a knowledge of the laws which regulate the propagation of epidemic diseases, all attempts at proper legislation on quarantine are vain.

"The mortality from the zymotic class of diseases was lowest in Edinburgh, and highest in Dundee. Thus, assuming the same proportion of persons living as in table xxxiv., viz., 100,000 in each town, there died from the zymotic class of diseases in the proportion of 472 in Edinburgh, 476 in Leith, 558 in Greenock, 569 in Aberdeen, 579 in Paisley, 581 in Glasgow, 646 in Perth, and 724 in Dundee. Of the individual zymotic diseases, small-pox caused only 766 deaths, of which 415 were males and 351 females. This gives the very small proportion of twenty-six deaths from small-pox during the year in every 100,000 persons, being in the proportion of thirty male and twenty-two female deaths in every 100,000 of either sex. Measles caused only 971 deaths in Scotland during the year, being in the low proportion of thirty-three deaths in every 100,000 persons of the population. This year, also, has therefore presented a corroborative proof of the correctness of the remark made in former reports, as to the close relation between small-pox and measles; inasmuch as both seem to be under the same unknown atmospheric or other influences, so that the one increases and declines along with the other. In 1860, the mortality from both was high, inasmuch as there were 1,495 deaths from small-pox, and 1,587 from measles; while in 1861, both were very low, only 766 deaths from small-pox, and 971 from measles having occurred. Scarlatina is in general the most fatal of the epidemic diseases of childhood, but during 1860 the mortality was below the average, seeing that only 1,764 deaths were attributed to it, or in the proportion of sixty deaths during the year in every 100,000 persons. During 1859, 126 deaths, and during 1860, 101 deaths from scarlatina occurred for every 100,000 persons. Diphtheria, since it made its appearance in Scotland in 1857, has steadily increased, year after year. Thus, in 1857, the deaths from that disease numbered seventy-six only; in 1858, they were 294; in 1859, they were 515; in 1860, they numbered 480; but in 1861, they had increased to 681; and thus constituted a fraction more than one per cent. of the deaths.

Hooping-cough proved fatal to 2,204 persons, of whom 989 were males, and 1,215 females, being in the proportion of seventy-one males, but seventy-eight female deaths, in every 100,000 of the respective sexes. Hoopingcough is therefore one of the few diseases which prove less fatal to the male than to the female; and this peculiarity is apparent from year to year. Though a small number of cases of diarrhoea and dysentery are constantly occurring among the population, yet these diseases, with cholera, only become prevalent during the summer or autumnal months when the temperature is high; their prevalence and fatality rising and falling with the temperature. During the year 1861, however, the temperature never rose high, the highest mean monthly temperature, viz., 57°.4, having been attained in August, while that of July was only 56°.8 and that of September 53°.7. The consequence of this was that only 1,041 deaths were caused during the year by diarrhea, 361 by dysentery, and sixty-seven by cholera, being an aggregate proportion of forty-nine deaths from these diseases in every 100,000 persons.

Typhus, in its varied forms, was the most fatal epidemic of the year, having cut off 2,579 persons, or including the 45 deaths from infantile remittent fever, which is only a form of typhus, 2,624 deaths. This gives the propor tion of 89 deaths in every 100,000 persons, or 4.2 per cent. of the deaths. This disease, like all the others to which the inhabitants of Scotland are liable, proved most fatal to those in the town districts. Thus, in every 100,000 persons in each of the three great groups of districts, typhus cut off 56 persons in the insular, 83 in the mainland-rural, and 101 in the town districts. But the eight principal towns presented great variety in the proportion of persons who died from typhus fever. Thus, for the sake of comparison, assuming the population of all at 100,000, typhus cut off 55 in Leith, 61 in Perth, 66 in Edinburgh, 82 in Aberdeen, 94 in Paisley, 95 in Dundee, 124 in Glasgow, and 136 in Greenock. Nowhere, however, did the disease appear to assume the epidemic type; but everywhere, like all other diseases, it proved most prevalent and fatal among those whose health had been previously reduced by living in close, unaired, overcrowded

dwellings, or in unhealthy, damp, undrained localities.

"Of the other zymotic diseases, croup caused 890 deaths; erysipelas, 258; influenza, 232; metria or childbed fever, 203; purpura, 49; syphilis, 122, of which 88 were congenital; worms, 30; thrush, 25; noma, 12; ague, 6, from the disease caught abroad, not in Scotland; and hydrophobia caused 1 death.

"Class II. Diseases of Uncertain Seat.—The diseases of uncertain seat cut off 2,319 persons in Scotland during 1861, or in the proportion of 79 deaths in every 100,000 persons in the population. Dropsy and cancer are the principal diseases tabulated under this class; the cases of dropsy being those in which the seat of the disease, or its primary cause, had not been defined. 778 deaths were attributed to dropsy, being in the proportion of 26 deaths in every 100,000 persons. Cancer caused 1,165 deaths, of which only 367 were males, but 798 females; thus showing that only 26 males, but 51 females, died from cancer during the year in every 100,000 of each sex. Females are therefore twice as liable to that painful disease as males. It would appear that the mortality from cancer maintains the same ratio in the insular, the mainland-rural, and the town districts, as the deaths from all causes, as is apparent from the fact, that in every 100,000 persons in each of these groups or districts, 27 died from cancer in the insular, 39 in the mainland-rural, and 41 in the town districts. Of the other diseases belonging to this class, mortification cut off 115 persons; abscess, 126; hæmorrhage, the seat of which was not defined, 65; ulcer, 35; fistula (all kinds,) 19; and gout, 16 persons.

"Class III. Tubercular Diseases.—During 1861, the tubercular class of diseases (which is composed of scrofula, tabes mesenterica, phthisis or consumption, aud hydrocephalus) cut off 10,582 persons; thus constituting 17.79 per cent. of the deaths, or in the proportion of 362 deaths in every 100,000 persons in the population. Of the 10,582 persons who died from this class of diseases, 5,189 were males, and 5,393 females, giving the proportion of 375 male deaths, but only 349 female deaths in every 100,000 persons of the respective sexes. This great excess of male deaths is chiefly caused by the much greater

fatality from hydrocephalus which attends the male; for, in the deaths from phthisis, the proportion of female deaths is higher than that of the male. This class of diseases being diseases of debility, the mortality therefrom falls with especial severity on the town populations, in a much greater ratio, indeed, than that of all other diseases. Thus, while in every 100,000 persons living in each of the three great groups of districts, only 249 died from this class of diseases in the insular, and 292 in the mainland-rural districts, the proportion rose to 482 deaths in a like population in the town districts. This fact would seem to prove that this class of diseases is a much surer test of the sanitary condition of a town or district than epidemics, which are irregular in their appearance, and are often absent for years running from a district which is in a truly bad sanitary condition. The mortality, however, from this class of diseases, proves the true sanitary condition of a town or district, because the diseases belonging to this class are mainly the result of causes which impair the vital energy and cause tubercular matter (i.e., imperfectly oxygenized matter) to be deposited in the tissues of the body.

"In the eight principal towns of Scotland, the mortality from this class of diseases greatly differs. Thus, for correct comparison, reckoning the population of each town as 100,000 persons, out of that number there died from the tubercular class of diseases, 348 in Leith, 352 in Perth, 436 in Dundee, 447 in Edinburgh, 454 in Aberdeen, 491 in Paisley, 549 in Greenock, and 569 in Glasgow. A five years' average, however, gives a more correct view of the comparative liability of each town to that class of diseases. A five years' average shows that in proportion to every 100,000 persons, 335 deaths from the tubercular class of diseases occurred annually in Leith, 416 in Perth, 457 in Edinburgh, 473 in Dundee, 501 in Aberdeen, 517 in Paisley, 564 in Greenock, and 567 in Glasgow.

whose cause of death was not recorded, the total mortality from consumption would amount to 7,937 deaths, indicating a proportion of 259 deaths during the year in every 100,000 persons. Of the 7,571 recorded deaths from consumption, 3,518 were those of males, 4,053 those of females; indicating a proportion of 254 male deaths, but of 263 female deaths, in every 100,000 of either sex. As a like result appears year after year, it may be considered as demonstrated that females die from that disease in greater proportions than males-a result which might be expected, when it is considered that the disease is one essentially of debility, mal-assimilation of the food, and deficient oxygenation of the blood.

"The fact, however, that females are more liable to the disease than males, and die in larger proportions, is generally ignored by writers on sanitary matters. It is necessary, therefore, to direct special attention to the subject, as it has most important bearings on the causes of the disease, and on the means which ought to be adopted for its prevention, alleviation, or cure. Thus, if the male and female deaths from consumption had borne the same relation to each other as the male and female deaths from all diseases, there ought to have been 3,580 female deaths from consumption for the 3,518 male deaths. Instead of this, however, there were 4,053 female deaths, or 473 more female deaths than ought to have occurred had consumption cut off each sex in the same proportion as all diseases did. Now, this is not an exceptional case, but is the ordinary law of this disease in Scotland, as was pointed out in last detailed report. As comparatively few women, in proportion to the men, follow those unhealthy trades which sanitary writers endeavour to prove are the fruitful causes of consumption, it is apparent that it cannot be the trade or occupation which is the cause of such a great preponderance of female deaths from consumption in Scotland. The fact of the great mass of the female population being more or less engaged in domestic or other pursuits which confine them to the locality in which their dwellings are situated, seems to indicate that the greater proneness of the female to consumption, to a great extent depends on the locality or dwelling itself. The males, from being less constantly in the locality, suffer

rather less than the females, who are more constantly at home.

"If such be the case, as these statistics seem to show is extremely probable, they go far to corroborate the conclusions which Dr. Bowditch, of Boston, United States, has drawn from a very thorough inquiry into one of the causes of consumption in Massachusetts.* It must be remembered that consumption is much more fatal in Massachusetts and the United States of America generally than in this country; and on investigation it was found that the towns, villages, hamlets, and houses which were situated on or near undrained localities, or were on heavy, impermeable soils, or on low-lying ground, and whose sites were consequently kept damp, had a very much larger number and proportion of cases of consumption than towns, villages, hamlets, or houses which were situated on dry or rocky ground, or on light, porous soils where the redundant moisture easily escaped.

"Let us see how such an explanation would agree with the very different proportion of deaths from consumption which occur in the eight principal towns of Scotland. Taking a five years' average (1857 to 1861 inclusive), it is found that, supposing all these towns are brought to an uniform population of 100,000 persons, there died annually from consumption 206 persons in Leith, 298 in Edinburgh, 310 in Perth, 332 in Aberdeen, 340 in Dundee, 383 in Paisley, 399 in Glasgow, and 400 in Greenock. The fact is, that if each town had been arranged in the order of comparative dryness of its site, they would almost have arranged themselves in the above positionLeith and Edinburgh the most free from consumption, and also having the driest sites; Glasgow and Greenock the most ravaged by that disease, and beyond all comparison situated on the dampest sites. The above fact, then, with regard to the towns, corroborates in the most striking manner the conclusions of Dr. Bowditch, and should be a valuable help to the sanitary reformers as to the very important measures which it is their more especial province to carry out. Dr. Bowditch's conclusions also are singularly borne out by the remarkable freedom from consumption at the

Consumption in New England, or locality one of its chief causes. Boston, 1862.

Cape of Good Hope and South Africa generally, Egypt, &c., and the comparatively high mortality from it in the moist climate of Great Britain; and, while they point out the cause, afford valuable indications as to the cure or relief of those affected.

"Of the other tubercular diseases, scrofula cut off 699 persons, tabes mesenterica 782, and hydrocephalus 1,530, being in the respective proportions of 23, 26, and 52 deaths in every 100,000 persons of the population. Hydrocephalus is proportionally much more fatal to the male than to the female, inasmuch as 859 of the deaths from that disease were males, and only 671 females, giving the proportion of 62 male deaths, but only 43 female deaths, in every 100,000 of each sex. This proves

that even at the earliest ages of life the tendency of the male to disease of the brain is much greater than that of the female.

"Class IV.-Diseases of the Brain and Nervous System.-Diseases of the brain and nervous system proved fatal to 4,823 persons in Scotland, being in the proportion of 164 deaths from that class of diseases in every 100,000 persons. Of these 4,823 persons, 2,546 were males, and 2,277 females; thus showing that in every 100,000 of each sex, 184 males, but only 147 females, perished from that class of diseases. This high relative proportion of male deaths, which is reproduced year after year, shows the much greater tendency of the male to diseases of the brain. It is a very much higher proportion than is due to the different death-rates of males and females by all diseases; and, as was pointed out above, is still more striking if the child's disease, hydrocephalus, be included, showing that, even at the earliest age, almost before either sex begins to use the brain, the tendency in the male to die from its diseases is much greater than in the female.

"Like all other diseases, however, the mortality from the brain diseases is highest in the town districts. Thus, in every 100,000 persons in each of the three great groups of districts into which Scotland is divided, 87 died from brain diseases in the insular districts, 143 in the mainland-rural, and 208 in the town districts. Of the eight principal towns of Scotland, Paisley, and then Glasgow, yielded the lowest proportion of deaths from

brain diseases; Perth, then Edinburgh and Greenock, the highest.

"Of the individual diseases under this class, apoplexy caused 1,008 deaths; paralysis, 1,458; convulsions, 689; epilepsy, 213; cephalitis, 354; insanity, 91; delirium tremens, 54; tetanus, 44; chorea, 14; while 896 were registered under the indefinite term of brain disease.

"Class V.—Diseases of the Heart and Organs of the Circulation.-2,491 persons died from diseases of the heart and of the organs of the circulation, of whom 1,278 were males, and 1,213 females. This gives the proportion of 92 male and 78 female deaths in every 100,000 persons of either sex in the population. Of the individual diseases under this class, heart disease cut off 2,350 persons, pericarditis 72, and aneurism 69 persons.

sex.

"Class VI.-Diseases of the Respiratory Organs. According to our present mode of classifying diseases, the inflammatory affections of the respiratory organs form the third most fatal class of diseases to which the inhabitants of Scotland are liable, and cut off during the year 8,400 persons, of whom 4,427 were males and 8,978 females. This gives the proportion of 287 deaths in every 100,000 persons of the general population, or 320 male deaths and 257 female deaths in every 100,000 of either This mode of classifying the diseases, however, gives a false idea of the relative prevalence of diseases which prove fatal by affecting the lungs and respiratory apparatus. In this country, the great proportion of cases of hooping-cough which prove fatal do so through inflammatory affections of the bronchial tubes or of the lungs. Croup also is confined to the air-passages; and all cases of consumption prove fatal through the alteration which that disease effects on the lungs and bronchial tubes. In considering the proportion, therefore, in which diseases of the respiratory organs bear to the other diseases to which the natives of Scotland are liable, all these diseases ought to be classed together; and we then arrive at a just conclusion as to the organ of the body which is most liable to become deranged in its action, and to bring disease and death on the population. When the 2,204 deaths from hooping-cough, the 890 from croup, and the 7,571 from consumption,

therefore, are added to the 8,400 deaths belonging to this sixth class, we have a total of 19,065 deaths caused by diseases of the respiratory organs. This shows that 32 per cent. of the ascertained diseases affect the respiratory organs, or that a third of the population. die through maladies affecting these organs.

"This striking fact shows us, that what we have chiefly to guard against in this climate are the causes which induce disease in the respiratory organs; and it has been shown again and again in these reports that the chief of these causes are the low temperature of winter and the keen, arid, easterly winds at all seasons, but more especially in spring. The diseases of the respiratory organs are SO strongly influenced by season, that their mortality appears to be quite regulated by the mean monthly temperature-as an ordinary rule the mortality therefrom being lowest in August, our mildest month, and highest in January or February, our coldest months. Thus, in the eight principal towns of Scotland, August was the warmest month of the year, and during that month 155 deaths from diseases of the respiratory organs occurred. January was the coldest month, and during that month 666 deaths from the same causes were registered, and the other months had each a mortality corresponding closely with their mean temperature.

"Of the individual diseases belonging to this class, bronchitis is by far the most fatal, having caused 5,017 deaths, or, allowing for the causes not specified, in the proportion of 171 deaths during the year in every 100,000 persons of the population, or nearly 8 per cent. of the total deaths. Of these, 2,541 were males and 2,476 females; thus showing a proportion of 183 male deaths and 160 female deaths in every 100,000 of each sex.

"Pneumonia, or inflammation of the lungs, was the next most fatal of the diseases belonging to this class, causing 1,974 deaths-being in the proportion 3.3 per cent. of the total deaths, or 67 deaths in every 100,000 persons of the population. This disease seems to prove much more fatal to the male than to the female, inasmuch as 1,139 of the deaths were males, and only 835 females, giving the proportion of 82 male, but only 54 female, deaths in every 100,000 persons of each sex for

pneumonia. Of the other diseases belonging to this class, asthma cut off 661 persons, pleurisy 268, laryngitis 161, while 319 were registered under the indefinite term of disease of the lungs.

"Class VII.-Diseases of the Organs of Digestion.-Diseases of the organs of digestion caused 5,036 deaths, being in the proportion of 172 deaths in every 100,000 persons, or 8 per cent. of the total mortality. These diseases cut off the respective sexes in very nearly the same proportions as all diseases do, inasmuch as 184 males, but only 161 females, were cut off by these diseases in every 100,000 of each sex. Of the various diseases arranged under this class, teething caused 1,137 deaths; enteritis, 947; disease of stomach, not more particularly defined, 765; ileus, 293; peritonitis, 298; gastritis, 152; ulceration of the intestines, 183; disease of the liver, 572; hepatitis, 166; jaundice, 185; hernia, 110; quinsey, 87; ascites, 61; intussusception, 33; stricture of intestines, 24; disease of spleen, 22; and disease of pancreas, 1.

"Of the other classes of disease, those of the urinary organs (of which the various kidney diseases are the chief) caused 844 deaths; diseases of the generative organs (of which child-birth is the principal) caused 506 deaths; diseases of the organs of locomotion-as of the bones, joints, muscles, &c., including rheu matism-caused 428 deaths; diseases of the skin, 72 deaths; malformation from birth, 152 deaths; atrophy, 492 deaths; and sudden death, where the cause was not ascertained, 105 deaths.

"The debility arising from premature birth, and from weakly constitutions at birth, cuts off a very large proportion of infants annually, 2,880 deaths having been registered during 1861, induced by these causes. This gives the high proportion of nearly 5 per cent. (4.84) of the deaths as arising from debility of constitu tion at birth.

"A very large number of deaths is annually assigned to old age, or decay of the physical frame without marked disease. During 1861, there were 5,792 deaths assigned to old age, or more than 9 per cent. (9.74) of the specified causes of death. The proportion of persons dying from old age is much higher in the insular and mainland-rural districts than in the town