recent advances in the mind of the more intelligent classes, towards a healthy state of opinion and feeling with regard to the poor.

As admission into this "Sick House" or Infirmary is, morally at least, a right of the locally resident sick poor of a very large and populous parish; the number of its inmates is subject to all the influences of season, weather, epidemic constitution, commercial activity, and other sources of fluctuation; so that most years the sick population has varied from 150 or 160 in the fine season (about June usually) to 300 or 320, 330, and upwards; the extreme in this direction happening usually in January. These numbers are exclusive of the much larger number of chronic or slight cases prescribed for in the forenoon, whether coming from the workhouse or their own homes, at the Infirmary, by the resident medical officers.

In common with other metropolitan asylums of sickness, general as well as parochial, the registers of the Infirmary were formerly kept in an old-fashioned and very imperfect manner, and were ill adapted to forward many of the objects of the medical statist. Since 1840, however, a better system has been in operation. At the suggestion of the writer, a form of registration has been adopted, substantially in accordance with the views of the London Statistical Society, and coinciding in most points with that recommended by the Committee on Hospital Statistics: so that hereafter the records of the Infirmary may be expected to furnish very valuable materials for numerical investigation of the laws of disease, more especially regarding the disorders of infancy and early childhood, and of extreme age, which are all comparatively little known in the wards of the general hospitals; also regarding the duration of several classes of incurable disease, organic or functional only, which are commonly either not admitted, or discharged after a short stay, and respecting which it is of the greatest importance, with a view to the extension of the practice of life assurance to its legitimate limits, that accurate statistical information should be obtained.

Materials for this Report.

The facts that collectively form the subject matter of this report, are contained in 11 chief tables, exclusive of subordinate tabulations illustrative of those 11 principal.

1. The first table presents a general view of the experience of the infirmary, as to annual admissions and deaths, with their ratios, in 17 years, commencing with July 1827, ending with June 1844, without distinction of sex, age, &c.

2. The second table gives the admissions of 8 years, ending with March 1836, and distinguishing sexes and ages, but not years.

3. Table III. presents similar facts, similarly analysed and arranged, for 41 years, ending with June 1840.

4. Table IV. gives the duration of treatment for 8 years, ending March 1836, and stated in weeks and lunar months, with distinction of sex only.

5. Table V. gives the like facts in like order for 4 years, ending

June 1840.

6. and 7. Table VI. gives the average stay in the sick-house, according to sex and age, for the period 1827-1836; and Table VII. gives the like results for the subsequent period, 1836-1840.

8 and 9. Tables VIII. and IX. refer solely to the mortality, which is presented in two different aspects in each table, and for two different series of years, viz., 1827-1836, and 1836-40. A mortality is presented, 1. in its relation to the admissions of each sex at each age; and 2. to the whole mortality of each sex at all ages.

10. Table X. shows the distribution of the admissions and deaths over the months and seasons of 11 years ending in 1839.

11. Table XI. gives the admissions for 62 years ending in March 1844, distinguishing whether from W. H. (workhouse), or O. D. (out of doors); and whether under the physicians or surgeons.-The discharges, whether-1. cured,-2. relieved or incurable,-3. by desire uncured,— 4. irregular,-5. to a lunatic asylum,-6. from the lying-in ward. -The deaths for the same period, whether under physicians or surgeons, each quarter. It gives, further, the average stay in the wards, whether of physicians or surgeons; also the gross quarterly amounts of outpatients prescribed for in the morning by the resident officers.

I regret that the shape in which the official records of the infirmary have been kept until very lately, has not admitted of any satisfactory analysis, including distinction of disease, or of trade or occupation.

Mr. Farr suggested to me that a table of mortality, in which the deaths should be classified according to duration of sickness, might be of much interest, and for benefit societies, and other assurance associations, might be of considerable value. I have to regret my inability to carry out the recommendation of so high an authority on this occasion.

TABLE I. -Admissions and Deaths in each Year from 1827 (June 31st) to 1844 (July 1st); in all 17 Years.

The mortality of each of those years (1838 and 1841) has been erroneously given by the registrar of the district. (See Report for 1843, page 500.) I have ascertained the fact by personal inquiries.-J. C.

From this table it appears that the admissions of those 17 years (i.e. 16 complete years, 1828-1843, and two half years), amounted col

lectively to about 46,000, (46,028), and that they varied from 2154 (in 1835), which was the minimum received in any one year of the period, to 3143 (in 1841), which was the maximum of annual admissions. The extreme limit of fluctuation as to receptions, seems to have amounted to about 1000 persons. The annual average of admissions, was. about 2700 (2707).

From the same table, it appears that the deaths for the 17 years ending with June 1844, were 5367; that the annual deaths on an average were 315; and that the proportion borne by the deaths in the aggregate to the admissions collectively, was 11.6 per cent.

Of late years the mortality appears to have risen very considerably, viz., from less than 7 per cent. in 1827, on the admissions, to 18.33 on the admissions of 1835, since which the mortality has not been lower in any year than 11.4 per cent., while on the 8 years, 18361843, the mortality has averaged 14.2 annually.

If we divide the 16 complete years (1828-1843) into two series of eight years each, ending with 1835 and 1843 respectively, we shall have for the former series (1827-1835) an—

Whereas, for the latter series (1836-1843), we shall have the following, viz.

Average mortality annually

(1837)

30.0

Difference (numerically) in favour of the latter
series, nearly

The causes of the increased mortality of late years are of course various one of them is suggested by this table;—the domestic accommodations in the workhouse have, it may be presumed, sensibly fallen short of late years, relatively to the pauper parochial population, causing a more vigilant scrutiny of claims and sedulous sifting of cases, and a generally diminished facility of admission for less urgent sickness.

I perceive by the last Report of the Census Commissioners, and the Report of the Registrar-General for 1843, that Marylebone must have increased some 14 or 15 per cent., in the period 1831-1844. I perceive also that the expenditure on account of the parochial poor has risen much of late. It was, for example, according to the Registrar-General, 26,438/. in 1839, 29,9177. in 1840, 35,5177. in 1841, and 41,4761. in 1842; being near 40 per cent. increase in 4 years; yet the admissions of the former 8 years (1828-1835) exceeded those of the latter series (1836-1843) by 97. It is probably in accordance with the view above suggested, that we find the smaller number of receptions of the second series yield, nevertheless, nearly 800 (797) more deaths. But other causes have concurrently contributed to the increase of mortality, especially grievous commercial fluctuations and depression, and an epidemic constitution, to which we owe the frightful rather than destructive spasmodic cholera, the far more mischievous influenza of various

years since 1831, and the low spotted fevers and generally adynamic and unfavourable character of disease of the same period. But on these topics I am not probably an unexceptionable commentator, having been myself on the professional staff of the parish, as physician to the parochial sick-house or infirmary since some time in 1834; nor do I in fact feel myself sufficiently at liberty to discuss satisfactorily the causes of the increased mortality exhibited above. I shall content myself with affirming that it has not arisen from any paucity of qualified medical officers, or any deficiency in the sick-house of any means or appliances, whether medicinal or dietetic, usually resorted to, or that have been judged necessary by the physicians or surgeons in the service of the guardians.

TABLE II.-Admissions for 8 Years, ending with March 1836, according to Sex and Age.

TABLE III.-Admissions for 4 Years, ending with June 1840; distinguishing in like manner Ages and Sexes.

3.93

5.05 1.12

100

The results given in these two tables, have been obtained at different times; and it is partly for this reason, that I now present them separately.

From the former table (No. II.) it appears that of 11,821 males admitted, 4,023, or 34.5 per cent., were under 15 years of age, and 487, or between 4 and 5 per cent. were above 60 years of age, the rest having been distributed in a regularly decreasing rate amongst the ages between 15 and 60. It appears, likewise, that of 10,863 females admitted at all ages, 3056, or 28.1 per cent., were under 15, and 660, or nearly 6 per cent., above 60; the intervening ages receiving their shares of the admissions in a gradually decreasing proportion, from 15 to 60. From the latter table (No. III.) it appears that of 4912 male admissions, 2163, or 43 8 per cent. were under 15, while 625 or 12.5 per cent. were over 60; and on the female side, of 5590 admissions, 2068, or 36 7 per cent., were under 15, and 796, or 14·1, above 60; so that in the former period, about 17·0 per cent. males, and 18.0 per cent. females, of the admissions at all ages, were under 10 years of age; while in the second period we have 25.8 per cent. males, and 250 per cent. females, under 10 years of age. And above 60 we have a similar numerical preponderance in favour of the second period, viz., 12.5 of the males at all ages above 60, and 14.1 of the females. This difference between the two periods, if not accidental, gives countenance to the supposition above alluded to, of increased stringency of poor law administration of late years.

TABLE IV.--Duration of Treatment in Weeks or Mcnths, with distinction of Sex, 1827 to 1836.

From this table it appears that in the period 26.5 males, and 22 13 females were discharged week after admission; that 72 per cent. males, and

VOL. VII.-PART IV.

1827-1836, about or died in the first 66.5 females were

X