Cornelius Walford.

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that the attempt, as it is carried out, leads to much jealousy, between the physicians sent
by the Gov. and the local practitioners. "

In Germany efforts at regis, have been made by private asso. of scientific men ; but
never to continue long in organization and action.

The inquiry as to the amount of disease existing in Ireland at the date of the Census of
1841, as conducted" by Dr. Wilde, under the direction of the then Census Commissioners,
was the first attempt with which we are familiar to regis, the existing diseases prevailing
at a given date in any one country ; but it cannot be regarded as a success. [DISEASE,
1851.] Dr. Richardson speaks of this as follows:

The immense work, the census of disease in Ireland, may be looked on as connected with the regis,
of disease, inasmuch as it supplied the facts of the amount and character of the diseases present at
a given time in a great country, the social condition of which was being chronicled at the same
moment. But the information thus gathered, all-important as a standard, was struck out too
suddenly to admit of analysis, as a regis, of the progress of the disorders specified.

For a short time the medical officers of health in Lond. tried to estab. a system of
regis, of disease ; but only with partial success. The first attempt which gave any hope
of developing into permanent results may be taken to be the founding of the Epidemio-
logical So. in Lond. in 1850. The Pres., Dr. Babington, in his intro. address, stated the
objects of the So. to be :

To endeavour by the light of modem science to review all those causes which result in the mani-
festation and spread of epidemic diseases ; to discover the causes, at present unknown, and investigate
those which are at present ill-understood ; to collect together facts on which scientific researches may
be securely based ; tp remove errors which impede their progress ; and thus, as far as we are able,
having made ourselves acquainted with the strongholds of our enemies, and their modes of attack, to
suggest those means by which their invasion may either be prevented, or, if in spite of our resistance
they have broken in upon us, to seek how they may be most effectually combated and expelled.

Four committees of the So. were said to be actively engaged in the year 1851 in
investigating the following important subjects :
I. The facts connected with smallpox and vaccination.



DISEASES, REGISTRATION OF. 377

2. The condition of common lodging-houses as influencing the propagation and spread of

epidemic disease.

3. The epidemic diseases prevalent in public hospitals.

4- Epizootic diseases, more especially those affecting domestic animals.

The results of the labours of these committees will be found in the pub. Trans, of the
So. It is seen that the object of the So. was investigation rather than regis. The various
other and outside efforts by which it was speedily followed also indicate that it did
not fully meet the requirements.

The next atteippt was commenced in 1853, by Dr. B. W. Richardson, and took awider
range than anything previously attempted in England. "My first endeavour (says that
gentleman) was to obtain a certain number of stations in different parts of the country,
and to supply to one or more resident medical men forms of returns in which they could
note the current diseases." The first great difficulty consisted in securing willing and
competent observers ; but this was overcome, and 12 stations were estab. in various parts of
the country. The observers in all cases were medical men in large practice, possessing
corresponding opportunities for knowing of the existence of any disease around them.
They were requested to confine their obs. to the following allied disorders : scarlet fever,
measles, smallpox, hooping-cough, croup, catarrh, influenza, erysipelas, cholera, ague,
remittent fever, diarrhoea, typhus, puerperal fever, and carbuncle. Tabular forms, con-
veniently arranged for noting the obs. , were supplied, accompanied by instructions con-
taining, inter alia, the following :

As it is the object of the T. to ascertain the presence of the disease named rather than the number
of cases, the occurrence of even a single case should be chronicled. But observers who may wish to
notice other important facts, such as the extent and mort. of an epidemic, its mode of orig^in or
importation, meteorological phenomena, etc., may do so in the blank space headed "Add. Obs."
Observers will please to return the rep. punctually on the first days of March, June, Sept. and Dec.

Place of obs. Latitude Longitude [Then the form.]

Dr. Richardson says :

We obtained irom these T. at one glance a perfect view of the progress of the diseases named at
given points of lat, and long., their prevalence according to season, the relative duration of each form
of disease, and the order in which one epidemic followed another.

To these essential facts much interest was'added through the " add. obs." made by each observer.
Knowing well how much the time of the busy medical practitioner is occupied, and feeling sure that
any intrusive and organized encroachment on his time and industry would be safe to carry with it its
own destruction, I abstained from doing more than suggest what information would be most useful,
leaving the details to voluntary effort. In the suggestions thus respectfully offered I took care,
however, always to throw in major considerations. The following points of information were specially
asked for :

1. Notes of meteorological changes taken daily, and classed side by side with the report of disease.

2. Notes on the diseases of inferior animals, classified by the side of the diseases occurring simul-
taneously in the human subject.

3. Notes on the condition of the vegetable world and of the diseases of vegetables, classified in the
same way.

4. Notes on the water supply of the different stations, and on the real or apparent connexion of such
supply with the prevailing diseases.

5. Notes on the sanitary state of the station — of drainage, of food, of architecture, and, in fact, of
the social condition in general of the locality.

6. Notes bearing on the mort. of the disorders specified in the returns.

7. Special note as to the method by which any given epidemic found its way into any given locality :
whether a case of the same disease had been imported, or whether any art. had been imported which
could have contained a poison.

8. Special note as to the outbreak of any new epidemic disease within the bounds of any station,
and as to the mode of origin and propagation of such epidemic.

We are told that "the occurrence of new forms of disease, and of peculiarities of types
in diseases common to the neighbourhood, were supplied with much fidelity. " The early
notification of the prevalence of diphtheria at Canterbury is noted as an instance.

The results of the inquiry were pub. regularly each quarter in the Sanitary Review ;
and very soon 50 fellow-labourers were working with Dr. Richardson. " In a vast number
of cases evidences of the origin of diseases from local causes were cited with a circum-
stantiality which was irresistibly conclusive ; and over - and over again the subsidence of
epidemics on the removal of such producing causes was clearly demonstrated." Here
was direct evidence of the good resulting ; but the enterprise was too great for individual
effort, and in l3s8 it subsided.

In 1853 it appeared by a Pari, return that there were 3233 parochial medical officers in
E. and W, It has been from time to time suggested that these should be made avail-
able for the regis, of diseases. But we have seen no practica,ble scheme propounded in
support of the proposition.

In 1854 the conductors of the Journ. of the Brit. Medical Asso. commenced in its pages
to regis, diseases as occurring in connexion with meteorological phenomena. .Several
stations of obs, were appointed, and for several years returns were supplied and pub, week
by week. The scheme was good, and the results were certain to be beneficial ; but the
work was again too great for private enterprise, and it was discontinued.

Dr. Farr does not appear to consider that the period for the regis, of diseases, in a
systematic manner, has yet arrived — at least so we judge from the obs. he offers thereon
in the l6th Rep. of the Reg.-Gen. pub. 1856.
The state of health among the people differs in different times and in different places ; and the



378



DISEASES, REGISTRATION OF.



principal purpose of the regis.Tof diseases is to determine the degree of their variation ineach district,
and in each class of the pop., as well as the extent to which they are modified by_ circumstances.
The causes of insalubrity are thus discovered at their source by death itself; and it is found that in
many instances these causes admit of removal by sanatory measures. The deaths that are the direct
result in any way of human agency undergo judicial investigation, which is often aided by the purely
statistical inquirj'.

The difEcnlties that attend the inquiry into the diseases of a whole pop. are numerous. They may
be referred to several heads. The phenomena are sometimes exceedingljr complicated, and those of
the greatest importance pass within the human body. Medical science is, notwithstanding all its
achievements, still imperfect ; the medical observers all over the country are not always familiar with
the latest improvements in the practice of their art, and it often happens that they are only called to
see their patients in the last days of illness. In parts of our towns, as well as in remote parishes of
the country, many young children and old people die without being seen by any medical man.

No perfect record of the diseases of mankind can, therefore, we believe, be obtained in the present
state of civilization ; but experience justifies us in saying that the record of the ascertained facts, and
of the opinions of the existing race of medical practitioners in Europe, is of value, and admits of many
practical applications.

-In 1861 the question of introducing into Ireland a system of regis, of births and deaths
analogous to that of England and of Scotland was before Pari., and attempts were made
to extend the regis, to diseases of non-fatal termination ; but again no practical proposal
was brought forward. A measure was passed in 1863, which did not extend to diseases
of non-fatal termination, but required the medical attendant, in case of death, to state
"cause of death," and "duration of illness." [Sec. 46, and Form D. in appendix.]

The same Dr. Benjamin W. Richardson, M.D., of whose efforts we have already
spoken, read before the Social Science Congress, 1861, a paper: Facts and Suggestions
on the Regis, of Disease, The writer, who now brings all his former experience to bear
upon the subject, says :

In order to arrive at a correct knowledge of the causes of the diseases of the community, and to see
the way clearly and scientifically to the prevention of disease, the first great step consists in securing
systematic and widely extended T. of facts bearing on the existence of particular diseases, occurring
at the same periods, in different localities, and under differing social conditions. This method of
research would apply to all diseases, — to those which are fixed amongst us, such as cancer and
consumption, and to those which are recurrent, such as measles, scarlet fever, and smallpox.

But, in recognising the necessity for the regis, of all the diseases that afflict humanity, I do not
think it a practical plan to broach the idea of a system of regis, which should at once attempt to
embrace diseases in their universality. I consider that regis, will commence best by a plan that shall
confine the labour to disorders transitory and migratory in character — I mean to disorders of the
epidemic class. These last-named affections offer themselves primarily to our consideration owing to
the facts that they present an acutenegs of outline, and a demonstration, which are peculiarly marked ;
they thus attract more immediate attention, and become objects for contemplation to all practitioners
of medical science ; and not to these only, but to the public at large. I wish it to be understood,
therefore, that in this communication I shall consider the question of regis, in its simple application
to epidemic affections.

He then divides his subject under the following heads: i. The study of epidemic
diseases. 2. Method of regis., its principles ^nd objects. 3. The attempts which have
been made to estab. a method of regis. 4. A plan for the complete regis, of these
diseases in England. To the first head we shall recur urlder Epidemic Diseases,
merely noting one obs. here :

It is and must be clear to every thinking mind that these great visitations of disease which ever and
anon enter our homes, shaping the same course, presenting the same general features, destroying on
an average the same numbers of persons, and passing away, as it were, in disciplined order, offer
marks for the scientific inquirer, which ought at once to be reg,d qff by him, and to suggest to him how
such grand- and steadily governed armies of disease may be arrested in their march, or even annihi-
lated altogether. But when we look around at the progress which has been made, Ei,nd is being made,
towards the perfect comprehension of these disorders, we see no system as yet, developed or
developing, that promises anything like a successful attainment of objects as beneficent as they are
great. The majority of disease observers, indifferent as to causes, are cointent to rest their exertions
on the remedial department of their art — in curing those conditions which ought never to have been
permitted ; while others who look for causes and study preventioq q.re carried away by their own
thoughts and experiences.

In reaching the second head, the writer says ;

In instituting a method for the regis, of disease, two objects must be kept fully in view, "pie first is
the collection of all the facts relating to any current epidemic ; the second consists in the classification,
analysis, and compilation of the f^cts collected. In pursuance of the first of these endeavours four
elements are required: (i) the whole competent mental strength of the district or country in which the
epidemic exists ; {2) uniformity in the system of obs. ; (3) a re9,dy and easy mode of recording obs. ;
(4) a properly constituted plan, by which the facts observed may be collected and prepared for
subjection to analysis and induction. In pursuance of the second great object, a control authority is
necessary. . . .

Under the third head he reviews the several attempts at the regis, of disease which we
have already noted, and adds :

To a certain limited extent the institution of the raort. returns of the Reg.-Gen. have operated as a
regis, of disease. These returns are invaluable as showing, on a grand scale, the mort. of epidemics,
their prevalence, their course, their effects on the sexes, their relationships to season, and it maybe, in
an imperfect manner, their connexion with meteorological conditions. Still, these returns are only
valuable absolutely as regards mort. ; this, their orig. object, is their only direct good. They exhibit
accurately the balance paid over by disease to death, but not that which is paid over by health to
disease.

Under the fourth head is propounded a plan for regis, which the author had proposed
in the Sanitary Reviezv, and of which we have already spoken.

At the same Congress Dr. Alexander Harkin, M.D., read a paper On the Regis, of
Births^ Deaths^ and Diseases pn Ireland] j with special reference to the Bills of Mr,



DISEASES, REGISTRATION OF. 379

Cardwell and Lord Naas. These particular Bills we shall speak of under Registration ;
but the author offers some obs. regarding the regis, of diseases which we propose to quote :

The scientific regis, of diseases, however, cannot be separated from that of births and deaths in any
well-regulated system ; for, when we attempt to consider their relative influence on the increase or
decrease of the pop., we discover that disease has more direct influence on the increase than births
themselves. It is long since Mr. Porter laid down the proposition that " pop. does not so much increase
because many are born, as because few die ; " and Dr. Price that " mort. follows invariably the rate of
sickness ;" and this is still true, with a reservation in favour of modern improvements in medicine. If,
then, the agency of disease is so powerful in controlling the increase of the pop., it is surely but
reasonable to expect that when the Gov. ib estab. a normal system of regis, of the leading vital
phenomena, it shall at the same time, and by the most complete machinery, collect the most reliable
information relative to the amount and nature of sickness, and of the circumstances under which it
arises ; in short that it shall, along with the fegis. of births and deaths, unite in the same bill the regis,
of diseases, beginning with that portion treated at the expense of the public.

On this latter point he enlarges as follows :

Who among us can adequately calculate the loss to medical science, and ultimately to our common
humanity, that results from our criminal neglect in not collecting and pub. the results of treatment,
successful or otherwise, in our great national hospitals, our county infirmaries, union hospitals,
dispensaries, lying-in hospitals, and asylums for the insane ; or sufficiently lament, that with such an
extended area or obs. how little, comparatively speaking, has been accomplished in estab. the laws
that_ regulate the causation and prevention of disease ? More than half the pop. of these realms are
medically relieved in ourpublic sanatoria, at vepy considerable outlay; how trifling the amount devoted
to the prophylaxies, or prevention of disease. With the exception of the fees paid for vaccination
(;^55o8 in Ireland) to protect us from the inroads of a single malady, nothing is done for the diminution
of preventable disease. Until, however, the dispensary medical attendant is required to devote himself
as much to preventive as to curative medicine; until he is recognized as the paramount sanitary
officer of ±he district — to which the course of events is rapidly tending — but half of his important duties
will have been performed. ■. .,

It must be remembered that the author all through Tils paper is referring to Ireland only.

In 1863 a system of regis, of disease was inaugurated by the Northumberland and
Durham Medical So., and complete reps, entitled "Health and Meteorology of New-
castle and Gateshead," with weekly T. of the actual number of cases of disease and death,
since 1867 have been issued by the same So. The returns upon which the Rep. have been
based are contributed weekly by the public medical practitioners, those in charge of the
union districts, and of the charitable and public inst., all cheerfully assisting. The Reps,
from the first have been prepared by Dr. PhiUpson, of Newcastle, and have been read at
the meetings of the So. , frequently giving rise to important discussions and most valuable
suggestions. The forms employed are at once simple and eifective.

In our art. Disease, under date 1867, will be found reference to a paper by Dr. Arthur
Ransome, setting forth some of the advantages resulting from regis, of disease.

In 1870 Mr. James Lewis, of the Reg.=Generars Department, Somerset House, issued
a pamph., Suggestions for National Returns of Sickness^ in which the subject is viewed in
a clear and practical light. The author is of opinion *'that in order to give increased
effectiveness to the administration of our sanitary laws, there should be National Returns
of Sickness, as well as National Returns of Deaths." He says truly :

Very njany difficulties would be involved in any attempt to deal with the sickness arising among
those members of the community who are treated at their own charge by medical practitioners totally
unconnected with any branch of public administration ; and the proposals in this paper are confined
entirely to cases of sickness occurring within the practice of Poor Law medical officers, and of the
jnedical officers of charitable inst. . . .

Every Poor Law medical officer, whether in charge of a district or a workhouse, is required by the
Consolidated Orders of the Poor Law Board to make a return to his board of guardians at each of
their ordinary meetings, setting forth certain particulars embracing the nature, treatment, duration,
and result of each case of sickness coming under his care. From most of the hospitals, infirmaries,
dispensaries, and asylums throughout the country no doubt similar information could be obtained. It
|s not unlikely also that the co-operation of F. Sos., Odd Fellows, and other provident bodies, would
in process of time be willingly afforded.

He further stated that there were about 3200 Poor Law medical officers in E. and W.,
and that these treated on an average 3,500,000 cases of sickness p.a. The various
medical charities were estimated to treat about 1,500,000 p.a., r^aking a total of about
5 millions of cases of sickness p.a. as occurring in the public medical practice of E. and W.
He was of opinion that returns from these sources of some 20 of the leading specific
diseases, with the number simply of all other diseases, should be returned weekly to
some central authority; and that the results should be tabulated and pub. for the
national good.

In March of the same year Mr. Lewis brought the subject before one of the sessional
meetings of the Social Science Asso. j when he made it quite clear that the best central
authority for dealing with the proposed returns would be the Depart; of the Reg.-Gen. ;
any necessary action indicated by the results of the weekly returns being undertaken
by the medical officers of the Privy Council. He continues :

I cannot imagine how anybody well-informed upon these matters can advocate a separation of the~
returns of sickness from the returns of death. They are complementary to each other, and should be
compiled by one and the same department. And when it is remembered that the Reg.-Gen. is also the
sole authority in this country upon matters relating to Ijoj). (an element which necessarily enters into
the statistics of sickness, as it does into the death statistics), I can come to no other conclusion than
thai 171 the statistical branch of the Refc - Gen.*s office ive have the nucleus of what ought eventually
to become the Department of English V. Statistics, with its three st^bdivisions for Census, Sickness,

dnd Mori' H^turp^,



380 DISEASES, REGISTRATION OF.

Then, in view of a commencement, a point so essential in all new undertakings, he says :

I incline to think that it would be politic if the Gov. were asked in the first instance to take measures
for obtaining and publishing weekly returns of sickness on the simple basis I propose : from Poor Law
medical officers, and from medical charities, F. Sos., etc., in Lond. and the various other large cities
and towns for which we now have a weekly return of deaths. Then with the present ffuarier/y
returns of death we might have a quarterly return of sickness for the whole country. This I regard
as a useful alternative proposition to my orig. one of a weekly return of sickness for all England.

He glances at the practical aspect of the case from another point of view :

Speculation as to the amount of defect to be anticipated from an attempt to collect returns of
sickness on a comprehensive scale would be to little purpose ; but I think there is reason to be some-
what hopeful on that score, if we may judge by the success which has attended the Manchester and
Salford Sanitary Asso. during the 10 years that it has pub. a weekly return of sickness.

At a gen. meeting of the Poor Law Medical Officers Asso., held in Nov. 1870,
resolutions were passed in support of the system advocated by Mr, Lewis. It was there
stated by Dr. Maunsell, of Dublin, that in that city a weekly return of deaths was
forwarded to the Reg. -Gen. from each dispensary, which showed the districts in which
disease was prevalent ; and that also a weekly return was forwarded to the Dispensary
Committees of the prevalence of the various diseases in each district. This system had
worked beneficially.

Appendix C. to 31st Rep. of Reg. -Gen., pub. 1870, contains a somewhat remarkable
document, under date 6 July, 1869 ; "Remarks submitted to the Consideration of the
Royal Sanitary Commission, by the Registrar of E. and W," From this we take one or



Online LibraryCornelius WalfordThe insurance cyclopeadia: being a dictionary of the definitions of terms used in connexion with the theory and practice of insurance in all its branches: a biographical summary ... a bibliographical repertory of all works written upon the subject ... an historical treasury of events and circumstanc → online text (page 92 of 157)