Medical Annotations

1864 The Lancet  
and it was ascertained that the funds promised and in hand were sufficient to pay the certified lawyers' bills and the trifling expenses incurred, leaving a small balance on the credit side. It was resolved, on the motion of Mr. Partridge, seconded by Mr. Hart, to present to Drs. Fraser and Andrews separately a handsomely bound volume containing a list of the names of those who have testified their sympathy on the occasion of the recent trial by becoming subscribers to this fund. Such a volume
more » ... und. Such a volume will be precious to those physicians and their families, and will form the most simple and appropriate memorial of the free-will and spontaneous generosity with which the profession have on this occasion vindicated and maintained the principles of equity and of fraternal interdependence. Votes of thanks were passed to the chairman and officers of the committee, who have conducted the business with economy, order, and dispatch. The treasurers have expressed a hope that outstanding subscriptions promised may be forwarded without the necessity for personal application, as it is desirable that all business of the fund should now be forthwith completed. The perfect success of the movement is a source of congratulation. It indicates the warm spirit with which the profession will support a man who has been unjustifiably attacked in the exercise of his duty. The case was one in which the defendants were blameless, and their professional brethren have borne them scathless. It is desirable, however, that the whole circumstances should be kept in mind, lest on the one hand speculating attorneys, or on the other medical practitioners sans peur but not sans 'reproche, should be tempted by the apparently facile generosity of a profession which has lately made more than one effort of the kind to suppose that these are movements which can be got up at will, or repeated without limit. The practitioner who appeals to his brethren under ' , , such circumstances, or in whose cause such an appeal is made, ' must have a perfect case if in any future o-jatingencies he should desire to arouse Pactolean sympathies. Dr. Fraser and Dr. Andrews were in that position, and the effort made in their behalf has been no less important to their reputation than honourable to the profession. THE TESTS OF THE HEALTH OF TOWNS. SINCE the year 1837, through the labours of the Registrar-General and his staff, we have had a complete record of all the births and deaths which take place in this country. From these returns various methods of estimating the public health have been adopted. That method, which may be called the "National System of Computation," or the Registrar's own, calculates the average number of deaths which occur in each town or district for every 1000 of the population, and affords a series of figures which, varying from 15 to S6, give the "deathrates" respectively of the localities from which they were originally received. At first sight, it would appear that by this method we had gained all we required, and that, as some sanitarians have imagined, we could by it as readily measure the health of towns as we can by the thermometer ascertain the mean range of their temperature. But some have refused to regard the prob!em as of so simple a character, viewing it rather as one of a very complex nature. Amongst our con-spicuous hygienic reformers are Messrs. Ransome and Royston of the "Manchester and Salford Sanitary Association." They have again laid before the public* certain reasons to show why we cannot without further investigation appeal simply to the death-rates of different places as tokens of relative rank in the scale of health. One chief reason is, that " these places are not in the same position as regards the character of their population." In the second place, although the method followed in the " National System of Computation" is sufficient for ordinary purposes, and will test roughly the progress made in the sanitary condition of the inhabitants of any particular town, yet, whenever great accuracy is required, it is proposed " to cut off entirely from the calculation those ages which are chiefly affected by migration, and to compare only the deaths under fifteen years of age," Dr. Whitehead, of Manchester, has brought forward another method of computing the death-rate of towns. According to, it, the number of deaths for every hundred births is assumed to be the " death-rate," and the proportion of deaths to births is made to measure the salubrity of places. In the opinion of Messrs. llansome and Royston, this system is founded upon a fallacious basis, for it takes for granted that the rate of increase is a fair test of salubrity. It compares the number of deaths with that of births, a standard constantly varying from causes independent of sanitary conditions; it avoids none of the errors belonging to other modes of calculation, and imports several of its own. For what these errors are we must refer the reader to the more recent papers of Messrs. Ransome and Royston. It has been proposed likewise to estimate the relative healthiness of towns by comparing the average age at death of their respective populations. The latter writers show, however, that all the errors due to immigration are retained and even magnified by it, since the ages at death of all new comers are included amongst the other deaths. Their conclusion upon this point is as follows:-" We believe, therefore, that of the various tests which we have examined, the second alone can be relied upon to give trustworthy results. By calculating the mortality ot that portion of the population which is unaffected by migration, we have a fair standard by which towns can be compared one with another, and racked in the scale of health. At the same time, however, we would repeat that, whilst we choose this as a means of compa.nsou, we do not entirely throw aside the other methods which we have reviewed, only they must not be burdened with more inferences than they will safely carry. The biri.h rate, when compared with the Registra,r-Geaerai's gross rate of mfirtaHty, shows the speed at which large towns are increasing, in spit" of the enormous number of deaths ; and the average duration of life, when employed in the same way, gives us some idea of the classes of the population amongst whom the deaths are most frequent." The Registrar General has shown that the rate of mortality bears a close proportion to the density of the population, but this fact has recently been called into question in Dr. Whitehead's 1)arnpl-4let.-F-In reference to this point, Messrs. Ransome and Royston show that there are two modes by which the amount of crowding may be estimated: one by caleula'.ing the number of persons to the acre; the other by noting the number of inhabitants to each house. By the latter we obtain an accurate idea of the extent to which the injurious effects of overcrowding prevail. A table is given to prove that in a certain district of Manchester the rate of mortality does not vary as the estimated average density, but as the number of inhabitants per house. It is very properly concluded, however, that our numerical tests cannot do away with the necessity for careful iDquiry after the true sources of excessive mortality ; these must be sought in the habits of the people, no less than in defective sanitary regulations. As Lord Stanley remarked at the * Remarks on some of the Numerical
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