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from the helmeted Sapeurs Pompiers incendiaries
of nursemaids' hearts in the gardens of
the Luxembourg and elsewhere.


To know how many persons in a hundred die
in any place at any time, gives but a rough clue
to the general state of public health. The English
system of registration upon which we found
most of our sanitary statistics, is the best in
Europe, yet it is so lamentably imperfect that
there is no full registration of births, and a complete
silence as to the still-born; there is no
record whatever of the nature and duration of
diseases that do not end fatally, while of those
ending in death, the registrar (ignorant himself
of medical science) accepts as the cause of
death, whatever statement he may get from competent
or incompetent witnesses. The excellent
and indefatigable Registrar-General has
stated that only eighty-three in a hundred of the
deaths throughout the kingdom have been certified
by medical attendants, and that in one
quarter of a year twenty-two thousand deaths
were returned without any recognised cause.
Among causes that are returned we find "want
of vitality," or'" worn-out stomach." Any one
acquainted with the ways of the poor in our
rural districts, must know how imperfect is a
great part of the evidence supplied to account
tor the deaths that happen. Mr. Aspland, of
Dukinfield, who has extended over eight years
an inquiry into the returns for his own district,
finds that " in only fifteen out of two thousand
seven hundred and fifteen deaths was the cause
of death stated by the registrars to be "unknown,"
whereas it ought to have been so returned
in the greater number. The last form of a
disease is never fairly to be called the cause of
death, even if it were always properly reported.
But when the report even of that is utterly untrustworthy,
and when all those elevations and
depressions of the public health shown in the
mass of sickness which mars life but does not
destroy it, are passed over without remark, we
certainly derive, from the returns of the Registrar-General,
less benefit than we ought.

Considerations of this kind were submitted at
Bradford to the National Association for the
Promotion of Social Science, by Mr. Henry
Wyldbore Rumsey, and they obtained so general
an assent that a committee was formed, including
among its members Dr. Farr, Mr. Simon, and
Dr. Southwood Smith: to whom afterwards Mr.
Chadwick, Sir James Clark, and other men, both
skilled and interested in this line of inquiry,
were added. To the last meeting of the association,
this committee reported its opinion that
registration of births and deaths should be
taken out of the hands of unscientific men, by
filling up all vacancies as they arise, with an
order of highly qualified medical superintendents:
the registration of marriages being left to
the clerk of the board of guardians, who now
generally undertakes that duty. The committee
found it to be desirable that the cause of deaths
not accounted for by the certificate of a legally
qualified medical practitioner, should be ascertained
by the medical superintendent registrar,
and that the same officer should be supplied
with means of registering the sickness in, at
least, all public institutions. That such returns
should specify age, occupation, and class; and
that the registration of all births should be enforced,
including the births of still-born children.

We will dwell only upon the suggestion of a
public registration of disease. This was at the
beginning of the eighteenth century, says Mr.
Rumsey, one of the twelve proposals of John
Bellers, "by which the lives of many thousands
of the rich as well as the poor may be saved
yearly." It has been urged since that time,
again and again, with various suggestions as to
the best manner of effecting it, and it is now
again before the public. Well-devised forms of
returns are wanted, but are easily to be obtained;
and valuable records of the cause and
duration of sickness in pur workhouses, hospitals,
and dispensaries, might be claimed by the
State for the public good. These would suggest
the proportion of sick time to healthy time
in the lives of those who live under the least
favourable conditions. The pauper returns
would represent from three to seven per cent,
of the population of a district; the applicants
to medical charities would add to this, only
another seven or eight per cent.

But, if forms of return were supplied, and
slight remuneration for the trouble of careful
registration were paid to the secretaries of
friendly and benefit societies, sick-clubs, and
self-supporting dispensaries, with suggestion of
a few obvious precautions easily to be observed,
valuable knowledge might be gained as to the
habitual health and the influences by which
strength is lowered among a large body of the
prudent and comparatively healthy working
class. More than this we might not be in a
hurry to expect; indeed, we do not expect so
much as this to be accomplished in a hurry.
But for the interests of the higher class of
private patients, the chances of healthy life, as
well as the chances of death in every grade of
society under its various conditions, should be
laid open to careful study; and it is well to know
that excellent statistics of private practice have
been worked out by some thoughtful surgeons
and physicians, without the faintest approach to
any breach of professional confidence. Thus, Dr.
Hartshorne, of Philadelphia, has devised for the
use of private practitioners a tabular record, in
which every case is entered by a single dot, and
the return of dots conveys all the required information.

There is much to be learnt that we only suspect
at present from comparison of sickness
with mortality. We know that in Scotland
there is less sickness, but more death, than in
England; and we know that in London, while the
death-rate is comparatively low, the public-sickness
rate seems to be higher than that of most
continental cities. Mr. Rumsey believes that at
present, in prolonging life, we prolong much in-

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