Report on the Infant Industrial Schools of Tuscany. By Signor

ENRICO MAYER, of Milan.

[Read before the Statistical Section of the British Association at Cork, Aug. 21st, 1843.] THE first infant schools, or, as they are there called, asylums, established in Tuscany, were opened simultaneously in Leghorn and Pisa in 1833. A third was soon after opened in Florence, and the example then was generally followed. They are supported wholly by voluntary contributions, and consequently their increase soon reached its furthest limit. There are now twenty of those infant schools, with 2000 children. The annual expenditure comes to about 17. sterling a child, house rent, servant's wages, teacher's salary, and soup, being all included. The management of these schools generally rests with committees of ladies, who take by turn the duty of inspection: the remarks written in the inspectors' book become the subject of deliberation at the monthly meetings of the committee. The infant asylums of Tuscany are intended for the poor, and are entirely gratuitous. They are generally divided into two classes, having each a separate room, and a separate mistress. The first class contains children from eighteen months or two years to four or five years old. The second class contains children from four or five to seven or eight. A play-ground is attached to every asylum, and the children perform easy gymnastic exercises, which, however, do not interfere with their own choice of amusements. The introduction of manual works in the infant asylums in Italy, constitutes one of the chief differences between them and similar institutions in France or England, and experiments are now making to continue the habits of early industry thus acquired, by procuring some work in the primary schools. A committee of tradesmen and artisans forms part of the society for infant schools at Florence, and they are to provide the children with some easy work, and facilitate afterwards their being employed in the exercise of different arts and trades. Linear drawing and the rudiments of geometry and mechanics are taught in the superior classes, but confining the instruction to that which can be of use in the exercise of every mechanical profession, without taking any one particularly in view. It is anxiously desired that the manual work of the children should be of a nature to be carried on individually, so that the social element of family life should continue undisturbed among them, and the infant population should be preserved as long as possible from the infection of factories. Instruction is much less than education the object of these infant asylums; these are made as much as possible conducive to moral training, and this by the most simple and gentle means of a maternal guidance. In the school room the children pass through a series of exercises calculated to develope their mental and bodily faculties without tiring them. They are never kept sitting for more than a quarter of an hour at a time. The religious instruction of the children is directed by the curate of the parish in which the asylum is established. The mistresses of the asylums keep a journal, in which the moral history of the institution may be said to be contained, and from which a number of most interesting facts have been extracted, elucidating the workings of human intelligence and human affection, at an age which has not, until now, been sufficiently studied by the moral philosopher. Though the Tuscan infant asylums are of so recent a date, yet their effects are already, and in a remarkable

degree, perceptible. The improvement in the health of the children received in the Tuscan asylums, is a most striking fact. The study of this fact on the part of our medical committees, has led to most important observations, not only with respect to the infants themselves, but extended to their families, and indeed to the whole of the poor population of our towns, and to the various districts of the towns themselves. The cases of death in our asylums is between 2 and 3 per cent., whilst the general mortality of children between two and six is in Florence 16 per cent. The same results have been observed in Lombardy, where infant asylums are more numerous than in Tuscany. A thorough reform of every system of education, going through every species of schools, will be necessary, in order to put them on a par with the high educational character of our infant schools. The moral results, likewise, are not confined to the infants themselves, but are extended to their families. A great proportion of the children received at the infant asylums in Florence, are found to come from the Foundling Hospital indeed, out of 600 children four hundred belong to that class. They are children whose parents were forced by extreme destitution to abandon them; but as soon as our infant asylums were known to exist, parental affection resumed its rights in the hearts of those hundreds of parents, and a dishonouring brand was wiped away from the head of those hundreds of children, who found again the joy of their family, and were restored to their name and their civil condition. In the three years anterior to the opening of the infant asylums, the average number of children taken out of the Foundling Hospital was 176; but in 1833, when the asylums were first established, the number withdrawn was 214, and in 1837 it increased to 404. Few facts more pregnant than this with important consequences, have ever been brought to light in the moral statistics of any country. The author, in conclusion, pointed out the superior efficacy of the elevating and kindly treatment of men above the harsh and repressive. "Who," he observes, “has not seen, in the bad direction of public instruction, or in the mismanagement of public charities, a necessity for the increase of coercive institutions, which yet prove insufficient for the repression of crime; and has not learned to conclude that there may be a system of instruction which teaches no virtue, a system of charity which relieves no misery, and a system of punishment which puts a stop to no crime?"

Second Report of the Committee of the Statistical Society of London on Hospital Statistics.

IN December, 1840, a committee was appointed by the Council of the Statistical Society "to consider the best means of obtaining periodical enumerations of the patients in the London Hospitals." The first step which the Committee took, on entering upon its duties, was to obtain an enumeration of the patients and other persons resident in the various hospitals of the metropolis during the first week of January, 1842. The results of this first enumeration, together with other tables of interest, will be found in the fifth volume of the Journal of the Statistical Society, p. 168. A second enumeration was made on the 9th of January, 1843, and returns were obtained from all the general hospitals.

The number of patients in these hospitals at the date of the second enumeration is shown in the following Table.

This number is somewhat in excess of that obtained by the Census Commissioners on the night of the 6-7th of June, 1841; when the patients enumerated were, males 1482, females 1081; total 2563.

The males and females are nearly in the same proportion in both returns, there being, in round numbers, about 15 males to 11 females. As might be anticipated, the mortality of males bears a much higher ratio to the mortality of females, than the hospital population of the one sex to that of the other. The hospital population being as 15 to 11, and the mortality as 13 to 7, (1260 to 708, see Table VII.)

The returns obtained from the ten general hospitals present a total of 2582 cases in which the name of the disease is specified, making with 52 unspecified cases the above total of 2634. The ages also are specified in all but 10 cases. The diseases and ages are jointly enumerated in Tables II., III., and IV., in the first two of which the sexes are given separately.

The returns obtained from the hospitals comprise some other particulars of interest. The average duration of a patient's stay in an hospital, for instance, may become an element in calculations of expense, and in the case of some diseases may even become a consideration of importance. A table, therefore, has been prepared, showing the length of time that the several patients had been in hospital at the time of the enumeration. (See Table V.)

If we assume that the actual stay in the hospital was the mean between the two extremes at the head of each column, we shall have, as the average stay in hospital of the 2626 patients whose stay is accurately stated, about 46 days, or six weeks and a-half.

In Table VI. the diseases and their duration up to the date of enumeration are stated. The table may furnish some useful elements of calculation, and of comparison with Table VII., in which the mortality of the London hospitals for the year 1842 is given in detail.

Table VII., which has been placed at the disposal of the Society by the kindness of the Registrar-General, possesses considerable interest, It comprises the deaths occurring in the general hospitals which have sent in their enumerations, and supplies important data for comparison with the preceding tables.

One of the most interesting facts displayed by this table is the great number of deaths from consumption that take place in the hospitals

of London in spite of the strict rules which in most of the subscription hospitals forbid their admission, and which are for the most part very rigidly enforced. Of 1968 deaths from all causes, no less than 322 were from consumption, being between one-sixth and one-seventh of the total mortality of hospitals, but less than 5 per cent. of the total mortality of the metropolis from that cause. It will be seen that the number of deaths of females from this disease in hospitals is less than half that of males, a fact which corresponds with the greater prevalence of consumption in the male inhabitants of large towns. It is necessary, however, to correct this statement as to the disproportionate mortality of men by the fact already alluded to; that the male population of hospitals is larger than the female in the proportion of 15 to 11. It is not a little remarkable, moreover, that in the face of this disproportion in the deaths from consumption, the enumerated cases of the disease amount to 28 males, and 34 females. At the time of the enumeration, therefore, there were more females in the London hospitals labouring under consumption than males, and yet the mortality of males is more than double that of females. The age of death in this as in other diseases is a very important and interesting heading in this table.

Mortality in the Hospitals at different Ages.

0-3 3-5 5-10 10-15 15-20 20-30 30-40 40-50 50-60 60-70 70

1842 .

Resident Patients

according to one

10

28

98

135

enumeration.

Annual Mortality

per cent..

371 799 488 365

206

95

81

29

29

86

To determine the average number of patients resident, more than one enumeration should be taken; but the relative numbers at the respective ages probably do not vary very much; and the facts before us bring out some interesting results, and may suggest others of still greater importance. If we assume that the London hospitals contained, through the year 1842, on an average, 799 patients aged 20 and under 30 years, then, as 376 deaths occurred at that age, the annual mortality must have been at the rate of 46 per cent. The deaths of patients between the ages 40-50, were 369; the average number of patients was 365; and the annual mortality 110 per cent. The mortality is highest in infancy, descends to 27 per cent. at the ages 15-20, and rises progressively again as age advances, to 279 per cent.

This is not the mortality of cases, but the mortality in a given time, out of a given number constantly sick. It will be rendered, perhaps, more intelligible, by supposing the patients lodged in eleven different hospitals, and that each hospital contains 100 beds always occupied, fresh patients taking the place of those removed by death, recovery, or discharge. The table shows that, in the hospital for 100 children under three years of age, 370 deaths would occur annually; that in the hospital for young persons between the ages 15-20, only 27 would die annually; that the hospital for persons aged 40-50 would have 101 annual deaths; and so on, for other ages. Admitting that the treatment was equally efficient at all ages, there are at the three periods of life,

20-30, 30-40, 40-50, differences caused by age alone in the mortality of the sick, expressed by the numbers, 46, 74, and 101. It is impossible, therefore, in a practical point of view, to determine the relative value of different methods of treatment without reference to the law of mortality at different ages.

The tables show also the influence of age on the rate of mortality, among persons labouring under the diseases distinguished in the returns. Compare, for instance, the number of consumptive patients, and the number of deaths from consumption at the several ages, with the same facts for heart disease.

Discrepancies of a trifling amount which appear in Tables II., III., IV., V., and VI., as regards the numbers assigned in each to the same diseases, are explained (in addition to the liability to error) by the uncertainty in classification which arises in a few instances from complications of disease, and in others from records which are vague or imperfect. Besides, the form which has been employed was drawn up for the causes of death, and is not equally adapted for diseases of the living. The tables which are here brought together, must be regarded rather in the light of materials placed in a convenient relation to each other for the purposes of comparison, than as leading to any broad inference, or as being in themselves sufficient for the establishment of any important truths. Such materials often derive an unexpected value from some inquiry which does not spring directly out of them. It is in this way that the labours of the Hospital Statistic Committee may be expected to prove useful. In bringing those labours to a close, the Committee have to offer their best acknowledgments to those hospital physicians and surgeons who have assisted them; and they trust that, by showing the possibility of combining the valuable information afforded by the several public hospitals, they may have paved the way for some future arrangements by which the knowledge to be derived from these valuable schools of experience may be recorded, collected, and digested.