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MORTALITY AND VITAL STATISTICS OF THE UNITED STATES

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610 either under the skin or, by trephining, on the surface of the brain without its ever getting rabid." By the applica- tion of this method Pasteur was able to obtain fifty dogs of all ages and all varieties perfectly refractory to rabies, without a single failure, when unexpectedly there presented themselves at his laboratory on Monday, July 6th, 1885, three individuals from Alsace-Theodore Vone, Joseph leister, and his mother. At Pasteur’s invitation M. Vulpian and M. Grancher paid a visit to the boy Joseph Meister, on whom they found fourteen wounds that had been inflicted by a dog which was regarded as incontestably rabid. The life of Joseph Meister was despaired of, and so it was agreed that he should be made the subject of an experiment similar to those by which Pasteur’s dogs were rendered refractory to the virus of rabies. On July 6th, at 8 P.M., sixty hours after the infliction of the bites by the rabid dog, in the pre- sence of MM. Vulpian and Grancher, under a fold of skin of the right hypochondrium M. Pasteur inoculated half a syringeful (Pravaz) of bouillon containing a fragment of a spinal cord of a rabbit, dead on June 21st, and preserved in a flask of dry air, consequently a cord that had had its virulence diminished by fourteen days’ subjection to the necessary influences. The following days fresh inoculations were made, always in the hypochondriac regions :- Corresponding experiments were made on rabbits by tre- - phining so as to gauge accurately the degree of virulence of the cords used. It appeared that the cords used on July 6th, 7th, 8th, 9th and 10th were not virulent, for the rabbits inoculated with them remained free from rabies; but the ,cords of the llth, 12th, 14th, 15th and 16th were all virulent and increasingly so, the rabies in the rabbits appearing after a period of seven days’ incubation with the cords used on the 15th and 16th. When the condition of immunity is attained the virulent virus may be inoculated and in any quantity without any result. MORTALITY AND VITAL STATISTICS OF THE UNITED STATES. THE Census Office of the United States has recently issued the eleventh volume of the Report upon the Census of the United States in 1880. It is a quarto volume of nearly 800 pages, constituting Part I. of a special report on the Mortality and Vital Statistics of the United States in 1880, by Dr. John S. Billings. The United States " has no system of registration of vital statistics such as is relied upon by all other civilised nations," and in default of such a system attempts have been made at each of the last five national censuses to collect, through the agency of the enumerators, data with regard to the births and deaths that occurred during the year preceding the date of each census. Such attempts have been made in Ireland and in other countries prior to the establishment of civil registration. The result of such attempts has invariably been to prove the impossibility of collecting complete or trustworthy data by such a method. Dr. Billings freely admits that "the - experience of the United States census furnishes no excep- tion to this rule." It is acknowledged that the enumerators do not ascertain and record more than from 60 to 70 per cent. of the actual number of deaths. With such a preliminary admission as to the nature of the facts dealt with, it may well be doubted whether the elaboration of the bulky volume of tables under notice can be statistically justified. Dr. Billings’ introductory remarks, however, which occupy nearly forty pages of the volume, call for notice, and are valuable for the results he has been able to deduce from these imperfect census data bearing upon the comparative healthiness of the United States, and the relative mortality from different forms of disease in different parts of the States. In the concluding paragraph of his introductory and explanatory remarks Dr. Billings says :-" As a general rule, it may be said that the figures given in these volumes are more valuable for suggesting inquiries than for answer- ing them, yet the more I compare them with those of other countries the more I have become satisfied that they are valuable for both purposes if properly used." The deaths recorded and tabulated for the year of obser- vation preceding each of the last three censuses were equal to a death-rate of 12’54 per 1000 in 1860, 12’77 in 1870, and to 16’09 in 1880. This apparent increase in the death-rate in 1880 is attributed to the success of efforts made in the last census to obtain more complete returns of the deaths than had been the case at the two preceding enumerations. In order to measure the extent of deticiency in the number of deaths returned by the enumerators at the last census, their returns for the State of Massachusetts (excluding the city of Boston), and for the whole State of New Jersey, were compared with the records furnished from the State regis- tration offices, the total deficiency in which is considered not to exceed 2 per cent. The result of this comparison is to show that the deficiency in the enumerators’ returns was 26’6 per cent. in Massachusetts (excluding Boston), and 36’5 per cent. in New Jersey. "The deficiency was greatest among the deaths of infants, of females, and of foreigners, and increases in a tolerably uniform ratio for each month of the year, going backward in time from the date of the census, and was greatest in the thinly settled sections of the country." With a view to correct this important deficiency in the number of deaths reported by the enumerators, a register form was sent early in the census year (which ended on May 31st, 1880), with a stamped envelope for its return at the end of the year, to everyone in the United States who was reported by his or her postmaster to be a physician, or to be addressed as such. It was requested that the par- ticulars of all deaths occurring during the year under obser- vation within the knowledge of the medical practitioner might be entered in these registers before they were re- turned. The number of these registers sent out was 70,299, of which only 25,809, or 37 per cent., were returned. The registers’ report returned to the census office contained records of 166,896 deaths, of which 61,020, or 36’6 per cent., were found not to have been reported by the enume- rators. Even after the correction of the enumerators’ returns for Massachusetts and New Jersey by the addi- tion of the cases obtained from the physicians’ registers, the new numbers, compared with the numbers furnished by the State registration offices, still showed a deficiency of 13’3 per cent. for Massachusetts, and of 20’1 per cent. for New Jersey. Dr. Billings assumes that after the addition of the deaths proved by the physicians’ registers that came to hand to have been omitted, the returns of the enumerators were " still deficient as much as 30 per cent.," which is believed to be the maximum. The result of this rough estimate is stated to be to raise the average annual mortality for the whole country from 15’09, as shown by the uncorrected enumerators’ returns, to 18’08 per 1000. It may be noted, however, that if the uncorrected rate (15’09) be raised by 30 per cent., the corrected rate would be 19’62. Dr. Billings on this point concludes that " it seems safe to assume that the death-rate was not less than 17 nor more than 19 per 1000 of the living population, and I shall assume the mean of these-viz., 18 per 1000-as the mortality rate of the United States during the census year." The grounds upon which Dr. Billings concludes that the maximum deficiency of the corrected death returns is 30 per cent. should be referred to. The recorded mortality during the census year in thirty-one American cities in which the registration records of death is 11 presume to be fairly accurate" gave a death-rate of 22-28 per 1000; and as the mortality of such cities is " usually between 4 and 5 per 1000 greater than the average mortality of a la:’ge country, including cities, towns, and rural districts," this is said to increase the probability that the rate in the whole of the United States is not far from 18 per 1000. This argument involves so much assumption that it is of doubtful value. Its validity mainly depends upon the accuracy of the pre- sumption that the death records of these thirty-one cities are "fairly accurate." This may be doubted when it is con- sidered that the death-rate of females in Cineinnati is stated
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either under the skin or, by trephining, on the surface ofthe brain without its ever getting rabid." By the applica-tion of this method Pasteur was able to obtain fifty dogs ofall ages and all varieties perfectly refractory to rabies,without a single failure, when unexpectedly there presentedthemselves at his laboratory on Monday, July 6th, 1885,three individuals from Alsace-Theodore Vone, Josephleister, and his mother. At Pasteur’s invitation M. Vulpianand M. Grancher paid a visit to the boy Joseph Meister, onwhom they found fourteen wounds that had been inflictedby a dog which was regarded as incontestably rabid. Thelife of Joseph Meister was despaired of, and so it was agreedthat he should be made the subject of an experiment similarto those by which Pasteur’s dogs were rendered refractoryto the virus of rabies. On July 6th, at 8 P.M., sixty hoursafter the infliction of the bites by the rabid dog, in the pre-sence of MM. Vulpian and Grancher, under a fold of skin ofthe right hypochondrium M. Pasteur inoculated half a

syringeful (Pravaz) of bouillon containing a fragment of aspinal cord of a rabbit, dead on June 21st, and preservedin a flask of dry air, consequently a cord that had had itsvirulence diminished by fourteen days’ subjection to thenecessary influences. The following days fresh inoculationswere made, always in the hypochondriac regions :-

Corresponding experiments were made on rabbits by tre-- phining so as to gauge accurately the degree of virulence ofthe cords used. It appeared that the cords used on July 6th,7th, 8th, 9th and 10th were not virulent, for the rabbitsinoculated with them remained free from rabies; but the,cords of the llth, 12th, 14th, 15th and 16th were all virulentand increasingly so, the rabies in the rabbits appearingafter a period of seven days’ incubation with the cords usedon the 15th and 16th. When the condition of immunity isattained the virulent virus may be inoculated and in anyquantity without any result.

MORTALITY AND VITAL STATISTICS OF THEUNITED STATES.

THE Census Office of the United States has recentlyissued the eleventh volume of the Report upon the Censusof the United States in 1880. It is a quarto volume of

nearly 800 pages, constituting Part I. of a special report onthe Mortality and Vital Statistics of the United States in

1880, by Dr. John S. Billings. The United States " has nosystem of registration of vital statistics such as is reliedupon by all other civilised nations," and in default of such asystem attempts have been made at each of the last fivenational censuses to collect, through the agency of the

enumerators, data with regard to the births and deaths thatoccurred during the year preceding the date of each census.Such attempts have been made in Ireland and in othercountries prior to the establishment of civil registration.The result of such attempts has invariably been to provethe impossibility of collecting complete or trustworthy databy such a method. Dr. Billings freely admits that "the- experience of the United States census furnishes no excep-tion to this rule." It is acknowledged that the enumeratorsdo not ascertain and record more than from 60 to 70 percent. of the actual number of deaths. With such a

preliminary admission as to the nature of the facts dealtwith, it may well be doubted whether the elaboration of thebulky volume of tables under notice can be statisticallyjustified. Dr. Billings’ introductory remarks, however, whichoccupy nearly forty pages of the volume, call for notice, andare valuable for the results he has been able to deduce fromthese imperfect census data bearing upon the comparative

healthiness of the United States, and the relative mortalityfrom different forms of disease in different parts of theStates. In the concluding paragraph of his introductoryand explanatory remarks Dr. Billings says :-" As a generalrule, it may be said that the figures given in these volumesare more valuable for suggesting inquiries than for answer-ing them, yet the more I compare them with those of othercountries the more I have become satisfied that they arevaluable for both purposes if properly used."The deaths recorded and tabulated for the year of obser-vation preceding each of the last three censuses were equal toa death-rate of 12’54 per 1000 in 1860, 12’77 in 1870, and to16’09 in 1880. This apparent increase in the death-rate in1880 is attributed to the success of efforts made in the lastcensus to obtain more complete returns of the deaths thanhad been the case at the two preceding enumerations.

In order to measure the extent of deticiency in the numberof deaths returned by the enumerators at the last census,their returns for the State of Massachusetts (excluding thecity of Boston), and for the whole State of New Jersey, werecompared with the records furnished from the State regis-tration offices, the total deficiency in which is considerednot to exceed 2 per cent. The result of this comparison isto show that the deficiency in the enumerators’ returns was26’6 per cent. in Massachusetts (excluding Boston), and36’5 per cent. in New Jersey. "The deficiency was greatestamong the deaths of infants, of females, and of foreigners,and increases in a tolerably uniform ratio for each month ofthe year, going backward in time from the date of thecensus, and was greatest in the thinly settled sections of thecountry."

With a view to correct this important deficiency in thenumber of deaths reported by the enumerators, a registerform was sent early in the census year (which ended onMay 31st, 1880), with a stamped envelope for its return atthe end of the year, to everyone in the United States whowas reported by his or her postmaster to be a physician, orto be addressed as such. It was requested that the par-ticulars of all deaths occurring during the year under obser-vation within the knowledge of the medical practitionermight be entered in these registers before they were re-turned. The number of these registers sent out was 70,299,of which only 25,809, or 37 per cent., were returned. The

registers’ report returned to the census office containedrecords of 166,896 deaths, of which 61,020, or 36’6 percent., were found not to have been reported by the enume-rators. Even after the correction of the enumerators’returns for Massachusetts and New Jersey by the addi-tion of the cases obtained from the physicians’ registers,the new numbers, compared with the numbers furnishedby the State registration offices, still showed a deficiencyof 13’3 per cent. for Massachusetts, and of 20’1 per cent.for New Jersey. Dr. Billings assumes that after theaddition of the deaths proved by the physicians’ registersthat came to hand to have been omitted, the returnsof the enumerators were " still deficient as much as

30 per cent.," which is believed to be the maximum. Theresult of this rough estimate is stated to be to raise the

average annual mortality for the whole country from 15’09,as shown by the uncorrected enumerators’ returns, to 18’08per 1000. It may be noted, however, that if the uncorrectedrate (15’09) be raised by 30 per cent., the corrected ratewould be 19’62. Dr. Billings on this point concludes that" it seems safe to assume that the death-rate was not lessthan 17 nor more than 19 per 1000 of the living population,and I shall assume the mean of these-viz., 18 per 1000-asthe mortality rate of the United States during the censusyear."The grounds upon which Dr. Billings concludes that the

maximum deficiency of the corrected death returns is 30 percent. should be referred to. The recorded mortality duringthe census year in thirty-one American cities in which theregistration records of death is 11 presume to be fairlyaccurate" gave a death-rate of 22-28 per 1000; and as

the mortality of such cities is " usually between 4 and 5 per1000 greater than the average mortality of a la:’ge country,including cities, towns, and rural districts," this is said toincrease the probability that the rate in the whole of theUnited States is not far from 18 per 1000. This argumentinvolves so much assumption that it is of doubtful value.Its validity mainly depends upon the accuracy of the pre-sumption that the death records of these thirty-one citiesare "fairly accurate." This may be doubted when it is con-sidered that the death-rate of females in Cineinnati is stated

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to be 18’97, in St. Louis 18-23, in San Francisco 17-02, and inNewark 16-49. A further ground for the belief that thedeficiency of recorded deaths in the United States did notexceed 30 per cent. is that the deaths of infants under one

year in Massachusetts during the census year were equal to17-05 per 100 births; "if this be taken," says Dr. Billings,"as the true average proportion for the United States,the deficiency in the number of deaths of childrenunder one year would be a little over 34 per cent.," and asthe deficiency at this age is known to be greater than at sub-sequent ages, it is assumed that the total deficiency can-not have been much more or less than 30 per cent., atwhich Dr. Billings places it. With reference to this line ofargument, it is worth pointing out that the recorded factsfor the United States show a rate of infant mortality of onlyll’lO per cent. of the births, against the 17-05 shown inMassachusetts, and that the value of the comparison de-pends in great measure upon the approximate accuracy ofthe record of deaths of infants in the latter State.

Full consideration, therefore, of the various elements ofdoubt that envelop all the bases of facts upon which Dr.Billings has had to deal, and upon which he has attemptedto construct trustworthy mortality statistics, makes it ex-ceedingly difficult to accept his final conclusion that "itwill be seen that the death-rate in the United States com-pares favourably with that of all other civilised countries."fit may readily be admitted that " since poverty andovercrowding are the chief causes of excessive mortality,and in the United States there is a more general andequable distribution of the means of supporting life, in-cluding especially a food-supply of good quality, and moreroom than in European countries," the death-rate might beexpected to be lower than in most of the countries of theold world. We cannot, however, accept Dr. Billings’figures and deductions as affording satisfactory evidencethat the death-rate in the United States in the census for1879-80 did not exceed 18 0 per 1000, although they abun-dantly prove that any conclusions based upon the recordeddeaths, except in a very small section of the States, in-cluding mainly a certain number of registration cities, areentirely untrustworthy.

It is matter for international regret that in such essential- departments of vital statistics as the registration of births:and deaths the United States should be so far behind mostother civilised countries. Until, however, son3e tolerablyuniform system for such registration be adopted throughoutthe States, we much doubt whether, either from a publichealth or a statistical point of view, the comparison ofAmerican and European mortality statistics can yield anyuseful result.

IRISH MEDICAL SCHOOLS AND GRADUATES’ASSOCIATION.

THE ninth annual meeting of the above Association washeld on the 17th inst. (St. Patrick’s Day), at 49, Berners-’street, the President, Dr. II. Macnaughton Jones, F.R.C.S.L,in the chair. There was a large attendance of members.The report, which extended over a period of less than eightmonths, was of a most satisfactory character. The number’of members had increased since July 29th last-when theeighth annual meeting was held at Cardiff-from 272 to355. Two members had died during that period-viz.,Drs. F. Helen Prideaux and J. J. Jennett. There had beenno resignations. The Council hoped that, their senior Vice-President, Dr. Balthazar Foster, being now an M.P., therewould be no delay in getting power for the King and Queen’s’College of Physicians to register its membership and theRoyal University of Ireland its degree of M.A.O. No stepshad yet been taken to secure rooms for the Associationin London, the Council thinking it better to wait till thenumbers on the roll had reached at least 500. The balancein the hands of the treasurer was declared to be over .S40.On the motion of Professor G. F. Yeo, M.D., Dr. Jones wasre-elected President in consideration of his services in con-nexion with the reorganisation and rapid development ofthe Association, and also because of the curtailment by thenew constitution of the period during which he had heldoffice. Brigade Surgeon W. Alexander, M.D., and W. II.White were elected to the two vacancies on the Council.Dr. James Thompson was re-elected Hon. Treasurer.

’ The annual dinner took place the same evening at theHolborn Restaurant. Ninety-two members and their friends(the latter including several ladies) sat down. The chairwas occupied by the President, who was supported by SirSpencer Wells, Bart., F.R.S., Sir Joseph Fayrer, K.C.S.T.(lIon. Physician to the Queen), Professor Ilumphry, F.R.S.(Cambridge), and other guests of the Association. Amongthe members present were Sir William Mac Cormac (Vice-President), Professor Gerald F. Yeo (Chairman of Council),Brigade Surgeons T. Wright and W. Alexander, Staff SurgeonO’Sullivan, R.N., Dr. S. J. Flood, A.M.S., Dr. Carte (Cold-stream Guards), Dr. James Thompson (Hon. Treasurer), andDrs. Daniell and Stewart (Hon. Secretaries).

WILLS OF MEDICAL MEN.

THE Irish Probate, sealed at Dublin, of the will andcodicil or scheme of Barnewall Peter White, M.D., late ofSt. Columbs, co. Londonderry, who died on December 3rdlast, granted to Mr. Michael King, one of the survivingexecutors, was resealed in London on the 2nd inst., theaggregate value of the personal estate in England andIreland amounting to upwards of .631,000. The testator

gives annuities to his wife and his two sisters charged onhis Tamlaght estate, in the county of Londonderry; and thereare a few other bequests. The Tamlaght estate he devisesto the use of his half-brother, Richard White, for life, withremainder to his son, Thomas Earle White, for life, withremainder to his first born and other sons successivelyaccording to seniority in tail male. Certain plate, furniture,books, and effects are made heirlooms to go with the estate.His waterside estate in the city of Londonderry, he settles onhis half-brother, Thomas White, for life, then on his son, andin default of a son on the said Thomas Earle White. Heappoints as his residuary legatee the person who shallsucceed to the Tamlaght estate. Should the remainders tothe said estates fail, the testator gives them to the Superioress-General of the Sisters of Charity, Dublin, to found an asylumfor the families of professional and commercial men, smallproprietors and agriculturists afflicted with insanity, whoserelatives have insufficient means to pay the usual pensionfor them in private asylums.The will of Murdoch Kelburne King, M.D., late of

Kingston-upon-Hull, who died on January 2nd last, wasproved at the York District Registry on the 22nd ult. byMrs. Mary King, the widow, the executrix, the value of thepersonal estate amounting to over .614,000. The testatorbequeaths the marble bust of himself to his wife for life,and then to the General Infirmary, Hull; the oil painting ofhimself, in his mayor’s robes, to his wife for life, and thento the Mayor, Aldermen and Burgesses of the Borough ofKingston-upon-Hull in their corporate capacity, and a fewother legacies. The residue of his property he leaves as hiswife shall appoint.The will and codicil of Gavin Milroy, M.D., formerly of

30, Fizroy-square, late of 21, Church-road, Richmond,Surrey, who died on January llth last, were proved onJanuary 23rd by Mr. Edward Hawes and George BlundellLongstaff, :1I.B., the executors, the value of the personalestate amounting to over 10,000. The testator bequeaths£ 1000 each to the National Refuges for Homeless andDestitute Children, and the Asylum for Idiots, Earlswood ;£ 100 each to the British Medical Benevolent Fund and theMedical Missionary Society of Edinburgh; .61743, being theamount received by him in 1872 from the Colonial Office asremuneration for his tour to the West Indies, and a furthersum from his estate to make up X2000 in all, to the Presidentand Council of the Royal College of Physicians, to found andcontinue a yearly lectureship of three lectures on StateMedicine and Public Hygiene ; the silver cup presented tohim by the College for acting as honorary secretary of theLeprosy Committee, and certain papers and books, to thesaid College; and many other legacies. The residue of hisproperty he leaves to some nieces, the wife of a nephew,and the infant son of a deceased niece.The will of Edward Christopher Holland, M.D., late of

15, Catherine- place, Bath, who died on January 5th last, wasproved on the 10th inst. by Mrs. Anna Holland, thewidow, and Mrs. Eliza Henrietta Hartnell, the daughter, theexecutrixes, the value of the personal estate exceeding


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