146 



NATURE 



\yiine 13, 1889 



is quite right in attacking this theory, but it is sub- 

 stantially no answer to the theory to say that a geo- 

 metrical progression may progress so slowly as hardly 

 to progress at all ; or that, when the number of births 

 falls below the number of deaths, there is a decreasing 

 geometrical ratio instead of an increasing one. Such an 

 argument is, doubtless, the correct statement of a purely 

 theoretical truth of abstract mathematics, but it does 

 not meet the case as popularly understood. Also in- 

 conclusive, in our opinion, are some of the comments on 

 increase of subsistence. To define subsistence as "all 

 that supplies men's wants " is to adopt a definition of 

 the term which calls for definition more loudly than the 

 word defined ; and to suggest that we may look to human 

 industry and scientific discovery for the increase of food 

 is to open up before us a very doubtful and probably 

 disappointing prospect. The teachings of Malthus may 

 have been more or less refuted by the history of the 

 present century, but we all agree that the danger of popu- 

 lation outrunning subsistence is one that common-sense 

 demands should always be kept in view. 



The marriage-rate is usually obtained by comparing the 

 number of marriages with the number of the population 

 in which they occur. This method is exact enough for 

 many purposes, but to attain theoretical accuracy the 

 comparison should be made with the number of eligible 

 bachelors, spinsters, widowers, and widows. Like the 

 birth-rate, the marriage-rate appears to be on the decline, 

 not only in this Kingdom, but also throughout Europe. 

 In England and Wales, bachelors now marry at a mean 

 age of 26-2 years and spinsters at 24'6 years, the age at 

 marriage exhibiting a tendency to increase. The average 

 number of births to a marriage is for England and Wales 

 about \\ ; the average for Italy being 5-15 ; Prussia, 4-92 ; 

 Austria, 373 ; and France, 3-42. In England and Wales 

 the average duration of ordinary married life has been 

 computed at about 27 years. 



It is customary to state the death-rate by comparing 

 the number of deaths with the number living, but the 

 results require to be received with caution. The popula- 

 tion of a place may vary in its. age and sex composition 

 with the arrival of immigrants and the departure of 

 emigrants ; also from an excess or defect of births over 

 or under deaths ; also from other and special causes ; and 

 these disturbing elements cannot always be left out of 

 consideration. Thus, the general deatii-rate in England 

 and Wales in 1881 was 18-9, for all ages, while the 

 general death-rate in France v/as 22*0; but had the age- 

 distribution in France been the same as in England, the 

 French rate would have been 20-9, and it is clearly with 

 this figure, and not with the 22-0, that the English figure 

 is justly to be placed in comparison. With respect to 

 the registration of death, and with a view to obtain better 

 information as to the cause of death, Dr. Newsholme 

 favours the appointment of medical registrars, and thinks 

 the certificate of the medical attendant on the deceased 

 should be withheld from the family and sent direct to 

 the registrar. 



To the general reader the discussion of the influence 

 exerted on mortality by climatic and social conditions, by 

 recent sanitary legislation, by density of population, and 

 by occupation, is sure to prove attractive. Figures are 

 adduced to demonstrate that mortality is usually highest 



in the first quarter of the year and lowest in the third ; 

 and we are told that mild winters and cool summers botb 

 lower the mortality, the former especially of the old, and 

 the latter of the young. Pervious subsoils apparently 

 afford a better protection against lung-disease and diph- 

 theria than retentive ones, as might naturally be expected ;: 

 but not so with phthisis, which, according to the figures 

 quoted, is no great respecter of subsoil. As is popularly 

 understood, the death-rates for married persons of both 

 sexes are more favourable than for the single or widowed, 

 but it must not be forgotten that in marrying and giving in' 

 marriage a process of natural selection takes place, and 

 that it is only the more or less healthy, if not also the more 

 or less strong, that enter the married state. The aggrega- 

 tion of an ever-increasing proportion of the population in 

 towns has an unfavourable etiect on mortality ; for the gene- 

 ral death-rate in the urban districts, which, according to the 

 mean rates for the country, and making due allowance 

 for age and sex, should have been 20*4, was as high as 

 23 "I, while in the rural districts, where it would have 

 been estimated at 22"83, it was only 190. However, the 

 inferiority of town to country, in this respect, is, appar- 

 ently, becoming less marked. Next to the subject of 

 crowding in towns, comes up for consideration the subject 

 of crowding in houses. Some observations in Glasgow 

 tended to show that among those living in one and two 

 roomed houses the death-rate was 2774 per looo ; 

 among the occupants of three and four roomed houses.. 

 I9'45 ; and among those living in houses of five rooms 

 and upwards only i r23 ; but such results cannot be attri- 

 buted solely to the extent of house accommodation. The 

 fewer the rooms, as a rule, the poorer the person, and 

 therefore the less able to procure a supply of good 

 and sufficient nourishment, suitable clothing for summer 

 and winter, healthful occupation and recreation, and, in 

 times of sickness, efficient medical attendance and com- 

 forts. Of the increased mortality to the poor man, one 

 cannot say what poilion is to be ascribed to the narrow- 

 ness of his habitation, and what portion to the com- 

 bination of various other and accompanying causes. A 

 whole chapter of the book under notice is devoted to the 

 effect of occupation on the death-rate, but we have not 

 the space to allow of quoting from it. The chapters on 

 the mortality due to each of the seven chief infectious 

 diseases, and to certain other special diseases that flesh 

 is heir to, will prove little less interesting to the reader 

 than those to which we have more fully referred. 



Dr. Newsholme is evidently very earnest in his 

 advocacy of the national registration of sickness, i.e. 

 sickness of a disabling character. The number of deaths 

 registered as due to a specified disease may or may not; 

 give an indication of the prevalence of that disease. 

 The prompt registration of sickness would result ii> 

 various advantages to the public health. Prophylactic 

 measures could and would be taken to prevent the spread 

 of threatening epidemics ; the isolation of patients and 

 suspects would be more generally provided for ; the 

 children of an infected family would be deljarred from 

 attending school ; while the public excitement consequent 

 on any unusual warning given by the registration would 

 lead to the discovery of conditions conducive to disease,, 

 to the thorough inspection of houses, workshops, public 

 drains, clothing, and the food and water suppHes. Suchi 



