live & Sede Cewh fr 


REPORT 


ON THE 


Pe wee a Le TY 


OF 


EDINBURGH AND LEITH, 
FOR THE MONTHS OF 


MARCH, APRIL, AND MAY 1846. 


BY 


JAMES STARK, M. D. 


FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH, 


EDINBURGH: 
‘PRINTED BY STARK AND COMPANY. 


MDCCCXLVI. 


hese 
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—. ee e 


R EP O- Roby: &e. 


Stnce the beginning of this year the mortality in Edinburgh bas been 
unusually high. What makes this the more remarkable is the fact that 
last year the mortality was lower than for three previous years; and that 
this year there is no fatal epidemic prevalent among us to account for the 
increasing number of deaths. The average monthly mortality for the last 
six years amounted to 355; whereas the average monthly mortality | of 
the five past months of this year amounts. to 393—showing a mean in- 
crease of 37 deaths per month. 

The Registrar-General’s Keports put it in our power to compare the 
mortality here with that of London and of. England since the beginning 
of the present year. From these we learn that London, unlike Edinburgh, 
has been unusually healthy this season ; in fact, Haaltiier than it has been 
for a period of aight years at least. It is a very curious circumstance, how- 
ever, that though the same has been more or less the case with the southern 
and middle districts of England, the northern division has not been so 
highly favoured, and has more nearly resembled Edinburgh in exhibiting 
an increased mortality. 

The low rate of mortality in London is with great justice ascribed by 
the Registrar-General to ‘‘ the extraordinary mildness of the winter of 
1846 ;” and the striking fact is stated that, excepting two weeks, the mean 
temperature since January has always been above 40°. Asa natural con- 
sequence of this the range of temperature has been small. In Edinburgh, 
on the other hand, the winter, though open and mild, and the mean monthly 
temperature never below 42°, exhibited many sudden alternations of tempe- 
rature, which are always noticed to be prejudicial to health. Thus, for 
instance, in London during March the range of the thermometer was 27° 
only, and in April the same; while in Edinburgh during March the range 
of temperature was 46°, and in April 39°. No wonder, therefore, that our 
mortality should be high, because, other things being equal, it is these 
sudden alternations of heat and cold which render one country or situation 
more unhealthy than another. 

With the view of directing the attention more particularly to the con- 
nection of mortality with atmospheric agencies, but especially with tem- 
perature, the following table is drawn up—the mortality being limited to 
Edinburgh alone. 


Report on the Mortality of 
TABLE |. 


+ 


~ Barometer. ‘Temperature. | 
High- | Low- |. | High-| Low | 
AY a oY. Mean. ge.| Ke | 2 | Wiean- 
Jonth cee. | eee, | MMCATUORge. | Maile) gr | Gas. | Mean. | Range 
Jan. | 30°18 | 28°52 | 29°09 | 1°66 | 264 | 59° | 25° | 4247) 34° | 
Feb. 30°04 | 28°56 | 29°43 | 1°48 | 1°60 | 64 98 |42°31) 36 
March,| 3020} 28°56 | 29°30 | 1°64 | 0°97 | 63 | 17 | 42°15} 46 
April, | 30°00 | 28-70 | 29°59 | 130 | 2:88 | 64 25 | 44°22) 39 
May, | 29°98| 28-72! 29°60 | 1°26 | 1:21 | 70 Si 53003 8 
| Mortality. 
Riek: ts and| 15 to | Above}! Total | Sull- | Grand 
junder. | 60. 60. |deaths.| born. | total. 
Jan 167 1136+6) 73 | 382 | 97 4.09 
Feb. 137 |112+7) 71 327 Q7 | 354 
March,| 164 |158+6) 73 4.01 33. | 434 
April, | i155 |138+9)] #2 a7 7 16.4) 893 
136+2| 61 356 Bla nheBtF 


May, 158 

” Note. —Canaan ‘Cottage, where the meteorological registers are kept, is situated 

“about a niile to the south of sepa in latitude 55° ae sith is ‘246 feet above 
the mean level of the sea. 


The following tables exhibit an abstract of the mortality in Edinburgh 
and Leith for the months of March, April, and. May, classified according 
to ages and diseases. It may be remarked that. the numbers given include 
_as nearly as possible the absolute amount of deaths in each place respec- 
“tively ; as in, addition to the returns from the burying-erounds, and the 
medical certificates, the principal undertakers have. kin< dly furnished me 
with the particulars of those cases where the bodies were removed for 
interment beyond the. bounds of Edinburgh. All ‘those cases brought 
from the country to the Royal Infirmary are excluded—the tables being 
limited to the residenters in Edinburgh and Teith. It is to be regretted 
that the classified table of diseases for Leith should be'so very imperfect 
for the months of March and April. This resulted-from the imperfections 
of the plan of registration adopted at South. Leith, but it is. to be hoped 
that this will not again occur, and that nothing i in future will prevent. the 
diseases there: being returned as completely as ‘for Edinburgh. 


Hf TABLE TI. 
ie EDINBURGH TABLE OF AGES 
of oyMarch,,; eae ideation ak 
ACs). creado dls Kat GLb Nhetecs len Oke cakes? Hnrinaaiat- 
Still-borty,,. 97 23.5440 fo, -433 Uh Danae Hat Heehoat bite olan 
1 year and) 4, gow os 494° 36 bee 79 AQ! gQro) 1B 
POC ie: aati Et ie ; at, 
O MCATS, wae eae dah wer Vein She saath LG atl tanh hss 
gi ais (8S ame Gees kg 13 ., Gr tht, ana 
SAD, 7 7 14 16 Getnulae y Syny 17 
15, As 44s 7 Besar” Ghat Re ES: A en 
40), ME ES We 9 Ata dS es 22 


Edinburgh and‘ Leith. 5 
March. April. May. 
Ages. M. Fi; Tot, Ma , pF sy: (Pot Ms’ Fe BY "Por. 
30 years, Zl old 36 11 17 28 11° 23 34 
40, 16)! 1g) 34 Lgok BPS V4 Qi 
50, 27 19 46. 23) (VE 43 14 14 28 
60, 16 15 31 12 18 30 17 14 31 
70, Ie ius22 34. 16 18 34 13 21 
80, 9 6 16 6 B5 15 16, 31 Po? te eS 
90, 4 6 10 4 10 14 1 1] 12 
100, Sitecl, at wes 1 willy 3 0 0 
Not stated, 2 4 6 1 l 2 ot Oe 
Total, 229 205 434 197 196 393 197 181 378 
TABLE III. 
EDINBURGH TABLE OF DISEASES. 
a : SS OK 
Class. Diseases. = ‘aj eG, Class. Diseases. S a. Mid 
. Ss ais es ss 
I. Small-pox, (vac- Consumption, 64 57 67 
cinated,) nates 5 oor Bune disease, 3 1. @ 
do, not vaccinat. 1 2-7 4 V. Pericarditis, L- 10 50 
Measles, 28. 22, 20 Heart diseasay 76. 7 5 
Scarlatina, tla lady VI. Teething, Gs. 6 
Hooping cough, 13 17 18 FOMPOTIUS oo Be ts Data O 
Croup, a Gs Vee Peritonitis, Sea oek 
‘Thrush, Fo War SSG Tubes mesenter. li 7 12 
Diarrbeea, AE (Gg, 215 ~ Ulcer. of stomach 
Dysentery, eS EU or intestines, 1] O @ 
Influenza, ee OS Hernia, ° ; a ne 
Remittent fever, 2° 2 2 Colic or‘ileus, O* 1 1 
‘Vyphus fever, 21 16 11 Hematemesis, 1. 0 0 
Erysipelas, Beep en Stomach disease, 2. 0 1 
Syphilis, hg: ll Jaundice, ’ a | 
II. Hemorrhage esas F405 Liver disease,\" 3, “2... 2 
Dropsy, gee rye 2 1 WIT... isciipria, CO eS 
Abscess, Pe. ne Diabetes, | eggs en 
Mortification, oe trys Stone, Geren APRA 6 
Scrofula, Ce ale Kidney. disease, 2 1° 2 
Cancer, cps ed Tis Co-DILtd, EE 
Debility, ey La Fe? fh Puerperal fever, 2. 0 3 
‘Sudden death,'2”° 2°" 0 Paramenia,* .~ 2, oO ~@ 
IIT. Cephalitis, . 4 ° O 2 Disease of uterus,1 0 1 
Hydrocephalus, 22 14 19 IX. Kheumatism, oe et 2 
Apoplexy, Pusegueh ge Spine and joint 
Paralysis, & TIO. 83 diseage, 4. 4 oa. 
Convulsions, POC SG eR X. Skin disease, EY Oy 
Epilepsy, FOS Se] _ Fistula, TR, 20: 
Insanity, Lt oI) XT... Old: age; 36....45 . 86 
Deliriumtremens,2 +4 O | XII. Intemperance TS 
Disease of Brain, 2 4 0 Privation, Slit, aca) 
Ly... Laryngitis, “0° FS 40 | Violent, deathsand , 
Quinsey, a Hoey suicides, Lad Sico Ls 
Bronchitis, 2 3 At XIV. -Still-born, 331162 21 
Pneumonia, 18, 21 20 | Cauces not specified, +, 18;.13 ...7 
Hydrothorax, Fo Ss | Aerts th tila eats 
Asthina, sores tF | Total,..434, 393.378 


6 Report on. the, Mortality of 


TABLE IV. 
LEITH ‘TABLE OF AGES. 
rg March. 2) a May. 
Norete eM. oF Tot. cM. Fee, Won te: ee ae 
~Still-born, 4, 1 5 3 0. .) .822., 2 5 7 
1 year & under 7 4 1 3 3 6 11 4 if 
2 2 1 ine SB 2 3 5 4, 2 6 
5, 0 1 ay i _) | ae 3 Q 5 
10, te «0 H 1 1 0 H 0 ) 0 
15, 1 1 Q 0 0 ) 0 0 0 
20, 3 0 3 0 ] J 2 0 2 
30, 4. i 5 on ae 6 3 2 5 
AQ, 4 ee 2 Oita A 6 5 11 
50, 2 4. 6 Til Raaa' 5 a, ee 4, 
60, Bion ied dite be Ate 0, 3 2 5 7 
70, : 4 3 T COs 7 eo eo) 4 2 8 5 
80, - 3 4 7 A 2) 6 0 5 5 
90, : ) 0 0 12s 0 2 ) 0 0 
Total, 36: 24 6°60 81 7518 49 370535 72 
TABLE V. | 


LEITH CLASSIFIED TABLE OF DISEASES. 


a2 a } Sue s 
Class. Diseases.,.....%4.q 2 © | Class. , Diseases. ty ee 
I. Measles, . . Dee O° 3 IV.. Laryngitis, ......,,.Q;; 1. 1 
Hooping cough, 2 2 = 6 Bronchitis, Des. 000053 
Croup, : Or] org Pneumonia, ap O14 
Thrush, Oo Oh dk] Asthma, Our @ “5g 
Tnfluenizas. 42,007 0 ct Hydrothorax... 1 1 0 
Typhns fevers. iad, oe: 22 Consumption, 4. 4 8 
Erysipelas, — O poke cil \. Heart diseasess 1 00:3 3 
If. Dropsy, QO yobes 2) s Ve Dis. of diges. org2i5 6; °F 
Debility, iy Gate ll VII. Stone, z Lia0: | 20 
Other diseases of . VIII. Child-birth, Lae Ov ak 
uncertain seat,O0. O 4). » Puerperal fever,,.0;; O 1 
IlI. Cephalitis, (mi- , R&I. Old age, Bp Tt 55 
ningitis,).34:40.) ry XU. Violent deaths, © . 1 @ 
Hydrocephalus, 0 1 2 | XIII. Still-born, toga ht 7 
Paralysis, O° 8 2 | Not.specified, . Bi dee LOO 
Convulsions, Bey OI 7 . —_- — — 
Epilepsy, OO: Oy 1 Total, 60 49 72 
Disease,of brain, 0. 1 1 


From the above classified table of diseases it will be seen, that, with the 
exception of the usual children’s diseases, measles and hooping-cough, there 
‘is no epidemic disease among us to account for the increased mortalityfof 
the present year. Typhus fever, which in the earlier months attacked 
persons of all classes, but was not by any means very prevalent, has du- 
ring the last month materially declined, and the fatal cases have been 
confined to the lower and middie classes. LErysipelas alone has been 
somewhat more prevalent. ) 
'~ Small-pox, from which Edinburgh has been unusually free this year, 
has during the last month made its appearance, in several localities, and 
proved fatal in six instances, As usual, it has chiefly attacked those who 
“were not vaccinated. i 


Edinburgh and Leith. 7 


Only one of the fatal cases during March was reported to be vacci- 
nated, but on making particular inquiry I have not been able to get sa- 
tisfactory proof that such was the case. The fatal vaccinated case in April 
was twice successfully vaccinated, yet took unmodified small-pox and died 
under it. Even though such a person had taken small-pox itself and re- 
covered, he would, in all likelihood, have been as liable as ever to a second 
attack. Two such instances I have witnessed in my own practice, in which 
children, after successful vaccination, took unmodified small-pox on being 
exposed to its contagion ; and after the lapse of about a year were again 
successfully vaccinated, yet were seized with unmodified small-pox a se- 
cond time, from being taken to a house in which lay a small-pox patient. 
My own conviction is, that these persons remain as liable tu a third at- 
tack as if they had never been vaccinated, or had never taken small-pox. 

The fourth class of diseases, those of the respiratory organs, are those 
which over Europe cut off the greatest proportional number of persons, 
very nearly an exact third of the mortality belonging to that class. As 
might be expected, these diseases are somewhat less prevalent in one lo- 
cality than in another; but it does not seem to follow, that the less the 
mortality is in proportion to the population, the less should be the pro- 
portion of deaths from diseases of the respiratory organs. London and 
Edinburgh are very good examples of the general truth of this remark. 
In London during the past months of this year, the mortality has amount- 
ed to only t in 103 living. In Edinburgh during the same period, the 
mortality, (excluding the still-births,) has been 1 in 76, or between a 
fourth and a fifth higher than in London for the same period. In Lon- 
don, however, the deaths from diseases of the respiratory organs, including 
hooping-cough and croup, were in the proportion of 376 to every 1000 
deaths ; whereas in Edinburgh, the same diseases were to the 1000 deaths 
in the low proportion of 292, showing a difference in favour of the supe- 
rior salubrity of Edinburgh to the extent of 84 out of the 1000 deaths, 
and this too ina year when the mortality is above the average. 

The safest way, however, to estimate the proportional mortality of dis- 
eases is to compare their proportion both with the population and with the 
total deaths. Estimated in this way, London has lost from diseases of 
the respiratory organs, including hooping-cough and croup, 1 in every 
273 of its present population, or, as above stated, in the proportion of 376 
out of every 1000 deaths. Edinburgh, during the same period, has lost 
1 in every 260 of its present population from these diseases, or in the pro- 
portion of 292 out of the 1000 deaths. If the deaths from consumption 
alone be estimated in the same way, it is found that in London 1 has died 
out of every 733 living, or in the proportion of 140 out of the 1000 deaths, 
whereas Edinburgh has lost from the same cause 1 out of every 501 living, 
or in the proportion of 150 out of every 1000 deaths. 

In my first report [ was led into an error as to the still-births being re- 
gistered in England, in consequence of the Statistical Nosology, stating 
that premature births were registered under the head of debility, and in 
consequence of an explanatory note being appended, which quoted a pas- 
sage from Dr Granville’s work referring exclusively to still-births. I am, 
however, informed by the Registrar-General, that still-births are not re- 
gistered in the English tables of mortality. This appears to me to be an 
important oversight, because in questions affecting the condition and health 
of the inhabitants, many important conclusions may be drawn from an 
accurate statement of the particulars connected with still-births. M. 
Lugol, in his Researches on Scrofula, attributes the mortality of the fetus 
in utero to the existence of the scrofulous constitution in one or both pa- 
rents, and unless means are used to register such facts both in town and 
country, no data can be procured for the confirmation or refutation of such 
statements. 

21 Heriot Row, June’ 1846. 


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