128 DR. ARTHUR RANSOME ON THE 



Dr. Haviland's recent map of the distribution of phthisis 

 thus makes it appear that the Island of Anglesey is one of 

 the worst districts in the kingdom for the production of 

 this disease, the great probability being that it is no worse 

 than its neighbours. 



It is most likely owing to this imperfection of nomen- 

 clature that changes have taken place in the apparent rates 

 of mortality from some of the diseases mentioned by Mr. 

 Baxendell. Many of the deaths recorded of late years as 

 arising from bronchitis would probably have been set down 

 in former times to pneumonia ; and hence the former dis- 

 ease appears to have increased in fatality, the latter to have 

 diminished. Hence also, owing to an improved diagnosis, 

 the term dropsy will have given place to the name of the 

 organ out of whose derangement it has arisen, and we 

 have it less frequently recorded as the cause of death, 

 whilst diseases of the heart, liver, and kidneys have appa- 

 rently increased in prevalence. 



The vague terms brain- disease, cephalitis, and convulsions 

 may also have undergone some amount of transposition. 



But Mr. Baxendell points out a very great increase (86 

 per cent.) in one disease, small-pox, that is not likely to 

 have been mistaken for any thing else ; and he further 

 shows that this increase has taken place mainly amongst 

 the adult members of the population. 



His remarks on this point are undoubtedly very impor- 

 tant, and will need to be well weighed by those who are 

 responsible for the efficient performance of vaccination. 



It is important to observe, however, that the whole of 

 this increase occurred in the years 187 1 and 1872, when 

 over 40,000 deaths took place from this cause. 



The period of ten years chosen by Mr. Baxendell is pro- 

 bably not long enough to aflFord a basis of argument respect- 

 ing epidemic diseases ; forty or fifty years are sometimes 



