195 Looking Back. FROM THE LANCET, SATURDAY, JAN. 15, 1825. SURGICAL LECTURES, DELIVERED BY MR. ABERNETHY. Theatre, St. Bartholomew’s Hospital. LECTURE 14.1 11’erioacs Affections. I say that there is a certain disorder of the nerves of the part antecedent to disease in the part. Suppose that there is disturbance in any part, you cannot say that it is disease ; it begins with irritation, and therefore I object to the word disease in that sense. Functional disorder precedes any change in the structure of the part, but I believe it to be originally nervous I say to persons who come to me with weakness of the muscles, spasm, and irritation, occurring in any part of the body, that it is the result of something wrong in the nervous system as a whole. I could quote plenty of cases illustrating this, showing that local irritation and disease are the effect of something wrong in the nervous system. This is, very well exemplified in the complaints which attend dentition in children, where the nervous irritation sometimes disorders all the parts of the body, there are convulsions, weakness of the muscles, the arms are turned out and sometimes inwards, and so on. The larynx .also becomes affected, and ah ! persons lose their voices all of a sudden, all through an affection of the nerves of the part. Then again the nerves of a part may be influenced by something operating on the trunks of the nerves leading to those parts ; as in injuries or affections of the spinal column, all the nerves in the parts supplied from below the part of the medulla spinalis injured, will be deprived of their vitality. Again, affections of the nerves of the cerebrum may produce local affections in every part of the body. We cannot conceive disease to be merely local ; there must .always be a plurality of parts affected. The subject is one difficult to explain ; but what I want chiefly to call your attention to is, a very painful affection of the nerves of a part called Tic Doloreux. It was a rare thing, in the early part of my life, to see many cases of disease produced by increased vascular action, which are now common ; and so it is with diseases depending on an undue nervous action in a part; for I do not think there was such a thing as tic - <Mo7’.c ever dreamt of in my time. How this comes, I don’t know. 1 An excerpt only of the report of the lecture is transcribed. VITAL STATISTICS. HEALTH OF ENGLISH TOWNS. IN 76 of the largest English towns 9164 births and 5350 deaths were registered during the week ending Jan. 10th. The annual rate of mortality in these towns, which had oeen 19 6, 16-9, and 20 - 0 per 1000 in the three preced- ing weeks, declined again last week to 18 - 5 per 1000. In London the death-rate was 18 8 per 1000, while it averaged 18’4 in the 75 other large towns. The lowest death-rates in these towns were 10’0 in Hornsey, 10-9 in Handsworth and in West Hartlepool, 11’8 in Walthamstow, 12’3 in South- ampton, 12-4 in York, and 12’7 in Leyton ; the highest rates were 21-7 in Manchester, 22-7 in West Bromwich and in Rochdale, 23’7 in Liverpool, 22-4 4 in Wolverhampton 24-4 in Rhondda, 25-2 in Oldham, and 58-2 in Great Yarmouth. The 5350 deaths in these towns last week in- cluded 504 which were referred to the principal infectious diseases, against 620, 493, and 603 in the three preceding weeks ; of thee 504 deaths 136 resulted from measles, 132 from whooping-cougb, 73 from diphtheria, 65 from scarlet fever, 50 from diarrhoea, 38 from "fever" (principally enteric), and 10 from small pox. No death from any of these diseases was registered last week in Hornsey, Bournemouth, Reading, Norwich, Burton-on-Trent, Bootle, Warrington, Barrow-in-Furness, Huddersfield, Halifax, York, or Stockton- on-Tees ; while the highest death-rates from the principal infectious diseases were recorded in West Ham, Hastings, Smethwick, Liverpool, St. Helens, Tynemouth, Newport (Mon.), and Cardiff. The greatest proportional mortality from measles occurred in Hastings, Devonport, Walsall, Liverpool, Salford, Tynemouth, Newport (Mon.), and Cardiff ; from scarlet fever in Great Yarmouth, King’s Norton, Coventry, and St. Helens ; from diphtheria in Hastings, Hanley, Smethwick, Bury, and Preston ; from whooping-cough in Tottenham, West Ham, Oldham, and Cardiff ; and from diarrhoea in Wolverhampton. The mortality from "fever" showed no marked excess in any of the large towns. Of the 10 fatal cases of small-pox in these towns six were registered in Liverpool and one each in London, Derby, Oldham, and Preston. The Metropolitan Asylums hospitals contained 10 small-pox patients on Saturday, Jan. 10th, against 21, 17, and 14 on the three preceding Saturdays ; four new cases were admitted during last week, against five, none, and one in the three preceding weeks. The number of scarlet fever cases in these hospitals and in the London Fever Hospital, which had been 2487, 2528, and 2378 at the end of the three preceding weeks, had further declined to 2219 at the end of last week ; 223 new cases were admitted during the week, against 279, 205, and 214 in the three preceding weeks. The deaths referred to diseases of the respiratory organs in London, which had been 408, 343, and 415 in the three preceding weeks, declined again last week to 354, and were 203 below the corrected average number. Influenza was returned as the primary cause of 39 deaths in London last week, against 37, 28, and 37 in the three preceding weeks. The causes of 74, or 1-4 per cent., of the deaths in the 76 towns last week were not certified either by a registered medical practitioner or by a coroner. The causes of all the deaths were certified in West Ham, Bristol, Leicester, Salford, Leeds, Newcastle-on- Tyne, and 42 other smaller towns ; the largest proportions of uncertified deaths were registered in Hanley, Birmingham, Smethwick, Liverpool, Warrington, Sheffield, and Sunder- land. ____ HEALTH OF SCOTCH TOWNS. The annual rate of mortality in eight of the principal Scotch towns, which had been 21’1, 21’3, and 21’ per 1000 in the three preceding weeks, further rose to 22’6 per 1000 during the week ending Jan. 10th, and was 3’ 8 per 1000 in excess of the mean rate during the same period in the 76 large English towns. The rates in the eight Scotch towns ranged from 17 - 0 in Perth and 17° 3 in Gieenock to 24’ 2 in Leith and 24-4 in Glasgow. The 740 deaths in these towns included 24 which were referred to whooping cough, 22 to diarrhoea, 15 to measles, seven to diphtheria, seven to "fever," and three to scarlet fever, but not one to small-pox. In all 78 deaths resulted from these principal infectious diseases last week, against 68, 59, and 77 in the three pre- ceding weeks. These 73 deaths were equal to an annual rate of 2’4 per 1000, which was 0’8 8 per 1000 above the mean rate last week from the same diseases in the 76 large English towns. The fatal cases of whooping cough, which had been 20 and 33 in the two preceding weeks, declined again last week to 24, of which 17 were registered in Glasgow, two in Edinburgh, and two in Dundee. The deaths from diar- rhoea, which had been 18 and 14 in the two preced- ing weeks, rose again to 22 last week, and included 14 in Glasgow, two in Edinburgh, two in Aberdeen, and two in Greenock. The fatal cases of measles, which had ben five, six, and 10 in the three preceding weeks, further in- i creased last week to 15, of which 10 occurred in Aberdeen, two in Glasgow, and two in Edinburgh. The deaths from diphtheria, which had been four, six, and 13 in the three preceding weeks, declined again to seven last week, and included three in Glasgow, two in Edinburgh, and two in Dundee. The fatal cases of "fever," which had been six, six, and four in the three preceding weeks, rose again last - week to seven, of which four were recorded in Glasgow. 9 The three deaths from scarlet fever corresponded with the
Transcript
195
Looking Back.
FROM
THE LANCET, SATURDAY, JAN. 15, 1825.
SURGICAL LECTURES,DELIVERED BY
MR. ABERNETHY.
Theatre, St. Bartholomew’s Hospital.
LECTURE 14.1
11’erioacs Affections.I say that there is a certain disorder of the nerves of the
part antecedent to disease in the part. Suppose that there isdisturbance in any part, you cannot say that it is disease ;it begins with irritation, and therefore I object to the worddisease in that sense. Functional disorder precedes anychange in the structure of the part, but I believe it tobe originally nervous I say to persons who come to mewith weakness of the muscles, spasm, and irritation, occurringin any part of the body, that it is the result of somethingwrong in the nervous system as a whole. I could quoteplenty of cases illustrating this, showing that local irritationand disease are the effect of something wrong in the nervoussystem. This is, very well exemplified in the complaintswhich attend dentition in children, where the nervous
irritation sometimes disorders all the parts of the body, thereare convulsions, weakness of the muscles, the arms are
turned out and sometimes inwards, and so on. The larynx.also becomes affected, and ah ! persons lose their voices allof a sudden, all through an affection of the nerves of thepart.Then again the nerves of a part may be influenced by
something operating on the trunks of the nerves leading tothose parts ; as in injuries or affections of the spinal column,all the nerves in the parts supplied from below the partof the medulla spinalis injured, will be deprived of theirvitality. Again, affections of the nerves of the cerebrummay produce local affections in every part of the body. Wecannot conceive disease to be merely local ; there must
.always be a plurality of parts affected. The subject is onedifficult to explain ; but what I want chiefly to call yourattention to is, a very painful affection of the nerves of a
part called Tic Doloreux. It was a rare thing, in the earlypart of my life, to see many cases of disease produced byincreased vascular action, which are now common ; and soit is with diseases depending on an undue nervous action ina part; for I do not think there was such a thing as tic- <Mo7’.c ever dreamt of in my time. How this comes, Idon’t know.
1 An excerpt only of the report of the lecture is transcribed.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN 76 of the largest English towns 9164 births and 5350deaths were registered during the week ending Jan. 10th.The annual rate of mortality in these towns, which hadoeen 19 6, 16-9, and 20 - 0 per 1000 in the three preced-ing weeks, declined again last week to 18 - 5 per 1000. InLondon the death-rate was 18 8 per 1000, while it averaged18’4 in the 75 other large towns. The lowest death-ratesin these towns were 10’0 in Hornsey, 10-9 in Handsworthand in West Hartlepool, 11’8 in Walthamstow, 12’3 in South-ampton, 12-4 in York, and 12’7 in Leyton ; the highestrates were 21-7 in Manchester, 22-7 in West Bromwichand in Rochdale, 23’7 in Liverpool, 22-4 4 in Wolverhampton24-4 in Rhondda, 25-2 in Oldham, and 58-2 in GreatYarmouth. The 5350 deaths in these towns last week in-cluded 504 which were referred to the principal infectious
diseases, against 620, 493, and 603 in the three precedingweeks ; of thee 504 deaths 136 resulted from measles, 132from whooping-cougb, 73 from diphtheria, 65 from scarletfever, 50 from diarrhoea, 38 from "fever" (principallyenteric), and 10 from small pox. No death from any of thesediseases was registered last week in Hornsey, Bournemouth,Reading, Norwich, Burton-on-Trent, Bootle, Warrington,Barrow-in-Furness, Huddersfield, Halifax, York, or Stockton-on-Tees ; while the highest death-rates from the principalinfectious diseases were recorded in West Ham, Hastings,Smethwick, Liverpool, St. Helens, Tynemouth, Newport(Mon.), and Cardiff. The greatest proportional mortalityfrom measles occurred in Hastings, Devonport, Walsall,Liverpool, Salford, Tynemouth, Newport (Mon.), andCardiff ; from scarlet fever in Great Yarmouth, King’sNorton, Coventry, and St. Helens ; from diphtheriain Hastings, Hanley, Smethwick, Bury, and Preston ;from whooping-cough in Tottenham, West Ham, Oldham,and Cardiff ; and from diarrhoea in Wolverhampton.The mortality from "fever" showed no marked excess
in any of the large towns. Of the 10 fatal cases of
small-pox in these towns six were registered in Liverpooland one each in London, Derby, Oldham, and Preston.The Metropolitan Asylums hospitals contained 10 small-poxpatients on Saturday, Jan. 10th, against 21, 17, and 14on the three preceding Saturdays ; four new cases wereadmitted during last week, against five, none, and onein the three preceding weeks. The number of scarletfever cases in these hospitals and in the London Fever
Hospital, which had been 2487, 2528, and 2378 at theend of the three preceding weeks, had further declined to2219 at the end of last week ; 223 new cases were admittedduring the week, against 279, 205, and 214 in the three
preceding weeks. The deaths referred to diseases ofthe respiratory organs in London, which had been408, 343, and 415 in the three preceding weeks, declinedagain last week to 354, and were 203 below the correctedaverage number. Influenza was returned as the primarycause of 39 deaths in London last week, against 37, 28, and37 in the three preceding weeks. The causes of 74, or 1-4per cent., of the deaths in the 76 towns last week were notcertified either by a registered medical practitioner or by acoroner. The causes of all the deaths were certified inWest Ham, Bristol, Leicester, Salford, Leeds, Newcastle-on-Tyne, and 42 other smaller towns ; the largest proportionsof uncertified deaths were registered in Hanley, Birmingham,Smethwick, Liverpool, Warrington, Sheffield, and Sunder-land.
____
HEALTH OF SCOTCH TOWNS.
The annual rate of mortality in eight of the principalScotch towns, which had been 21’1, 21’3, and 21’ per 1000in the three preceding weeks, further rose to 22’6 per 1000during the week ending Jan. 10th, and was 3’ 8 per 1000 inexcess of the mean rate during the same period in the 76large English towns. The rates in the eight Scotch townsranged from 17 - 0 in Perth and 17° 3 in Gieenock to 24’ 2 inLeith and 24-4 in Glasgow. The 740 deaths in thesetowns included 24 which were referred to whooping cough,22 to diarrhoea, 15 to measles, seven to diphtheria, seven to"fever," and three to scarlet fever, but not one to small-pox.In all 78 deaths resulted from these principal infectiousdiseases last week, against 68, 59, and 77 in the three pre-ceding weeks. These 73 deaths were equal to an annualrate of 2’4 per 1000, which was 0’8 8 per 1000 above the meanrate last week from the same diseases in the 76 large Englishtowns. The fatal cases of whooping cough, which had been20 and 33 in the two preceding weeks, declined again lastweek to 24, of which 17 were registered in Glasgow, two inEdinburgh, and two in Dundee. The deaths from diar-
rhoea, which had been 18 and 14 in the two preced-ing weeks, rose again to 22 last week, and included14 in Glasgow, two in Edinburgh, two in Aberdeen, and two
in Greenock. The fatal cases of measles, which had benfive, six, and 10 in the three preceding weeks, further in-i creased last week to 15, of which 10 occurred in Aberdeen,two in Glasgow, and two in Edinburgh. The deaths from
diphtheria, which had been four, six, and 13 in the threepreceding weeks, declined again to seven last week, andincluded three in Glasgow, two in Edinburgh, and two inDundee. The fatal cases of "fever," which had been six,six, and four in the three preceding weeks, rose again last- week to seven, of which four were recorded in Glasgow.9 The three deaths from scarlet fever corresponded with the
196
number in each of the two preceding weeks and included twoin Paisley. The deaths referred to diseases of the respiratoryorgans in these towns, which had been 193 and 158 inthe two preceding weeks, further declined last week to 152,but slightly exceeded the number in the correspondingperiod of last year. The causes of 31, or more than 4 percent., of the deaths in these eight towns last week were notcertified.
___
HEALTH OF DUBLIN.
The death-rate in Dublin, which had been 30’ 8. 24’6, and29’4 per 1000 in the three preceding weeks, declined againto 26’8 per 1000 during the week ending Jan. 10th. Duringthe past four weeks the death-rate has averaged 27’7 per1000, the rates during the same period being 19’ 0 in Londonand 19’ 8 in Edinburgh. The 195 deaths of persons belongingto Dublin registered during the week under notice showed adecline of 19 from the number in the preceding week, andincluded 14 which were referred to the principal infectiousdiseases, against 20, 21, and 23 in the three precedingweeks ; of these, three resulted from diphtheria, three fromdiarrhoea, two from measles, two from scarlet fever,two from whooping cough, and two from "fever." These14 deaths were equal to an annual rate of 1’9 per 1000,the death-rates last week from the same diseases being1-7 in London and 1-4 in Edinburgh. The fatal cases ofmeasles, which had been nine, seven, and nine in the threepreceding weeks, declined again last week to three. Thedeaths from diarrheea, which had been three, four, and threein the three preceding weeks, were again three last week.The mortality both from scarlet fever and from diphtheriashowed a decline from that recorded in the preceding week.The 195 deaths in Dublin last week included 37 of childrenunder one year of age and 57 of persons aged 60 years andupwards ; the deaths of infants and those of elderly personscorresponded with the respective numbers in the precedingweek. Six inquest cases and six deaths from violence wereregistered. and 62, or nearly a third, of the deathsoccurred in public institutions. The causes of 19, or nearly10 per cent., of the deaths in Dublin last week were notcertified.
____
VITAL STATISTICS OF LONDON DURING DECEMBER, 1902.
IN the accompanying table will be found summarised
complete statistics relating to sickness and mortality in theCity of London and in each of the metropolitan boroughs.With regard to the notified cases of infectious diseases it
appears that the number of cases reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 7’4 per 1000 ofthe population, estimated at 4,579,107 persons in themiddle of last year. In the three preceding monthsthe rates had been 9-1, 10-0, and 9-1 per 1000 re-
spectively. The rates were considerably below the averagein Paddington, Kensington, Chelsea, Stoke Newington,the City of London, and Shoreditch, while theyshowed the largest excess in Hackney, Southwark,Battersea, Wandsworth, Deptford, and Lewisham. The
prevalence of small-pox showed a slight decline from thatrecorded in the preceding month ; of the 12 cases notifiedduring December, four belonged to Islington, two to Fulham,two to Hackney, two to Finsbury, one to Stepney, andone to Poplar. The Metropolitan Asylums hospitals con-tained 14 small-pox patients at the end of last month,against 42, 19, and 17 at the end of the three precedingmonths ; the weekly admissions averaged three, having alsobeen three in each of the two preceding months. Scarletfever was considerably less prevalent during Decemberthan in either of the two preceding months ; this diseaseshowed the highest proportional prevalence in St. Pancras,Hackney, Lambeth, Battersea, Wandsworth, Deptford, andLewbham. The number of scarlet fever patients undertreatment in the Metropolitan Asylums hospitals, which hadbeen 2656, 2820, and 2705 at the end of the three pre-ceding months, had further declined to 2327 at the endof last month ; the weekly admissions averaged 236, against327, 358, and 301 in the three preceding months.The prevalence of diphtheria showed a slight declinefrom that recorded during November last ; among thevarious metropolitan boroughs this disease was propor-tionally most prevalent in Fulham, Hackney, Wands-worth, Lewisham, and Woolwich. There were 927
) diphtheria patients under treatment in the Metropolitan Asylums hospitals at the end of December, against 981,l 941, and 1019 at the end of the three preceding months ;
the weekly admissions averaged 136 last month, against- 142, 149, and 157 in the three preceding months. Enteric- fever showed a considerably diminished prevalence, last month as compared with recent months ; the
greatest proportional prevalence of this disease occurredin Kensington, Finsbury, Shoreditch, Stepney, and Wands-worth. The number of enteric fever patients in theMetropolitan Asylums hospitals, which had been 359,401, and 339 at the end of the three preceding months,had further declined to 210 at the end of December; theweekly admissions averaged 30 last month, against 63, 59,and 37 in the three preceding months. Erysipelas was pro-portionally most prevalent in St. Marylebone, Holborn,Bethnal Green, Southwark, Camberwell, and Greenwich.The 33 cases of puerperal fever notified during the monthincluded four in Wandsworth, three each in Battersea,Lambeth, and Camberwell, and two each in St. Mary]eb3ne,Islington, Hackney, Stepney, and Woolwich.The mortality statistics in the table relate to the deaths
of persons actually belonging to the various metropolitanboroughs, the deaths occurring in public institutionshaving been distributed among the various boroughsin which the deceased persons had previously resided.During the five weeks ending Jan. 3rd the deaths of7974 persons belonging to London were registered, equalto an annual rate of 18’2 per 1000 living, against 16’4, 16’0,and 17’4 per 1000 in the three preceding months. Thelowest death-rates last month in the several metropolitanboroughs were 11’ 7 in Hampstead, 14’ 1 in Stoke Newington,14 4 in Paddington, 14’7 in Hackney, 14’9 in Woolwich,and 15’1 in Wandsworth; the highest rates were 20’7 inBermondsey, 20’8 in Stepney, 21’0 in Poplar, 21-9 inHolborn, 22’0 in the City of London, and 25’4 in Finsbury.The 7974 deaths from all causes included 764 which werereferred to the principal infectious diseases ; of these, 261resulted from measles, 52 from scarlet fever, 116 from
diphtheria, 204 from whooping-cough, 55 from enteric fever,one from simple continued fever, 75 from diarrhoea, and notone from small-pox or typhus. The lowest death-ratesfrom these diseases were recorded in Kensington, Hamp-stead, Stoke Newington, Holborn, and Woolwich ; andthe highest rates in Fulham, St. Pancras, Finsbury,Stepney, Bermondsey, and Deptford. The 261 fatal casesof measles were 28 below the corrected average number ;among the various metropolitan boroughs this disease showedthe highest proportional mortality in St. Pancras, Stepney,Bermondsey, Camberwell, Deptford, Greenwich, and Lewis-ham. The 52 deaths from scarlet fever showed a declineof 32 from the number in the corresponding periods of theten preceding years ; this disease was proportionally mostfatal in Islington, Hackney, Bethnal Green, Lambeth, andDeptford. The 116 fatal cases of diphtheria were less thanone-half of the corrected average number ; among the variousmetropolitan boroughs this disease showed the greatestproportional mortality in Fulham, Chelsea, St. Maryle-bone, St. Pancras, Southwark, and Lewisham. The204 deaths from whooping-cough were 39 in excess ofthe average number in the corresponding periods of the tenpreceding years. This disease was proportionally most fatalin Fulham, City of Westminster, St. Marylebone, Islington,Finsbury, and the City of London. The 56 fatal cases
of "fever" showed a decline of 34 from the correctedaverage number ; among the various metropolitan boroughsthe highest "fever death-rates were recorded in Kensing-ton, St. Pancras, Islington, Hackney, Lambeth, and Camber-well. The 75 deaths from diarrhoea slightly exceded thenumber in the corresponding periods of the ten precedingyears ; this disease was proportionally most fatal inFulham, Chelsea, Stoke Newington, Holborn, and South-wark. In conclusion, it may be stated that the aggregatemortality in London last month from these principal in-fectious diseases was more than 22 per cent. below theaverage.
Infant mortality in London during December, measuredby the proportion of deaths among children under one year ofage to registered births, was equal to 155 per 1000. Thelowest rates of infant mortality were recorded in Kensington,St. Marylehone, Hampstead, Hackney, the City of London,and Shoreditch ; while the highest rates occurred in Chelsea,City of Westminster, Finsbury, Camberwell, Deptford,Greenwich, and Lewisham.
