on which a correct estimate can be founded. 
 
 This difficulty subsisting in the ascertainment of the 
 absolute number of deaths, Mr. Malthus has presumed 
 that the proportion of mortality to the population in this 
 island, at the present time, may be stated as one to forty: 
 the lowest proportion of deaths, he observes, that can well 
 
64 
 
 Presuming, for the present, that in the 
 year 1700 the mortality in England, in 
 
 be supposed in the circumstances of the country,' and, if 
 true, indicating an astonishing superiority in healthiness 
 over the generality of other states. In adopting the 
 ratio thus assumed by Mr. Malthus upon grounds con- 
 fessedly imperfect, less scruple may be entertained from 
 the probability that, if it be erroneous, it deviates from 
 the (ruth by supposing the proportion of deaths to be less 
 than it really is ; and consequently, by employing it as a 
 measure of comparison, there is no danger of drawing ex- 
 aggerated inferences in relation to the absolute mortality 
 arising from particular diseases. If, however, the assump- 
 tion be just, it confirms the persuasion, prevailing among 
 medical inquirers, of a progressive decrease of the fata- 
 lity of disease in general ; a decrease, which may be at- 
 tributed in great measure to improved habits of the people 
 in respect to cleanliness, to the adoption of measures 
 during some years past to prevent the diffusion of con- 
 tagious febrile diseases, and in some small degree, it may 
 be hoped, to the gradual improvement of the healing art. 
 
 The influence Avhich preventive medicine may have on 
 the population of a country, is at present strongly illus- 
 trated by the effects of the introduction of vaccine inocu- 
 lation. It cannot be doubled that this practice has/ 
 since its introduction, considerably diminished the annual 
 mortality. It must not however be supposed that this 
 diminution is in the same ratio with the decrease of deatiis 
 from small pox, since that were to presume that the vac- 
 cinated children were exempted from death by the agency 
 of any other disease. Mr. Malthus has stated his belief, 
 
65 
 
 proportion to its inhabitants, was one to 
 thirty-six; and that the relative increase 
 
 that, if the introduction of the cow-pock should effect 
 the extirpation of the small-pox, a perceptible difference 
 will be found in the increase of mortality from some other 
 diseases, supposing the proportion of marriages to remain 
 undiminished. The statement of this belief, which is un- 
 avoidable, seems to have been strangely misconstrued into 
 an objection to the practice of vaccination. The principles 
 of that author, and the reasonings founded upon them, for- 
 bid such an inference, even if it stood not in contradiction 
 to the direct avowal of his inclination to believe, u that the 
 gradual light which may be expected on the interesting 
 topic of human inquiry in which he has engaged, will 
 teach us to derive from the extinction of a mortal disorder 
 a real blessing, a real improvement in the health and hap- 
 piness of mankind." 
 
 The political economist, who adopts the principles of 
 Mr. Mai thus, could he direct at will the population of 
 his country, would adjust the balance between the supply 
 of inhabitauts and the means of subsistence, by the opera- 
 tion of the preventive rather than the positive checks to 
 superabundant population. It would consequently be his 
 aim to prevent premature mortality, and his endeavour to 
 preserve, by every means, the lives of those in existence, 
 whether as already contributing by their exertions to the 
 common support, or as advancing to the period when 
 they would become qualified to sustain their share of active 
 employment. He would estimate the death of every indi- 
 vidual prematurely cut off, as a loss to the state, in the 
 
 K 
 
66 
 
 of consumptive mortality has, in the 
 course of the century, amounted to one- 
 
 proportion in which, according to his age, the expense of 
 his maintenance had already exceeded the amount of his 
 productive labour. Such an economist would be a most 
 strenuous advocate for the application and extension of 
 preventive medicine. He would deprive small-pox of its 
 victims by encouraging vaccination : he would oppose the 
 ravages of con'agious fevers, by instituting houses of 
 reception : and he would check the influence of disease ia 
 general by promoting habits of cleanliness and sobriety. 
 If , by this preservation of life, his population increased 
 beyond his means of subsistence, he would employ his 
 preventive check to obviate a redundance, and by di- 
 minishing the number of marriages, he would adjust the 
 supply of births to the real wants of his society. That by 
 so doing he would greatly increase the productive labour, 
 and augment the power of his people, in proportion to 
 their numbers, will not be denied ; but that he would 
 increase the sum of happiness in his community mav, per- 
 haps, be doubted. Would he not necessarily condemn a 
 large proportion of his people to celibacy, and upon the 
 remainder accumulate the difficulties, the cares, and the 
 anxieties, inevitably attendant on the support and educa- 
 tion of numerous families ? 
 
 The effects which have now been hypothetical]}- attri- 
 buted to the interference of the politician, will, in the 
 present state of things, be produced by the operation of 
 natural causes. A general decrease of deaths, whether it 
 be effected by entirely closing one of the great sluices, or 
 
67 
 
 third, or is become as four to six, it fol- 
 lows that there must have been an absolute 
 
 by narrowing all the channel?, of mortality;, must be pro- 
 ductive of a reduction in the number of marriages, and, 
 consequently, of births. Whether such consequences would 
 be in themselves salutary, or conducive to the augmentation 
 of the sum of human happiness, is an inquiry beset with 
 too many difficulties, and involving foo many abstruse 
 considerations, to be entered upon here. This, at least, 
 we can perceive, that the provision for the multiplication 
 of life prevails over the provision for its preservation ; 
 and hence we may safely conclude, that the ultimate ten- 
 dency of this is beneficial. It is sufficient for us to know, 
 that the preservation of life is a duty incumbent on man ; 
 that the means of effecting it, to a certain extent, are 
 placed within his reach ; and that experience has shewn 
 that those means have not been ineffectually employed. 
 
 The decrease of mortality, which has been presumed, 
 and partly proved, to have taken place of late years in 
 this kingdom, is probably owing, in great measure, to 
 the preservation of infant life, which the introduction of 
 vaccination has a tendency to augment in a much greater 
 ratio, than any of the various causes, by the combination 
 of which it has hitherto been effected. But the diminu- 
 tion of mortality in general, and of early mortali*) in 
 particular, inevitably tends to increase celibacy. Aug- 
 menting the probability of a larye family, giv.s force to 
 the influence of the preventive check to marriage. This 
 probability has been increased in the higher and Middle 
 ranks of life since the introduction of variolous inocu>a- 
 
68 
 
 increase to a certain extent, unless in the 
 same period the proportion of mortality 
 to population has become as 1 to 54. 
 But this supposition is too extravagant to 
 require refutation. It is sufficient to 
 observe, that an uncommon degree of 
 healthiness is attributed to this island, 
 when it is admitted, that the mortality at 
 present may perhaps amount only to 1 in 
 40. Admitting, however, with a late 
 author, that the last-mentioned proportion 
 is just, let us inquire what the proportion 
 must have been in the year 1/00, to ac- 
 count for the difference of the relative 
 mortality of consumption, upon the sup- 
 position of there being no absolute in- 
 
 tion, and of various improvements in the treatment of 
 children in early infancy. On these classes of society it 
 may be presumed to have exerted its influence insensibly, 
 in conjunction with other and more powerful causes. If 
 the fatality of small- pox should be annihilated by the uni. 
 Tersality of vaccination, the probability of more numerous 
 families will extend also to the lower orders ; and on them 
 it must be expected to have a similar effect. But its influ- 
 ence here will be counteracted by the happy want of fore- 
 sight in some, and, in others, by the consideration of the 
 encouragtments to marriage, which it is the tendency of 
 almost all our charitable institutions to propose. 
 
 4 
 
6Q 
 
 crease. In that ease we shall be con- 
 strained to state the general mortality in 
 1700 to have been l in 27 nearly, which 
 implies a degree of imhealthiness incon- 
 sistent with the known condition of the 
 country at that period. It is obvious, 
 that no such proportion of deaths, as has 
 been stated in these two instances, could 
 have happened without such a corres- 
 ponding augmentation in the population 
 of the country, as is known not to have- 
 occurred, and is altogether extravagant to 
 suppose. 
 
 From the foregoing considerations it 
 seems to be clearly established, that the 
 apprehension of the increase of consump- 
 tion is not vain and imfoun d The 
 degree of that increase will probably be 
 estimated differently bv different calcula- 
 tors; but will not, by any mode of cal- 
 culation, be shown to be meorisiderable. 
 Without pretending to otfer the following 
 comparative statements as conclusive, I 
 venture to propose them as probable ap- 
 proximations to the truth. 
 
70 
 
 Suppose the inhabitants of England to 
 have been, at the commencement of the 
 seventeenth century, six millions, the 
 annual mortality one in thirty-six, .and 
 the consumptive to the general mortality 
 one to six. In this case, the total num- 
 ber of deaths from consumption must 
 have been 27,777. Suppose at the close 
 of the century the inhabitants to be the 
 same in number, the consumptive mor- 
 tality to have increased to the proportion 
 of one to four, and the annual mortalitv 
 to have sunk to one in forty. In this 
 case it is evident, that the absolute in- 
 crease of deaths from consumption will be 
 less than its apparent relative increase of 
 one third, in the same proportion as the 
 total mortality has decreased, which is by 
 one ninth ; in other words, the absolute 
 number of deaths from consumption in 
 this case will be 37,500, instead of 41,666, 
 the number to which thev would have 
 amounted if the proportion of general 
 mortality had remained unchanged ; and 
 the absolute increase will be equal only to 
 somewhat more than one-fourth. 
 
n 
 
 If it should be thought that sufficient 
 difference has not been allowed for the 
 increased healthiness of the kingdom at 
 the end of the century, under the known 
 circumstances of its increased population, 
 let us suppose, that in the year l,"oo the 
 annual mortality was so great as one in 
 thirty-two, in \v T hich case the consump- 
 tive mortality would have been equal to 
 31,250; and consequently the increase in 
 the century would have amounted only to 
 the dirference between that number and 
 37,500, that is to 6250 ; and the absolute 
 increase, instead of being one-third, 
 would have been one-sixth. Yet if this 
 should be deemed a juster measure of 
 increase for the whole century than the 
 preceding, still it cannot be considered as 
 a just measure of the increase for the last 
 thirty years; during which period, whe- 
 ther we refer to London, or to the coun- 
 try, we find reason to believe, that the 
 consumptive mortality has increased in a 
 much more rapid ratio than it had in the 
 preceding part of the century. 
 
72 
 
 In these hypothetical statements the 
 population has been supposed to be sta- 
 tionary, because no alteration in it does 
 in any manner affect the argument ; but 
 when the increase of consumptive mor- 
 tality is admitted, the augmentation of 
 the population can no longer be disre- 
 garded in estimating the magnitude of 
 the evil. 
 
 From an examination of the two parts 
 of the sixth table it appears, that during 
 the last half century the proportion of 
 consumptive to general mortality has 
 been as l to 4.2. But as the consump- 
 tive mortality may be comparatively less 
 in the country than in towns, from 
 which the grounds of the calculation have 
 been chiefly derived, to avoid exaggera- 
 tion, let the proportion for the kingdom at 
 lame be stated to be as l to 5. If this be 
 admitted as just, and if it be granted that 
 the annual mortality is to the population 
 as \ to 40, while it is ascertained that the 
 inhabitants of Great Britain amount to 
 eleven millions, it will be found that the 
 
73 
 
 ANNUAL VICTIMS TO CONSUMPTION IN 
 
 this island are not less than fifty- 
 five THOUSAND PERSONS. 
 
 If the period of life, at which these 
 victims perish, be considered, the loss in 
 a political point of view will assume addi- 
 tional importance. The popular notion 
 of consumption, as one of the ministers 
 of fate, is chiefly drawn from its effects in 
 the superior - and conspicuous ranks ol 
 society, where it more frequently com- 
 mences its attack at an early and interest- 
 ing period of life. From the numerous 
 instances of this kind, which real life 
 daily presents to our view, and fiction 
 continually employs to heighten the 
 scenes of imaginary distress, we are led to 
 confine in idea the influence of this dis- 
 ease to an earlier and shorter period of 
 life, than that to which it is in reality 
 extended; and consequently to consider 
 it as peculiarly destructive to those beings, 
 by whom the relations have not yet been 
 formed, which, connecting the indivi- 
 dual with the community, combine in 
 
 L 
 
74 
 
 their dissolution the public with the pri- 
 vate loss. But if from these scenes of 
 conspicuous woe, we turn to the humble 
 walks of private affliction, in the lower 
 and laborious classes of society, in the 
 great mass and strength of the people, we 
 shall find it prevailing at a more advanced 
 age, at a period at which the preservation 
 of existence, politically considered, is an 
 object of peculiar value. It assails the 
 labourer and the mechanic in the prime 
 of life ; not an insulated, unconnected, in- 
 dividual, but the father of a family, which 
 he leaves helpless and indigent, a burden 
 on the public to maintain. Nor is this 
 protracted influence less extended to the 
 females in the same rank of life. The 
 sufferings they frequently sustain in be- 
 coming the mothers of a numerous off- 
 spring, too frequently call into action the 
 latent seeds of the disease ; and from the 
 circumstance which renders the continu- 
 ance of their life of increased importance, 
 is traced the source of their untimely 
 death* 
 
75 
 
 From statements of Dr. Haygarth and 
 Dr. Aikin it appears, that one half of 
 those who died of consumption in two 
 years at Chester, had passed their thirtieth 
 year ; and at Warrington, three eighths 
 had passed their forty-fifth year. At our 
 dispensary, the number of those who have 
 died beyond thirty exceeds the number of 
 those who died before the attainment of 
 that age, in the proportion of two to one*. 
 The period between thirty and forty 
 seems to be most fatal, the deaths within 
 
 * Deaths from Consumption, 
 
 Under 5 years of age 
 Between 5 years and 10 
 
 10 
 
 15 
 
 « 20 
 
 30 
 
 , 40 
 
 Above 60 - 
 
 Under 14 
 Between 14 
 Abuve 45 
 
 Total 135 
 
 45 
 
 Plymouth. 
 
 3> 
 
 
 O i 
 
 
 5^ 
 
 >26 
 
 e( 
 
 
 10> 
 
 
 26- 
 
 -26 
 
 13" 
 
 •23 
 
 75 
 
76 
 
 that term being equal to all those occur- 
 . ring before thirty, and rather greater than 
 those happening after forty. 
 
 The importance of determining the 
 interesting question, whether consump- 
 tion be an increasing disease, may justify 
 the length to which the pursuit of the 
 inquiry has been extended. If the increase 
 of consumptive complaints be established 
 as an incontrovertible fact, if this increase 
 has already proceeded to the extent which 
 has been rendered probable, and is still 
 advancing with accelerating rapidity, the 
 promulgation of it must surely add energy 
 to the warning voice, which has loudly 
 demanded, without having sufficiently 
 awakened, the attention of the guardians 
 of the rising generation to the danger 
 which threatens it. If it be established 
 as a fact, let us not vainly hope to 
 find an antidote to its ravages in the 
 hidden stores of nature ; but let us rather 
 strenuously seek to ascertain the causes of 
 its extended influence; and endeavour, 
 by all the arts of prevention, to obviate 
 
the attack of a foe, which prudence may 
 assist us to avert, but no prowess will 
 enable us to overcome*. 
 
 * It is no part of the design of this tract to enter into 
 the investigation of the causes here alluded to. Its aim is 
 simply to excite such an inquiry by others, possessing a 
 wider field of observation, and to be a preliminary step 
 towards it. The inquiry, indeed, will be unnecessary, if 
 the preliminary fact be not established ; and, if it be not, 
 it must be owing either to a fallacy in the sources whence 
 the premises are drawn, to errors in conducting the calcu- 
 lations, or to inconclusive reasonings from them. But if 
 from the above statements, as they now are, or as they may 
 hereafter stand corrected by just criticism, the conclusion 
 be verified, the future inquirer will at least not be stopped 
 in limine, as the author of a late inquiry into the changes 
 in the climate of Great Britain, by a denial that any 
 change had occurred. 
 
 In speaking of the chance of curing consumption, it is 
 far from my intention to depreciate the merits, or abate 
 the zeal of those, by whom new methods of trial are re- 
 commended ; but only to state the smallness of the chance, 
 for the purpose of .quickeuing attention to the necessity of 
 early recourse to prevention. In attempts to cure the 
 disease, when formed, we generally have the earnestly 
 concurrent assistance of the patient and his friends. In 
 applying the means of prevention, have we not, too often, 
 the concurrent counteragency of both these parties ? The 
 alliance, which at first might have been decisive, is with- 
 held ; until it is at best fruitless and unavailing. 
 
;a 
 
 Having thus deduced from the evidence 
 contained in the sixth table, the extension 
 of phthisical disease in general, our atten- 
 tion is recalled to the more immediate 
 object of inquiry ; its relative influence in 
 this place, compared with other places 
 mentioned in the table, especially those 
 in the second part. 
 
 If the average of consumptive mor- 
 tality at Plymouth be compared with 
 the general average deduced from the 
 same source in all the places cited in 
 the second part of the table, collectively 
 taken, it will be found to differ only 
 in the small proportion of one seven- 
 teenth, the relation of the former to the 
 latter being as 4.28 to 4. If London and 
 Bristol be excluded, it will somewhat 
 exceed the average of the remaining 
 places, the relation in that case being as 
 4.28 to 4.3 G.- But that the difference in 
 the latter instance would have been 
 reversed, and in the former considerably 
 augmented, if the comparisons had been 
 instituted from data derived from identical 
 
periods, is a conclusion warranted by the 
 preceding remarks in proof of the pro- 
 gressive increase of the malady under 
 consideration. For it cannot have escaped 
 observation, that, while the average of mor- 
 tality from the other places is drawn from 
 documents which do not extend beyond 
 the year 1773, and are included within 
 that and the year 1747, the average of 
 Plymouth is derived from a period so 
 much more recent, that the far greater 
 part of it extends into the present century. 
 But if the average of Plymouth be con- 
 trasted with those averages, which are 
 deduced from periods nearly correspon- 
 dent in time, of which we have instances 
 only in Bristol and London, it will be 
 found that the phthisical mortality at 
 Plymouth has of late years been nearly 
 one fourth less than in London*, and less 
 by nearly one half than in Bristol*. 
 
 In the unsettled state in which Europe 
 has for some time been, and in which she 
 
 * Tab. VI. P. II. 
 
80 
 
 is probably destined long to continue; 
 while in some countries the genial influ- 
 ence of climate is denied by open hostility, 
 and in others neutrality is no longer per- 
 mitted to afford a sanctuary even to the 
 votaries of health ; it has become an object 
 of increased importance to determine, 
 what places in our own island are best 
 adapted to the residence of those, who are 
 assailed by the " giant malady of the 
 country" 
 
 The mildness of the winter season in 
 the south-west of England has of late 
 vears induced consumptive invalids to 
 seek refuge in Devon and Cornwall* It 
 would certainly be an object of curiosity 
 and of utility to ascertain the frequency 
 and mortality of indigenous consumption 
 in these counties, relatively to other dis- 
 tricts in the eastern, northern, and mid- 
 land parts of the island. Unfortunately 
 for this inquiry, most of the calculations 
 we possess, are derived from registers 
 kept in large towns, and consequently 
 liable to be influenced by various local 
 
Si 
 
 causes. On account of this influence it 
 has been suggested, that the number of 
 
 Bo * 
 
 cases of consumption occurring at Ply- 
 mouth may not afford a just criterion for 
 estimating the relative frequency of the 
 disease in the western part of the island ; 
 because the occupations and habits of 
 many of the inhabitants of this town are 
 conceived to be peculiarly favourable to 
 the production of the disorder*. Various 
 employments in a sea-port necessarily ex- 
 pose a large proportion of the labouring 
 class to the severities and vicissitudes of 
 weather; and under such circumstances 
 the inducement to a more free use of spi- 
 rituous liquors, will be aided by a greater 
 facility of obtaining them. Of this argu- 
 ment it may be deemed no trifling con- 
 firmation, that the proportion of males to 
 females, whose deaths from consumption 
 
 * This objection was suggested by a physician of this 
 place, who, in the course of his extensive practice, has 
 had frequent opportunities of observing the greater preva- 
 lence of consumptive complaints in the little towns and 
 Tillages on the seaside near Plymouth, than in the country 
 at large. This he ascribes lo the combined operation of 
 the causes assigned. 
 
 M 
 
 -. 
 
82 
 
 are recorded in the first table, exceeds three 
 to two ; a proportion the reverse of that 
 which might have been expected, if the 
 greater exposure of men in sea-faring oc- 
 cupations had not been adverted to*. 
 
 It may also be objected to the applic- 
 ation of a proportion derived from the 
 phthisical mortality of a Dispensary only, 
 to the district containing that institution ; 
 that consumption may be presumed to be 
 more prevalent among that class which 
 applies to such charities for relief, than 
 among the middle and higher ranks ; and 
 consequently, that the relative mortality 
 will be greater in that portion, than in 
 the aggregate of the inhabitants of the 
 district. Consonantly to this supposition 
 
 * This presumption of the greater liability of\the female 
 sex in general is not, it must be confessed, warranted by 
 the only other instance in point, which has occurred to 
 me. In this the proportioa of males exceeds that of fe- 
 males, although in a far less degree than in the instance 
 above-mentioned. At Ackworth, in Yorkshire, there 
 died of consumption, from 1747 to 1767, thirty-three 
 males and twenty-eight females, which is in the proportion 
 of 8.25 to 7, 
 
S3 
 
 it will be observed in the sixth table* 
 that the proportionate mortality, stated 
 from Dr. "Willan's general practice, ex- 
 ceeds that deduced from the bills of mor- 
 tality ; which could not have happened, if 
 Dr. Willan's statement had not been 
 materially influenced by the description 
 of his patients, a large proportion of 
 whom, notwithstanding the known extent 
 of his private practice, must have been 
 derived from the Carey-street Dispensary. 
 
 In considering the effect of these objec- 
 tions in the instances cited in the table, 
 we shall find, that the latter alone, and 
 that partially, applies to Dr. Willan's 
 statement ; and that the former is applic- 
 able to Bristol and London, f where the 
 combined operation of exposure and in- 
 temperance must assuredly be experienced 
 in full as great a degree as at Plymouth) 
 and not to Shrewsbury and Chester. If 
 therefore, the mortality at Plymouth be 
 contrasted with that at Chester or Shrews- 
 bury, an allowance must be made for the 
 local reasons assigned in each of the objec- 
 
84 
 
 tions ; but if the comparison be made 
 With Bristol or London, such a correction 
 only is necessary as may be warranted by 
 the second objection. Upon the whole it 
 appears not improbable, that more accu- 
 rate and comprehensive statements might 
 confirm the opinion entertained of the 
 comparatively favourable influence of the 
 climate of the west of England on con- 
 sumptive complaints. 
 
 One observation more respecting this 
 disease shall suffice. In the first table, 
 the whole number of cases of phthisis is 
 stated to be ]g8, and of deaths 75; and 
 accordingly in the fourth table, the pro- 
 portion of mortality is said to be as l in 2. 
 6l. But from this statement it must not 
 be inferred, that the recoveries have been 
 in this proportion. The practice at our 
 institution lays not a claim to such suc- 
 cess. This disagreement will be ex- 
 plained by recollecting, that in the course 
 of seven years the same persons may have 
 been admitted at different times, labour- 
 ing under the same disease, and at each 
 
85 
 
 time of admission may have been consi- 
 dered as distinct persons. Some also 
 having been relieved, and discharged for 
 the purpose of going into the country for 
 change of air, may have there died unre- 
 corded. Others, wearied with a long 
 attendance, desire to be discharged, and 
 resigning themselves to their fate, sink at' 
 last unnoticed into the grave. What 
 allowances are to be made on these ac- 
 counts cannot be easily estimated. In 
 early stages of the complaint some bene- 
 fit is doubtless derived from preventive 
 medicine, in removing the disease, or in 
 deferring the period of its fatal attack ; 
 and certainly some rare instances do, from 
 time to time, occur of recoveries under 
 circumstances apparently most unpromis- 
 ing. By the recollection of these our 
 hopes are animated, and our feelings 
 reconciled to the task of attending the 
 victims of this disease, the most painful 
 office of a painful profession. 
 
 The disease, which from its importance 
 claims the next attention, is fever, the 
 
so 
 
 prevalence of which in this town is, as 
 has been already hinted, less extensive 
 than might have been expected from the 
 consideration of its populousness, its 
 liability during war to an excessive in- 
 crease of its inhabitants, and to its expo- 
 sure to contagion from its intercourse 
 with fleets and armies. 
 
 The proportion of typhus to other dis- 
 eases at our Dispensary, on an average of jj 
 seven years, is as l to 20.2. At the ¥ 
 Dispensary in Liverpool, we find from \ 
 the tables given by Dr. Currie*, that the : 
 proportion of typhus to other diseases 
 was, on an average of seventeen years, as 
 3 to 4.5 nearly. In that period the num- ? 
 her of general cases admitted at the Dis- * ^ 
 pensary amounted to 213,305, of which 
 48,367 were cases of typhus. In the 4 
 space of seven years the number of gene- 
 ral cases admitted at our Dispensary has 
 been 44og, of which 218 have been cases 
 of typhus. 
 
 * Currie's Medical Reports, &c. 550, ?d. edit. 
 
&7 
 
 But before a comparison can be insti- 
 tuted on these data, some circumstances 
 must be taken into consideration, which 
 may materially influence the result. In 
 the first place, the disproportion will be 
 made much more considerable by deduct- 
 ing from the general cases, admitted at 
 Liverpool, one sixth part*, as the proba- 
 ble proportion of surgical cases, which 
 '■ are not admitted in these tables. But, on 
 • the other hand, it is probable, that this 
 . difference would be counteracted bv the 
 * j addition of all the medical cases admitted 
 ;-* in the same period into the infirmary at 
 Liverpool. And as cases of fever are not 
 , admitted into this infirmary, and as Ply- 
 mouth has no such institution, it is obvi- 
 . ous that this addition must be made, be- 
 - fore we can institute a fair comparison 
 between the proportions of fever to other 
 diseases, to which the same class of peo- 
 ple in the respective towns is liable ; the 
 
 * In assuming the surgical cases to be one sixth of the 
 whole, the proportion is adopted, -which actually subsists 
 in a return for September, l790 r stated in page 225 of 
 the work abore cited, 
 
as 
 
 care of the general diseases being in the 
 one instance divided between two estab- 
 lishments, and the care of the particular 
 disease being restricted to one of them, 
 while in the other instance, one establish- 
 ment includes the admission of the parti- 
 cular as well as the general diseases. This 
 necessary correction cannot be made, 
 owing to the number of admissions into 
 the Liverpool Infirmary being unknown. 
 A correction is also required, on the other 
 hand, in the Plymouth statement, since the 
 proportion ought to be increased by 
 deducting from the general cases all those 
 . which have occurred in persons not 
 residing within the town ; as it is obvious 
 from the nature of the Institution, that 
 no cases of fever occurring in persons of 
 this description can have been admitted* 
 Still, however, after making these con- 
 trary allowances, there will probably be 
 no great error in presuming the prevalence 
 of fever to be more extensive among the 
 lower class of inhabitants of Liverpool, 
 than it is among those of the same de- 
 
89 
 
 Scription in Plymouth, in the proportion 
 of four to one. 
 
 This amazing difference must, however, 
 Without hesitation, be ascribed in a much 
 greater degree, to causes rendering Liver- 
 pool peculiarly obnoxious to the influence 
 of fever, than to causes operating to ren- 
 der Plymouth peculiarly unobnoxious to 
 similar influence. Of this, little doubt can 
 be entertained, when it is known, that of 
 the inhabitants of Liverpool "seven thou- 
 sand live in cellars under ground, and 
 nearly nine thousand in back houses, 
 which in general have an imperfect 
 ventilation, especially in the new streets 
 on the south side of the town, where 
 a pernicious practice has been lately 
 introduced of building houses to be let 
 to labourers, in small confined courts, 
 which have a communication with the 
 street by a narrow aperture, but no 
 passage for the air through them. 
 Among the inhabitants of these cellars 
 
 ff 
 
90 
 
 and back houses typhus is constantly 
 present*." 
 
 The proportion of fever cases at Ply- 
 mouth approaches nearer to that which 
 appears to obtain in London. From an 
 average of Dr. Willan's practice, during 
 four years, it appears that the cases of 
 fever were to the general cases as 1 to 10, 
 the total number of the former being 
 11,484, of the latter 73 if. Here, how- 
 ever, it must be observed, that Dr. Wil- 
 lan's cases included not only those admit- 
 ted at the Carey-street Dispensary, but 
 also those occurring in his own very ex- 
 tensive private practice among the middle 
 and higher classes of society ; and as the 
 
 * (Turrit's Reports. Sec. 2<22, Cd. edit. 
 
 ^ See Reports on the Diseases in London. — It is here 
 necessary to observe, that, in estimating the number of 
 fever case*, in Dr. Willan's Monthly Reports, I include 
 not only what he styles contagious fever, but his synochus 
 and slow fever, because I apprehend the term typhus, ia 
 the other instances, to have been employed in the extensive 
 sense in which it was applied by Cullen, and, conse- 
 quently, to ha^e embraced all those cases. 
 
01 
 
 prevalence of fever in those classes is 
 comparatively very inconsiderable, we 
 are probably entitled to deduct such a 
 number from the general cases, as will 
 render the proportion of fever to the re- 
 mainder as l to 13, or even 12. It must, 
 at the same time, be remembered, that a 
 contrary correction must be made, as in 
 the case of Liverpool, on account of the 
 London hospitals, from which fever is 
 also excluded. 
 
 In Dr. Clarke's relation of the recent 
 proceedings at Newcastle, for the estab- 
 lishment of a house of recovery*, there 
 are many facts relative to the prevalence 
 of fever, in that and some other towns ; 
 but there are not sufficient data for 
 instituting a comparison, even on the 
 grounds assumed in the preceding in- 
 stances. In one placef , he speaks of the 
 
 • Collection of Papers intended to promote an Insti- 
 tution for the Cure and Prevention of infectious Fevers in 
 Newcastle, kc. By John Clarke, M. D. 
 
 t Part I. p. 19, note. 
 
02 
 
 number of cases of fever in one year hav- 
 ing amounted to 425 ; in another*, he 
 gives the number of cases admitted at the 
 dispensary in four successive years, the 
 average of which is 15(5. But as he does 
 not state the total number of cases ad- 
 mitted in the same period, the relation of 
 one to the other cannot be obtained. We 
 may, however, arrive at a conclusion by 
 another process, namely, by finding the 
 proportion of fever cases to the number of 
 inhabitants. The number of fever cases 
 admitted at the Newcastle Dispensary, 
 assuming 150 as the average, is to the 
 population of that town, estimated at 
 30,000, as 1 to 231. And if the number 
 of general cases admitted at the Newcastle 
 Dispensary be to the inhabitants at large 
 in the same relation as the corresponding 
 number is at Plymouth, namely, as l to 
 24, then it will follow, that the propor- 
 tion of cases of fever, at the former place, 
 is as 1 to 10. 
 
 Part I. p. 56. 
 
03 
 
 Upon the whole, from these premises', 
 which must be allowed to be but imper- 
 fect, we, shall perhaps approximate the 
 truth in supposing the relative occurrence 
 of fever to other disorders, among the 
 lower class of inhabitants, to be in Liver- 
 pool as 1 to 5 ; in Newcastle, as 1 to 10 ; 
 in London, as 1 to 13 ; and in Plymouth, 
 as 1 to 18. This calculation will appear 
 less objectionable, when it is recollected, 
 ihat the best evidence in its support sub- 
 sists in the two instances, which form the 
 extremes. 
 
 Few remarks remain to be made on the 
 other diseases included in the first table. 
 
 The decrease of intermittent fever 
 in this district is sufficiently obvious, by 
 contrasting its rare appearance at present 
 with the frequent mention of it in the 
 writings of Dr. Huxham. Yet, from an 
 observation of that author*, connected 
 
 * Ex quo sane tam udas habuimus tempestates, febres 
 intermittentcs omnigenae per has regioncs grassata; sunt 
 
94 
 
 with subsequent experience, it should 
 seem that the prevalence of intermittents 
 in this place, at the period when he wrote, 
 was owing to accidental circumstances ; 
 and that the present, as well as previous, 
 exemption from this disorder is to be 
 ascribed to local and original causes, and 
 not to the operation of those general 
 causes, connected with the agricultural 
 improvement of the country, by which its 
 influence in this island has been confined 
 to very narrow limits. 
 
 Dr. Heberden remarks that there is 
 scarcely any fact to be collected from the 
 bills of mortality more worthy of atten- 
 tion than the gradual decline of dysen- 
 tery. In the seventeenth century, the 
 number of deaths under this head appears 
 
 maxiiiie, etiam in hoc oppido et per viciniam ; cum tamen 
 annis abhinc viginti veras intermittentes rarissime viderim. 
 Imo bene memini milites plurimos, emeritos, ad arcera 
 nostram olim transvectos ab oris Icenis et Portu magno» 
 pertinaci admodum quartana tantum non confectos penitus, 
 qui tamen hie, a sola benignitate cceli, convaluere protinus, 
 -r-Huxham de Aerc, An. 1735, p. llf. 
 
95 
 
 to have been never less than one thousand, 
 and sometimes to have exceeded four 
 thousand. In the eighteenth century, the 
 decline was constant, regular, and rapid ; 
 the average number of cases, in the first 
 ten years, amounting to one thousand and 
 seventy, and in the last ten years only to 
 twenty. Yet, from the year 1733, colic 
 has been included under the same head 
 with dysentery. Our tables confirm the 
 infrequency of these diseases. Dysentery 
 is almost unknown ; and the decrease ot 
 colic in this town, during the last thirty 
 or forty years, has been, I have reason to 
 think, very remarkable. Its relative oc- 
 currence is as l to 133, and its propor- 
 tional mortality as l to 321. Of dysen- 
 tery no fatal case has occurred. 
 
 The increase of apoplexy and palsy, 
 Dr. Heberden observes, has been gradual 
 and constant. The proportional mor- 
 tality from these diseases is now more 
 than double what it was a hundred years 
 ago. On the average of the last five years 
 of the last century it appears, from the 
 
06 
 
 bills, lo have been as l to 50. Our table 
 confirms the observation, as far as relates 
 to the present times, by giving the relative 
 mortality as l to 32. 
 
 Dropsy is one of the diseases, which 
 appears to be rather on the decline in the 
 southern part of the island. This seems 
 to have been in great measure effected by 
 the operation of the duties imposed on dis- 
 tilled spirits. The proportional mortality 
 from this disease, as deduced from an 
 average of the last three years of the 
 eighteenth century, in the bills, corre- 
 sponds, very nearly, with that afforded by 
 our table, being in the one instance as 1 
 to 20.8, in the other, as 1 to 19. The 
 proportion of cases of dropsy to the gene- 
 ral cases is as 1 to 36. I am inclined to 
 believe this proportion much less than 
 obtains in the northern part of the island, 
 where the use of whiskey seems still to 
 retain a predominating influence on dis- 
 ease. Has this species of distilled spirits 
 a peculiarly destructive influence ? In 
 certain districts of a neighbouring county, 
 
 5 
 
97 
 
 where brandy is supposed to have been 
 drunk with a liberality proportionate to 
 the facility with which it was once ob- 
 tained, I have been assured by a gentle- 
 man of accurate observation, whose op- 
 portunity of forming an opinion had been 
 long and extensive, that dropsy did not 
 particularly prevail. Yet the free use of 
 spirituous liquors, as a frequent cause of 
 dropsy, rests on evidence too strong to be 
 questioned, 
 
 Diabetes, I am led to believe from 
 my inquiries, has been in this neighbour- 
 hood a disease of rare occurrence. Our 
 table gives only two instances ; and nei- 
 ther of these furnished a well-marked case 
 of the disease. It has been supposed to 
 be more frequent in Scotland than in 
 England ; yet in a place where diseases 
 of curiosity are sought after with avidity, 
 and where in diseases little understood 
 relief would be sought from distant parts, 
 twenty cases only occurred to Dr. Cullen, 
 in his long practice. And in the same 
 situation thirteen years afforded only 
 
 o 
 
98 
 
 twelve instances to Dr. Gregory, and 
 twenty years the same number to Dr. 
 Duncan. 
 
 At the conclusion of the first table is 
 stated the total number of cases treated at 
 the Dispensary in the first seven years of 
 its existence, together with the total 
 
 NUMBER OF FATAL EVENTS arising OUt 
 
 of those cases in the same period. If a 
 comparison of these numbers had afforded 
 any presumption of more than usual suc- 
 cess, I should silently have participated 
 in the gratification resulting from the 
 reflection, that the liberality of the pub- 
 lic had produced a more than wanted 
 share of benefit to the objects of its com- 
 passion. But feelings of a different ten- 
 dency cannot influence me to forbear 
 contrasting the real mortality, as it fairly 
 and simply stands,* in our Institution, 
 with that which obtains in other establish- 
 ments of a corresponding, or nearly simi- 
 lar nature. From the great difference in 
 the proportional mortality at different 
 institutions, as stated in the subjoined 
 
99 
 
 table, it will probably be inferred, that no 
 great confidence can be placed in any 
 comparisons on this head, unless the 
 nature and mode of conducting the res- 
 pective establishments were better known. 
 A source of material difference arises 
 from the admission, or exclusion of sur- 
 gical cases, the proportion of deaths from 
 the latter being always much smaller than 
 from the former. The mortality also, on 
 several accounts, may be presumed to be 
 greater at dispensaries than in hospitals. 
 In the former, diseases of all descriptions, 
 and at all periods, are admitted ; while 
 from the latter, contagious distempers, as 
 fever and small pox, in most instances, 
 and consumption in many, are excluded : 
 and how large the proportion of fatality 
 from these sources is, needs not to be 
 recapitulated. 
 
 How inferior the chance of success in 
 dispensary to that in hospital practice is, 
 will be obvious to him who reflects on 
 the situation of the diseased poor man in 
 his miserable habitation, often without 
 
100 
 
 necessaries and without attendance, or 
 with these, when supplied, most inju- 
 diciously employed, and contrasts it with 
 the condition of the same person trans- 
 ferred to a ward of a British hospital. 
 
 It may perhaps be said, that a large 
 portion of cases admitted at a dispensary 
 are of a slighter nature, and such as 
 would not be sent to an hospital ; and 
 therefore, that the mortality should be 
 proportionably less. This observation 
 is certainly just, but it is applicable only 
 to those hospitals where out-patients are 
 not received. But it will not escape 
 remark, that in the following table the 
 greatest differences subsist in the reports 
 from dispensaries; and this difference 
 appears to be totally irreconcilable in the 
 first two instances, where a more than 
 common correspondence might have 
 been presumed to obtain. It is equally 
 impossible to reconcile the report of the 
 Carey-street Dispensary, under Dr. Wii- 
 lan's direction, with the result of that 
 
101 
 
 physician's general practice, as well pub- 
 lic as private. 
 
 That the total proportion of deaths in 
 our dispensary is large, I am still inclined 
 to believe from perceiving the proportion 
 to be unexpectedly large in two or three 
 prevailing disorders. In typhus the loss 
 has been one in six ; whereas in the 
 Newcastle Dispensary, and in the Edin- 
 burgh Infirmary, the loss is one in fifteen, 
 and in the Whitehaven Dispensary one in 
 twenty. In pneumonia the proportion 
 of deaths with us is also one. in six. In 
 the first instance, the difference may 
 partly arise from a diversity in the appli- 
 cation of the term typhus. Perhaps many 
 of the cases included in our table under 
 the title febris might have been classed 
 as slighter cases of typhus ; and had this 
 been done, the apparent mortality would 
 have been much less. An observation, 
 common to fever and pneumonia, but 
 more decidedly applicable to the latter, is, 
 that admission is too generally deferred 
 to a very late period of the disease. Of 
 5 
 
102 
 
 the hundred and thirty eight cases of 
 pneumonia, I suspect there was no op- 
 portunity of employing the lancet in a 
 fifth part. The list of deaths is swelled 
 also by the fatal effects of small pox, of 
 the cases of which one half has proved 
 mortal. If delay in applying for assist- 
 ance be observable in the two last-men- 
 tioned diseases, it is still more remarkable 
 in this ; but I am far from thinking that 
 a difference in the event would so cer- 
 tainly follow a contrary practice in the 
 latter instance as in the former. But 
 whatever the influence of this cause may 
 be, it is difficult to conceive its operation 
 confined to our institution, unless indeed 
 the novelty of the establishment may be 
 supposed to involve such a consequence. 
 
TABLE VII. 
 AVERAGE OF DEATHS 
 
 AT 
 
 SEVERAL INSTITUTIONS. 
 
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PART II. 
 
 TABLES 
 
 ILLUSTRATIVE 
 
 OF THE 
 
 INFLUENCE OF THE SEASONS 
 
 ox 
 
 MORTALITY, 
 
 WITH OBSERVATIONS. 
 
 In the following tables, the number affixed to each month is the aggre- 
 gate amount of the deaths in that month of all the years of the stated 
 period. 
 
 In the second division of each table the succession of the months is 
 arranged in relation to the increase of deaths in each of them. 
 
 The second number affixed to February denotes the amount of the 
 deaths, upon the supposition of the assignment of thirty-one days to 
 that month. 
 
Ill 
 TABLE VIII. 
 
 *BLANDFORD. 
 40 Years— 1733 to 1772. 
 
 fJune I 190 1 
 
 Summer <j July V 145 I 480 
 
 (August ) 144 ) 
 
 C September 1 165 1 
 
 Autumn <? October V 172 V 
 
 (November ) 174 ) 
 
 C December ) lfis 1 
 
 Winter ^ January V 220 > 
 
 (.February j 218 ) 
 
 511 
 
 606 
 
 991 
 
 3 >2231 J 
 
 f March 
 Spring ^ April J> 193 J- 634 
 
 (.May 
 
 } 223 } 
 3 213 ) 
 
 1240 
 
 August 144 
 
 July 145 / 
 
 September 1(55 
 
 December 168 
 
 October 172 
 
 November 174 
 
 June 190 
 
 April 193 
 
 May 218 
 
 February 218 — 235 
 
 January 220 
 
 March 223 
 
 • Phil. Trans. The deaths from small-pox, of which a separate 
 account is given, arc not included in this table. 
 
 / 
 
112 
 
 TABLE IX. 
 
 * CHESTER. 
 
 2 Years— 1772, 1773. 
 
 Summer <J .lulv > 38 > 138 
 
 f June 1 61 1 
 
 ler 1 .luly V 38 > 
 
 (August ) 39 ) 
 
 ( September ") 37 } 
 
 «J October V 56 > 
 
 (_ November J 73 J 
 
 C December ') 82 
 
 Winter -^ January > 69 
 
 (February ) 81 
 
 Autumn^ October > 56 > 166 
 ( November 
 
 C December 
 
 232 
 ry 3 81 i 
 
 March 
 
 Spring J April , 105 
 
 May 
 
 111 
 
 September 37 
 
 July 3S 
 
 August 39 
 
 October 50 
 
 June Gl 
 
 May 63 
 
 March 65 
 
 April 67 
 
 January 6*9 
 
 November 73 
 
 February 81 — S" 
 
 December 82 
 
 * Phi!. Trans., vol.64, Gj 
 
 1 
 
1*4 
 
 TABLE X. 
 
 •WARRINGTON. 
 1 Year. 
 
 C June 1 22 
 
 Summer < July f l6 ^ 54 
 
 £ August 
 
 f September 
 Autumn ■< October > 1 1 > 30 
 
 (_ November 
 
 
 84 
 
 f December 
 
 Winter < January J> 35 ^-94 
 £ February 
 
 (March 1 35 ) 
 
 Spring 1 April > 29 > 84 
 
 (.May ) 20 ) 
 
 262 
 
 } 
 
 178 
 
 November 6 
 
 October 1 1 
 
 September 13 
 
 July 16 
 
 August 16 
 
 May 20 
 
 June 22 
 
 April 29 
 
 December 29 
 
 February 30 — 33 
 
 January 35 
 
 March 35 
 
 • Phil. Trans, vol.64. 
 Q 
 
114 
 
 TABLE XL 
 
 PLYMPTON - MAURICE, PLYMPTON SAINT 
 MARY, PLYMSTOCK, adjoining Country Parishes 
 iu the County of DEVOX. 
 
 6 Years— 1779— -1S04-. 
 
 f June 1 36 1 
 
 Summer { July > 23 V 91 
 
 (.August ) 32 ) 
 
 (September ] 40 ] 
 
 Autumn «> October > 43 > 120 
 I November ) 37 ) 
 
 f December ^ 39 1 
 
 Winter ^ January > 48 > 139 
 
 £ February ) 52 J 
 
 (March 1 35 1 
 
 Spring < April \ 64 > 156 
 
 (May J 57 ) 
 
 211' 
 
 506 
 
 1 
 
 295. 
 
 July 
 
 23 
 
 August 
 
 32 
 
 March 
 
 35 
 
 June 
 
 36 
 
 November 
 
 37 
 
 December 
 
 39 
 
 September 
 
 40 
 
 October 
 
 43 
 
 January 
 
 48 
 
 February 
 
 52 — 5& 
 
 May 
 
 57 
 
 April 
 
 64 
 
115 
 
 TABLE XII. 
 
 ST. ANDREW, CHARLES ; STOKE DAMARELL; 
 EAST STONEHOUSE ; comprising the towns of 
 PLYMOUTH, PLYMOUTH-DOCK, and STONE- 
 HOUSE. 
 
 6 Years— 1799— 1804. 
 
 f June 
 
 Summer 1 July )> 638 J>2059 
 
 I August 
 
 i -h , - >42(j5 
 
 f September 1 725 
 
 Autumn 1 October V 751 S-2206 
 
 (November J 730 ) 
 
 f December 1 820 1 
 
 Winter ^January > 860 >2485 
 
 (February J 8 °5 J 
 
 f March 
 
 Spring V April ^ 856 } < 25S6. 
 (May 
 
 \ 7l6 } 
 
 V 638 >2( 
 
 J 705 ) 
 
 V 751 V22( 
 J 730 ) 
 
 I 8 ' 
 
 ) 81 
 
 7 899 1 
 
 }■ 856 y 
 
 ) 831 ) 
 
 2 >9336 
 
 1 
 
 5071 
 
 July 638 
 
 August' 705 
 
 June 7l6 
 
 September 725 
 
 November 730 
 
 October 751 
 
 February ; 805 — 870 
 
 December 820 
 
 May 831 
 
 April 856 
 
 January 860 
 
 March 999 
 
116 
 
 TABLE XIII. 
 
 •LONDON. 
 
 15 Years— 1728, 1743. 
 
 r June 
 
 Summer < July 
 
 V AU2I 
 
 August 
 
 -) 30197-) 
 £28210 \ 89235S 
 
 3 30829 > f 
 
 V 191382 
 r September -^ 33375 -\ I 
 
 Autumn < October J 34590 S 102146 J 
 
 t November J 34181 3 
 
 r December ■) 35952 -\ 
 Winter 2 January S 37682 S 10979J 
 (■February 3 36157 > 
 
 Spring J April 
 
 (•March -) 37126} 
 ) April > 34242 > 
 
 (.May 3 33410 3 
 
 104778 
 
 ! 
 
 4 
 
 214569/ 
 
 >40595l' 
 
 July 
 
 28210 
 
 June 
 
 30197 
 
 August 
 
 30829 
 
 September 
 
 33375 
 
 May 
 
 33410 
 
 November 
 
 34181 
 
 April 
 
 34242 
 
 October 
 
 34590 
 
 December 
 
 35952 
 
 February 
 
 36157 — 
 
 March 
 
 37126 
 
 January 
 
 37682 
 
 — 39002 
 
 * Short's Observations, &c. — Heberden, p. 47, 
 
U7 
 TABLE XIV. 
 
 ♦YORK. 
 
 7 Years, 
 
 /•June -> 274 -j 
 
 Summer l July > 220 S731 - 
 
 i August -> 237 ■> f U23 . 
 
 /-September -) 225 -\ \ 
 
 Autumn J October [ 237 J 692 ) ^ 
 
 I November > 230 > & I * 
 
 c December -) 292 -\ ^ / 3 
 
 Winter 3 January > 320 J894 
 C February -> 282 -> 
 
 , March -) 316 ■) 
 Spring ? April \ 277 Ss5S 
 
 I May ? 263 -> 
 
 July 220 
 
 September 225 
 
 November 230 
 
 August 237 
 
 October 237 
 
 May 265 
 
 Jane 274 
 
 April 277 
 
 February 282 — 306 
 
 December 292 
 
 March 3] 6 
 
 January 320 
 
 • Heberdcn, p. 49» 
 
U8 
 
 TABLE XV. 
 
 COUNTRY-TOWNS IN ENGLAND. 
 
 I\Ian.y years. 
 
 s June 
 Somifler < July 
 
 <• August 
 
 ' 13034- > 30509' 
 
 136SO 
 
 3 12795 5 
 
 12999 
 
 r September 
 1 < October } 13629 J 40702 
 
 Winter 
 
 Spring 
 
 . 13629 I 
 
 t November 3 14074 3 
 
 'S0211 
 
 December 
 
 •? January 
 
 •j 15658 -^ 
 M6932 J4S716. 
 February 3 161 26 3 
 
 > 17641 -j 
 
 > 17670 J 5 1929 
 
 3 1661s 3 
 
 180856 
 
 J 
 
 March 
 1 
 lay 
 
 c Man 
 
 >Apri 
 (.May 
 
 100645. 
 
 August 
 
 12795 
 
 September 
 
 12999 
 
 July 
 
 13034 
 
 October 
 
 13629 
 
 June 
 
 13680 
 
 November 
 
 14074 
 
 December 
 
 I0608 
 
 February 
 
 16126 —17422 
 
 May 
 
 1661S 
 
 January 
 
 16932 
 
 March 
 
 17641 
 
 April 
 
 >176?0 
 
 * Short's Observations, &c— Heberden, p. 4?. 
 
I1Q 
 
 TABLE XVI. 
 
 Comprising 
 the aggregate numbers of the eight preceding Tables. 
 
 June -^45176 
 
 r j une i 
 
 Summer 1 July [42325 £ 132293 
 
 t August ) 44797 2 
 
 s September -\ 4757.0 
 Autumn •? October 
 
 Winter 
 
 Spring 
 
 I 
 
 November J 49505 
 
 • ; 7 
 
 >494S5) > 146573 
 J 40 505 J 
 
 r Jjecemuer -\ i>d040 -\ 
 < January > 56166 > 
 v. February J 5 375 1 * 
 
 i 
 
 March -^ 56340 
 
 ^ April 
 (-May 
 
 -\ 56340 -\ 
 S533G8 >161220 
 3 51482* 
 
 275871' 
 
 324177 
 
 >6Q304S 
 
 July 
 
 42325 
 
 August 
 
 44707 
 
 June 
 
 45176 
 
 September 
 
 47570 
 
 October 
 
 49480 
 
 November 
 
 405O5 
 
 May 
 
 51482 
 
 December 
 
 53040 
 
 April 
 
 5339S 
 
 February 
 
 53751 
 
 January 
 
 56166* 
 
 March 
 
 56340 
 
 * July 
 
 42325 
 
 August 
 
 44797 
 
 June 
 
 46682 
 
 September 
 
 49165 
 
 October 
 
 4 94 SO 
 
 November 
 
 51153 
 
 May 
 
 51482 
 
 December 
 
 53040 
 
 Ap'ril 
 
 55177 
 
 January 
 
 56 166 
 
 March 
 
 56340 
 
 February 
 
 58069 
 
 * In this column the months are supposed to contain an equal num- 
 ber of days, viz. 31. The calculation has been made by adding to 
 each of the months which consist of 30 days, i-ioth of its number, and 
 by adding to February 3-28ths of its number, after deducting i--<th©R 
 account of leap years. 
 
120 
 
 PS 
 
 < 
 
 w 
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 r- 1 p* 
 
 o 
 
 Q 
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 H 
 Ci 
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 P< 
 
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 9 
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 S 
 
 H H 
 * £ JS 
 
 ^ to 
 
 pq ~ 
 
 3 
 
 
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 b- 
 
 1 
 
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 CO 
 
 
 
 
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 — 'N.Cir}«0. tf50>0>couo'0 
 
 eo 1 
 
 CO 
 
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 otioio^ooie»-««<rsN 
 
 3g 
 
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 <N 
 
 <NC*s^CN<M<Ncocoeoeos< 
 
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 CO ■* 
 
 
 
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 CO 
 
 00 iO 
 
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 W«iQOKXONOO<0 
 
 Tt< 
 
 pH rt 
 
 
 I— < i-H r-i 
 
 CC 
 
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 xt*uo — — t^eo — co^tN 
 
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 X X 
 
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 cy"?f<T?soc)Tr^OTj''* 
 
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 0»T*i0T?C0'0 v C'OO l O , T 
 
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 Spri 
 
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 rt Z 
 
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 — • o o* 
 
 c o 
 
 3 -9 
 
 ■5 tt 
 
 .5 ■ 
 
 
 53 S 
 S .2 
 
 3 -S 
 
 s c * 
 
122 
 
 TABLE XVIII. 
 
 PROPORTION OF DEATHS IN EACH OF THE 
 
 MONTHS OF FIVE YEARS, 
 
 as in the preceding table, the months being arranged in 
 
 pairs, according to their respective distances 
 
 from the middle of summer. 
 
 964 
 
 91 } 3367 
 
 1212 
 
 V 
 
123 
 
 in 
 
 < 
 fa 
 
 a 
 
 
 fa 
 
 fa 
 
 
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 -"= 
 
 
 It- 
 
 
 
 
 
 
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 f= 
 
 
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 p^i 
 
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 x 
 
 
 ■53 
 
 
 l-M 
 
 
 
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 w 
 
 O 
 
 v-2 
 
 
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 P3 
 
 cn 
 
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 CO 
 
 H 
 
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 fa 
 
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 Q. 
 
 
 
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 en 
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 X X) 
 
 CM co 
 
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 C- 00 
 
 — <0 NO M fl -t CiCi>Cl NO 
 CN O* G* C-t CO CO C* O* — • — '-' "- 1 
 
 -J<30^O l O'r}<<©C0-«'*00C0 ir > 
 
 ^-H^(N'o'o«i>o^ i e' t oo) 
 
 4 s -2 ~ b 3 
 
 — ^ C r ~ — -fl in 
 
 *S'"8 , gJo§ia5l'3JS»§u 
 
 ?■« ° « S o- ^kS =; - = 
 
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 r* 
 
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 Tf 
 
 95 
 
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 C» »0 t-» SO 'O *fJ *>• 'O CO CI CX CO o 
 f «5 
 
 
 OOOMMO'l'OlSlOStH -^i 
 
124 
 
 TABLE XX. 
 
 PROPORTION OF DEATHS IN EACH OF THE 
 
 MONTHS OF SIX YEARS, 
 
 as in the preceding table, the months being arranged in 
 
 pairs, according to their resp Sye distances 
 
 from the middie of summer. 
 
 67\ 
 
 54 \ 285 
 
 124/ 
 
125 
 
 TABLE XXL 
 
 NUMBER OF PATIENTS ADMITTED AT THE 
 
 PLYMOUTH DISPENSARY, 
 
 in each month of six years, from September, 1799, to 
 August, 1805, the succession of the months being ar- 
 ranged in the order of their abundance in disease*. 
 
 1 August 
 
 . 
 
 , 298 
 
 2 July 
 
 • 
 
 313 
 
 3 June 
 
 * 
 
 . 316 
 
 4 April 
 
 • 
 
 . 322 
 
 5 October 
 
 • 
 
 . 323 
 
 6 December 
 
 • 
 
 , 323 
 
 7 September 
 
 . 
 
 . 331 
 
 8 November 
 
 . 
 
 331 
 
 9 May 
 
 • 
 
 , 339 
 
 10 February 
 
 (371) 
 
 344 
 
 11 January . 
 
 • 
 
 . 347 
 
 12 March 
 
 • 
 
 . 363 
 3950 
 
 * To obviate a possible objection it may be observed, that the faci- 
 lity of admission at this institution is at all times such as to preclude 
 the idea of the admissions being influenced by any other cause than the 
 wants of the applicants. 
 
120 
 
 TABLE XXII. 
 
 NUMBER OF PATII OMITTED AT '■■ 
 
 PLYMOUTH MSPENSA1 
 
 in each month of six yea*, from September, 170Q, to 
 Anau=t. 1805, the months being arranged in their natu- 
 ral succession, and classed in seasons, as in Table XIX> 
 
 1999\ 
 
 ?95G 
 
 1951 
 
 / 
 
127 
 
 The prevailing opinion in this country 
 of the influence of the seasons on disease 
 and mortality is justly observed by Dr. 
 Heberdeii to subsist in opposition to the 
 evidence of the clearest facts. Of these 
 facts some are passing in constant and 
 daily review, while others are derived 
 from less obvious, though more conclu- 
 sive, sources. But the prejudice, which 
 prevails in defiance of the former, re- 
 ceives a very limited correction from the 
 latter; while it acquires continual sup- 
 port by deriving its origin from various 
 sources. The influence of the ever-vary- 
 ing condition of the atmosphere of this 
 island on the animal spirits of its inha t- 
 tants, has been conceived to give a colour 
 to opinion in many instances. That in 
 the present instance it should prove a 
 source of erroneous judgment, is little to 
 be wondered at. Those who, to employ 
 their own metaphorical and delusive ex- 
 pressions, feel their bodies braced, their 
 nerves strung with new vigour, and their 
 spirits elastic, will naturally infer, that 
 the sharp air, the keen frost, the serene 
 
128 
 
 sky, to which these effects are ascribed, 
 must be more propitious to health, than 
 the warm, moist, and foggy atmosphere, 
 in which they had previously been op- 
 pressed with languor, and enfeebled by 
 relaxation. Hence is derived the uni- 
 versal interchange of congratulation on 
 the healthfulness of the weather, when to 
 a mild and open November succeeds the 
 keen frost of January or December. 
 
 At a period, happily remote from our 
 times, when England was subject to the 
 frequent visitation of pestilential disease, 
 the approach of summer was dreaded as 
 the harbinger of the plague ; and winter 
 was hailed as the deliverer from its ra- 
 vages. And in our own times we have 
 had such frequent occasions to lament the 
 wide-wasting ravage of disease in the 
 warm climates of the western world, 
 where British valour sinks into an un- 
 timely and inglorious grave, that analogy, 
 the fruitful parent of fallacious conclu- 
 sions, leads us to associate the ideas of 
 warmth and contagious distempers in our 
 
129 
 
 own temperate climate. But the fevers 
 of contagious origin in this island prevail 
 undoubtedly to a greater extent in the 
 winter than in the summer ; and the ex- 
 planation of the fact is found, in part, 
 sufficiently obvious, in the less ventilation 
 of the houses of the poor, in which con- 
 tagion is generated, in winter than in 
 summer. Sparingly provided with the 
 supplies of artificial heat, they sedulously 
 exclude the entrance of external cold ; and 
 preventing as much as is possible the 
 renovation of the air in their rooms, they 
 breathe with little intermission a highly 
 vitiated atmosphere during a considerable 
 length of time. 
 
 Perhaps in considering the origin of the 
 popular belief, the force of early impres- 
 sions and early associations in those 
 classes of society, on whom, on most 
 occasions, depends the cast of public 
 opinion, may be entitled to some atten- 
 tion. In this, as in many other instances, 
 we trace the influence of classic lore. 
 From the poets of Greece and Rome we 
 
 s 
 
130 
 
 imbibe early notions of the beauties of 
 spring. Their enlivening descriptions, 
 true to the feelings of their authors in the 
 genial climes of Italv and Greece, have, 
 with poetic licence, been transferred to 
 our northern skies ; and the shivering in- 
 habitant of Britain talks of the approach 
 of spring in the language of Arcadia. 
 
 But it is not to poetic description alone, 
 the influence of which is insensibly so ex- 
 tensive, but to the pages of science also, 
 that this illusion is to be traced. From 
 the dictates of Hippocrates and Celsus 
 originated, we may presume, the creed of 
 the physicians of modern Europe on the 
 salubrity of the seasons. " Saluberrimum 
 ver est ;" (says the elegant physician of 
 Rome) " proxime deinde ab hoc hiems ; 
 periculosior aestas ; autumnus long^ peri- . 
 culosissimus ;" and in the succession of 
 eighteen centuries this observation has not 
 become less applicable to the country in 
 which it was originally made. In modern 
 times the records of Marseilles and Mont- 
 pelier, which may be cited in defect of 
 
151 
 
 evidence immediately derived from Italy, 
 correspond very nearly with this descrip- 
 tion of the year. At the latter place, the 
 mortality from June to November exceeds 
 that from December to May nearly in the 
 proportion of four to three. At Mar- 
 seilles, the difference is on the same side, 
 but not in the same degree. 
 
 The strongly contrasted winters of 
 ] 7Q5 and l/Q'D will, in all probability, be 
 adduced in future, as irrefragably refuting 
 the opinions, which in this island attri- 
 bute unhealthiness to a mild, and healthi- 
 ness to a severe winter. But, although 
 this instance will justly be appealed to, as 
 placing the fact in a striking point of 
 view, yet the admission of the general 
 position cannot reasonably be expected, 
 without the production of evidence in its 
 support on a much more extended scale. 
 Of this nature is the proof adduced by 
 Dr. Heberden from the London bills of 
 mortality, supported by the concurrence 
 of similar conclusions deduced from regis- 
 ters in some other towns in England. 
 
132 
 
 The principle also, on which the conclu- 
 sion is founded, receives confirmation 
 from records at Paris and throughout the 
 kingdom of Sweden. 
 
 In the preceding tables (from VIII. to 
 XXII.) is collected and arranged various 
 evidence on the question, as far as it re- 
 lates to this kingdom, derived from the 
 recorded mortality at different periods and 
 at different places ; and particularly, in 
 conformity with my design of illustrating 
 relative local mortality, in this town and 
 its vicinity. 
 
 In the division of the year into four 
 seasons, the boundaries have neither been 
 assigned with precision by nature, nor 
 definitely prescribed by custom. In the 
 distribution of the months into the re- 
 spective seasons adopted in these tables, 
 no arrangement more correspondent to 
 nature seemed practicable, while an equal 
 portion of time is to be allotted to each 
 season. The protracted arrival of sum- 
 mer for many years past justifies the as- 
 
133 
 
 tmeat of its commencement to the 
 month of June, and the mild, open, and 
 
 days" of many a November i 
 »cue this calumniated month 
 from being delivered over to the gloomy 
 period of winter. But, however this dis- 
 position may be objected to in the kalen- 
 dar of the naturalist, the medical inquirer 
 will, it is presumed, find in the tables 
 themselves sufficient reasons for its adop- 
 tion. 
 
 In deducing inferences from the six- 
 teenth table, no risk is incurred of erro- 
 neous conclusions from the operation of 
 partial causes. It includes a mortality to 
 the extent of six hundred thousand per- 
 sons, occurring at various periods in the 
 course of the last seventy years of the last 
 century, in towns and in the country, in 
 places remote from each other, and sub- 
 jected by situation to as great variation of 
 climate as can occur in so limited a space. 
 The counties of York, Middlesex, Lan- 
 caster, and Devon, from their relative 
 position, may be presumed to afford a 
 
134 
 
 mean of the variations of the weather, 
 indicated by the barometer^ thermometer, 
 and hygrometer, in the southern division 
 of the island. 
 
 From this table, thus comprehensively 
 formed, it appears, that the mortality is 
 greatest in winter ; but little less in 
 spring;' considerably diminished in au- 
 tumn ; and in summer much further re- 
 duced. The difference between the mor- 
 tality in summer and winter is nearly as 
 four to five ; and if the summer and au- 
 tumnal period be contrasted with the 
 winter and vernal portion of the year, it 
 will be as six to seven. Retaining this 
 table as a standard of comparison, in ex- 
 amining the other tables, from which it 
 is formed, a generally prevailing corre- 
 spondence will of course be expected. 
 Some variations in degree will, however, 
 be found, and some deviations from the 
 general course. The difference between 
 the winter and summer half-year is less in 
 the London table than in any of the 
 others, and greatest in Warrington, Ches- 
 
135 
 
 ter, and the country parishes in Devon- 
 shire. Mav it hence be inferred, that, 
 where the relative general mortality is 
 least, the proportion between the morta- 
 lity in summer and winter will be great- 
 est ? For example, in the district in De- 
 vonshire confined to the three towns, the 
 annual mortality is 1 in 25* ; in the dis- 
 trict comprising three adjacent country 
 parishes, it is l in 45 : in the former, the 
 deaths in the summer half-year are to 
 those in the winter as to 7, in the latter 
 as 5 to 7 . Or, is the difference of pro- 
 portion in London to be ascribed to this 
 circumstance, that the metropolis has less 
 than the usual proportion of persons of 
 advanced age, whose deaths happen most 
 frequently in winter, owing to the retire- 
 ment of many towards the close of life, 
 and the increased proportion of people of 
 
 * Perhaps tiic annual mortality is in this instance stated 
 too high; the grounds upon which it is so stated, are 
 mentioned in page 151 note. For the purpose, however, 
 for which the statement is here made, it is sufficient that 
 
 e mortality be admitted to he greater in lar , f .••■> ns than 
 in the country, which Is un ScniabSe. 
 
130 
 
 middle age derived from the perpetual 
 recruits, which the population is receiving 
 from persons of that description ? 
 
 The deviations from the general infer- 
 ences are chiefly to be found in the 
 eleventh table. In the country parishes, 
 from the registers of which it is formed, 
 the mortality is greatest in spring, and is 
 particularly excessive in the months of 
 April and May. As in winter it is com- 
 paratively less, so in autumn it is rather 
 
 greater. May it from these facts be in- 
 to j 
 
 duced, that life is more directly subjected 
 to the influence of weather in the country 
 than in towns ; and that the diseases of 
 spring and autumn, particularly of the 
 former, are those to which the inhabitants 
 of the country are most obnoxious ? If 
 the limited extent of the table forbid the 
 confident adoption of these conclusions, 
 to future observations must be left their 
 establishment or refutation. 
 
 Further exceptions occur in the eighth, 
 twelfth, and fifteenth tables, and also in 
 
137 
 
 the tenth. In the three first, spring is 
 found to exceed winter in fatality, and in 
 the last summer yields in healthiness to 
 autumn. 
 
 If an exception be taken to the ratio of 
 comparatiye mortality deduced from the 
 aggregate table (XVI.) on account of the 
 influence of the London table, which has 
 been shewn to differ materially from the 
 others, the necessary correction will pro- 
 bably be made, and an approximation to 
 a fair general average obtained, by stating 
 the deaths in the winter half to exceed 
 those in the summer half of the year by 
 one fifth of the whole. But if no such 
 exception be taken, the mortality in the 
 different seasons may be apportioned on 
 the following scale, presuming upon the 
 grounds formerly stated, the whole annual 
 mortality of Great Britain to amount to 
 2/5,000. 
 
 Mortality in summer 60,400 
 
 autumn 66.800 
 
 spring 73,650 
 
 winter 74,150 
 
 T 
 
 275,000- 
 
138 
 
 To each of the tables is subjoined a 
 succession of the months in the order of 
 their fatality. If, for the purpose of 
 comparison with other months, an equal 
 number of days be assigned to February, 
 this month will be found most abundant 
 in deaths. In one or two instances only 
 it is exceeded by March and April. June, 
 which is classed in the most healthy sea- 
 son, yields, in many instances, in salu- 
 brity, to some of the autumnal, and even 
 winter months. 
 
 If from the records of death in large 
 districts, in all the various forms in which 
 it assails mankind, our attention is direct- 
 ed to its more confined operation in a 
 small i circle, where it acts through the 
 medium of decided disease, it will appear 
 from the deaths at the Dispensary in six 
 years, that the difference in the influence 
 of the seasons is still more strikingly con- 
 trasted. From the nineteenth table it 
 will be found, that the deaths from De- 
 cember to May inclusive exceed those in 
 the remaining months in the proportion 
 
13Q 
 
 of three to two ; and that the mortality in 
 the winter is double to that in the summer 
 period. 
 
 But it may be justly observed, that the 
 scale of mortality in the different months 
 is not a criterion of their respective un- 
 healthiness, if that is to be estimated by 
 the frequency of disease. If in times 
 past, when vaccination had not yet ex- 
 tended its security to millions, influenza 
 had prevailed in the spring, and small- 
 pox had raged in autumn, the former sea- 
 son might doubtless have been deemed 
 the most sickly, although the latter would 
 have been distinguished by a dreadful su- 
 periority in fatality. But exclusively of 
 extraordinary sources of variation, the 
 proportion of death will certainly not be 
 found to correspond with the proportion of 
 disease occurring in the same month ; 
 neither will so marked a difference be ob- 
 served to subsist between the unhealthi- 
 ness of different months, or seasons, by 
 the one criterion, as by the other. At 
 least these conclusions seem to be war- 
 
140 
 
 ranted by the monthly returns of admis- 
 sion to the Liverpool Dispensary during 
 seventeen years, and to the Plymouth Dis- 
 pensary during six years. 
 
 At Liverpool, the succession of the 
 months, in respect to the frequency of 
 disease, is in the following order : March, 
 April, January, October, May, Decem- 
 ber, November, February, June> Septem- 
 ber, July, August. At Plymouth, the 
 succession upon the same principle is 
 March, January, February, May, Novem- 
 ber, September, December, October, 
 April, June, July, August ; and the dif- 
 ference in the two months, which form 
 the extremes, is only as eleven to nine. 
 If the contrast be extended to longer pe- 
 riods of time, the twenty-second table 
 shows, that the proportion of patients 
 admitted at the Dispensary in the summer 
 is to that in the winter as nine to ten, and 
 that the proportion in summer and au- 
 tumn is to that in winter and spring as 
 nineteen to twenty. 
 
 \ 
 
141 
 
 The popular opinion of the extensive 
 prevalence of autumnal diseases is not 
 confirmed by this statement, in which 
 autumn maintains the second place among 
 the seasons in the scale of salubrity. The 
 refutation, however, of this opinion can- 
 not be rested on inferences derived from 
 the limited period of six years, in which 
 the autumnal epidemic cholera has not 
 been of frequent occurrence. 
 
 These and many other points mav easi- 
 ly be determined, if they shall be deemed 
 worthy of further investigation. 
 
 Upon the whole, sufficient proof seems 
 to have been adduced, that in this coun- 
 try the warmer months are most favour- 
 able to the health of the inhabitants ; and 
 that disease and death extend their influ- 
 ence with the increase of cold in our 
 ordinary winters. That their influence is 
 prodigiously augmented by any extraor- 
 dinary degree of cold, the winter of 1795 
 has placed beyond all question. 
 
142 
 
 Sufficient proof has also been adduced, 
 that the prevalent diseases of Great Britain 
 are those which are most liable to be in- 
 fluenced bv temperature. Few subjects 
 relating to health are so generally misun- 
 derstood as the effects of temperature, or 
 so completely under the control of popu- 
 lar prejudice. The lives, and what is of 
 infinitely more importance to human hap- 
 piness, the health of numbers will be pre- 
 served, when it shall be better and more 
 generally understood. At present it is 
 peculiarly unfortunate, that the prejudice 
 in favour of cold contributes, in many in- 
 stances, to augment the disposition to 
 disease ; and the prejudice against its em- 
 ployment too often deprives the physician 
 of the most efficacious mode of combating 
 disease in existence. 
 
APPENDIX. 
 
145 
 
 No. 1. 
 
 PROPORTION 
 
 OF 
 
 MORTALITY 
 
 TO 
 
 POPULATION. 
 
 In the preceding pages, when assuming 
 the annual mortality in Great Britain to 
 be to the population in the proportion of 
 one to forty, the difficulty of ascertaining 
 this relation in general was adverted to. 
 It may not, therefore, be superfluous to 
 subjoin the following observations relat- 
 ing to this subject, from the works of 
 
 u 
 
Dr. Price, together with a table, the ma- 
 terials of which, with some exceptions, 
 have been drawn from the same source. 
 
 " The ingenious Susmilch, to whose 
 works (says Dr. Price) I owe my observa- 
 tions concerning Berlin, makes the pro- 
 portion of people who die annually in 
 great towns to be from 1 in 28 to 1 in 24 ; 
 in moderate towns, from l in 28 to l in 
 31 ; and in the country, from 1 in 40 to 
 1 in 50. The observations and facts, 
 produced in this work, prove, T think, 
 that these proportions may be more truly 
 stated as follows : 
 
 In great towns, from 1 in lg or 20 to 1 in 23 or 24. 
 
 In moderate towns, from 1 in 23 to 1 in 28. 
 
 In the country, from 1 in 35 or 40 to 1 in 50 or 60. 
 
 " To these proportions exceptions will, 
 however, occur in particular places from 
 local circumstances. 
 
 " Susmilch supposes the proportion of 
 inhabitants of the country to those of 
 towns to be 3i to 1 . This, I think, he 
 
14; 
 
 has rendered sufficiently probable in Po- 
 merania, Brandenburgh, and some other 
 countries. In well-peopled countries, the 
 proportion may be just: in Sweden, it is 
 computed that the inhabitants of the 
 town are to those of the country only as 
 1 to 13." 
 
 Price on Reversionary Payments, 
 vol. L 5th ed. 
 
148 
 
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154 
 No. 3. 
 
 TABLE XXV. 
 
 RELATION OF DEATHS IN SUMMER AND 
 WINTER, AT DIFFERENT PLACES. 
 
 Period of 
 calculation. 
 
 Places. 
 
 Deaths. 
 
 Proportion. 
 
 Summer. 1 
 
 Winter. 1 
 
 13 
 
 fears 
 
 2 Sweden . . . 
 
 • 
 
 18880 
 
 20C90 
 
 lOtoll 
 
 5 
 
 I 
 
 2 Eccles, near Man 
 Chester . 
 
 •I 
 
 415 
 
 455 
 
 10—11 
 
 40 
 
 
 3 Bland ford . . 
 
 • 
 
 617 
 
 725 
 
 10—11.8 
 
 15 
 
 
 4 London . . . 
 
 • 
 
 122611 
 
 146^17 
 
 10—12 
 
 60 
 
 
 2 Vevey, Switzerland 
 
 l6P7 
 
 2140 
 
 10— 12.5 
 
 •40 
 
 
 3 Blandford . . 
 
 • 
 
 645 
 
 829 
 
 10—12.8 
 
 20 
 
 
 2 Gainsborough . 
 
 • 
 
 590 
 
 765 
 
 10—13 
 
 6 
 
 
 5 Plymouth . . 
 
 
 1103 
 
 1446 
 
 10—13.1 
 
 5 
 
 
 Stockholm* . . 
 'Edinburgh . . 
 
 • 
 
 1139 
 
 1515 
 
 10—13.3 
 10—13.3 
 
 
 
 9 
 
 
 * Manchester . 
 
 ■ 
 
 1788 
 
 2427 
 
 10—13.3 
 
 
 
 9 25 country (own! 
 in England . 
 
 ] 
 
 1 
 
 5250S 
 
 66357 
 
 10—13.5 
 
 
 
 
 
 9 56 
 
 1210 
 
 10 — 13.5 
 
 3 
 
 
 •Chester . . . 
 
 • 
 
 340 
 
 47S 
 
 10—14 
 
 8 
 
 
 a Warrington . 
 
 • 
 
 G92 
 
 96S 
 
 10—14 
 
 6 
 
 { 
 
 8 PlymouthDispen- 
 sary .... 
 
 i 
 
 69 
 
 121 
 
 10—17 
 
 . 
 
 ! 
 
 
 
 1 
 
 
 1 
 
US 
 
 11 Summer includes June, Tuly, August, and September; Winter 
 includes December, January, Ftbruiry, and March. 
 
 42:22*222 Price on Rever sioiary Payments, 5th ed. ii. 270, note. 
 
 S3 Phil. Trans. voL 68. In tie first instance, the deaths front 
 smallpox are excluded. 
 
 * Short's Observations. — Hebeden,4S. 
 
 * Tab. XVII. completed to suyears, 1799 to 1804 inclusive. 
 8 Short's Observations. — Hebrden, 47. 
 
 7 White. — Heberden, 49. 
 
 8 Table XIX. 
 
 * In the note above cited fom Price, the number of deaths at 
 Stockholm are traniposed as t> the seasons ; but as this place is not 
 sited as an exception, the suppsed error has been here corrected 
 
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 Time. With a Preface and Notes, Biographical, Critical, and Expla- 
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 XXV. AN HISTORICAL ENQUIRY respecting the Performance 
 on the Harp in the Highlands of Scotland; from the earliest 'Times, 
 until it was discontinued, .about the J ear 1734. Tu Which is prefixed, 
 an Account of a very ancient Caledonian Harp, and of the Harp of 
 Queen Mary. Draw n up bv the Desire of the Highland Society 1 f Scot- 
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 With three Engravings. Superbly printed in royal 4to. ll. 5s. 
 
 XXVI. THE WORKS of MRS. CHAPONE : containing— Litters 
 on the Improvement of the Mind. — Miscellanies in Pro<e and 
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 Foolscap Svo. l(5s. 
 
Mrs. Chapone's Letters on the Mind, and Miscellanies, mar be 
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 2 vol. Price 8s. 
 
 XXVII. TBE LADY'S LIBRARY; containing— I. Dr. Gregory's 
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 N VE L S, R M A X C E S, &c. 
 
 XXVIII. THE WHOLE WORKS of HENRY MACKENZIE, Esq. 
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 never before published: Very beautifully printed in 8 vol. Post Svo. 
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 XXIX. ROMANCES; consisting of Mejnoun and Leila, a Per- 
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 XXX. GUEEX-HOO HALL, a Legendary Romance; and AN- 
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 XXXI. FLIM-FLA.MS ! or the Life and Errors of mv L'ncle and his 
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 POETRY. 
 
 XXXII. MARMION, or Flodden Field; a Poem, in Six Cantos. 
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 XXX'II. ORIENTAL TALES, translated into English Verse. By 
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 XXXIV. RHYMES on ART; or, The Remonstrance of a Painter: 
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 Criticism, Patronage, and Public Taste. By MARTIN ARCHER 
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 _m 
 
6 
 
 XXXV. THE MOUNTAIN BARD; consisting ofBaffeds and Song», 
 
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 XXXVI. POPULAR BALLADS and SuNGS, from Tradition, MSS. 
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 **"* This "Work is similar in Plan and Arrangement to Mr. Scott's 
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 XXXVII. NARRATIVE POEMS; or, Love Tales. By I. DIS- 
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 XXXVI! I. LONDON CRIES ; or, Pictures of Tumult and Distress: 
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 XXXIX. THE POETICAL WORKS of J. B1DLAKE, A. B. 
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 XL. BICKLEIGH VALE ; with other Foems. By NATHANIEL 
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 XLII THE INFERNO of DAXTF, translated into English Blank 
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 XLIII. THE MINSTREL; or, The Progress of Genius: with some 
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 XLV. POEMS on several Occasions. By MICHAEL BRUCE. 
 
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 XLV II. THE PLAYS of WILLIAM SHAKSPEARE, printed from 
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D I FIN1TY. 
 
 XLVIII. MACKLIN's Splendid Edition of the HOLY BIBLE. With 
 
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 XLIX. INSTITUTES of BIBLICAL CRITICISM, or Heads of the 
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 L. A TREATISE on SELF-KNOWLEDGE. By JOHN MASON, 
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 LI. SERMONS, on varous Subjects. By JOHN BIDLAKE, B. A. 
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 AGRICULTURE AND MISCELLANIES. 
 
 LIII. THE FARMER'S MAGAZINE, a Periodical Work; exclu- 
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 LIV. THE SHEPHERD'S GUIDE; being a 'Practical Treatise 
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 LV. ESSAYS on the NATURAL HISTORY and ORIGIN of PEAT 
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 Rev. ROBERT IlLXXIE, Kilsyth. Svo. 5s. 
 
 LVI. THE PLOUGHAVRIGHT's ASSISTANT; being a New 
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 Implements made use of in Agriculture. By JOHN GRAY, Au- 
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 8vo. In the press 
 
 LVIf. THE CODE of HEALTH an<j LONGEVITY; or, a Ccnci;© 
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 the Attainment of Long Life. By SIR JOHN SINCLAIR, Bart. 
 Second Edition. 4 vui. Svo. 2l. 8j. 
 
s 
 
 LVIII. A NEW SYSTEM of DOMESTIC COOKFRY, formed apod 
 P.-.iNC : les of Economy, and adapted to the Use ot' Private I 
 Con.- ', the Art <f Carving, Observation-: on the Management 
 
 ct" the Duey and Poultry Yard ; Instructions for Home Bbbwsbt, 
 "Wiyti, &c ; Cookfky lor the Sick, and for the Poos; many very 
 v -riul miscellaneous Receipts, tions proper to be given to 
 
 Servants both in Town and Country. To which is prefixed, an Iissay 
 c-ii Domestic Economy and Household Makagemeiit, contaii i g 
 many Observations which will be lound exceedingly useful to 
 tress ol a Family. By a LADY- A itioh, in a neat and 
 
 c • r prin -i Voiume, containing ten useful Bvo. 
 
 r- J- 
 
 " This is really one of the T.ost pr2ctical]y b we have seen en 
 
 the suhitc:". The iniy who has writ 
 Inxorioat :sb!cs, hut to combine eK • - pven her directions in s 
 
 • 
 
 r xtentled to I objects in i 
 
 utilitv of the H- ok is very mixh in- — I 1807, 
 
 \ol. i.wii. p- IBS. 
 
 FIX. IMISON'S ELEMENTS CE and ART. A New 
 
 Edition, enlarged by T. Websti _ 1. Svo. with M Plates. 
 
 This Woik comprises an Introduction to Natural Philosophy and 
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 tuns, the principal of which are. Bread-makir.g, !5r -ach- 
 
 ing, D} co printing, Tanning, ( . Refining, Pot- 
 
 tery, Manufacture of Glass, V inning, Lacquei 
 
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 meuts, Lutes, Jni- — D ;, Ti parens 
 
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 Engraving on Stone, and a icellaneous Articles. 
 
 I.X. THE SCOTS' MAGAZINE, Complete, from January 1" i 
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 nt condition. -101. 
 
 LXI. PICTURE of EDINBURGH; containing a History and De- 
 srrption of the City, with a particular Account of every remarkable 
 Object in, or Establishment connected with, the Scottish MetrOj 
 By J. STARK. Illustrated with a Pian, and upwards of thirty Engrav- 
 ings on Wood. lbmo. 6s. 
 
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 fltsme Wi i h are tinted to be in the Press, are all in great forwardness, 
 and uill certainly be published in Januaiy or Fclruary. 
 
 C S(ju re, Printer, FltroivaiVIna «C 
 
.