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place early in life, and that the disease is non-recurrent as a general rule, children over ten, and adults, are, to an extent proportionately large to the whole population, protected from the disease.
Leaving the question of age, I find that great differences of opinion have been offered on the point, whether sex exerts any influence on the occurrence of scarlet fever? The prevailing idea on this subject has been, and is, to the effect that females suffer most. Dr. Tweedie, whose opinion we all recognise, arguing on his own general experience, and on the results of an imperfect table, says, “ females are more subject to the disease than males”: with great candour, however, he repeats the opinion of Withering, “ that, in children, the numbers of sufferers are equal in both sexes; but, amongst adults, females suffer most.” Fothergill, in writing of the malignant attack of scarlet fever which visited London in 1749, says, “ a greater number of girls have it than boys, more women than men.” Rayer affords similar testimony; but Dr. Binns, in describing an epidemical scarlet fever which occurred in the Ackworth school, tries to show, by reference to a small but, as far as it goes, fair table of cases, that girls are less liable to the disease than boys.
The 431 cases in my own possession, and to which I have before drawn attention, show an equality between the sufferers of different sexes. I could not, however, consider so few cases as 431 worthy of note for any definite conclusion derivable from them.
Once more, therefore, I turned to the Registrar General's reports, and gathered what succeeds.
In 102,382 deaths from scarlet fever, occurring in England in the years 1838, 1839, 1840, 1841, 1842, 1847, and 1848, and in London in 1842, 1843, 1844, 1845, 1846, there were
Amongst males, 51,660 L
„ females, 50,722
- 102,002 (930 males in excess.)
This calculation took in sufferers of every age, and left, at first sight, a fair inference on the mind, that males are, on the whole, more subject than females to scarlet fever. To understand the question fairly. however, it was necessary to go further; viz., to analyse a large number of cases, and find at what ages the deaths occurred.
34,744 cases of death from the disease, occurring in Manchester, Liverpool, and Birmingham, in the year 1849, in twenty-four towns in 1840, in London in 1842, 1843, 1844, 1845, 1846, and 1848, and in England in 1847, were therefore analysed. The relative number of deaths in both sexes, and in certain specified periods of life, were
From this calculation, I derived the general fact that, under the age of ten, more males die from scarlet fever than females ; but that, above ten, the contrary obtains.
Having ascertained this preliminary fact, I looked at the question in its bearings on relative mortality in reference to relative population. It was very difficult to find data of any extensive kind to elucidate this relationship; but ultimately I got one district where population and special mortality admitted of being studied together.
In the districts of Kent, in the year 1843, there wereDeaths from scarlet fever ( 205 were males at all ages, 413, of which 1208 females
les | giving 3 females in excess.
& The population of these districts, as obtained by the census taken rather more than a year before, was
Total population in 1841, 232,228 were males) giving 4,657 females in 469,113, of which 1236,885 females 5
Now, this last table is, it will be seen, quite contrary to the first two in its results; and separate writers, inclined to controversy, might, by referring to only one of these tables, baffle an adversary considerably. Considered, indeed, in their singleness, the tables might and would be made to convey the most incorrect ideas. But when the three tables given are viewed carefully, and with an unbiassed eye, their very differences are found to be of the highest value, inasmuch as these differences place before the mind the true state of matters. For, collectively, the cal
culations indicate that scarlet fever makes no selection as regards sex, but attacks more males, or more females, according to the relative number of males or females who are resident in any district where it is epidemical.
The last table illustrates this fact exceedingly well. There are more deaths from scarlet fever amongst females in a given portion of country than amongst males; and there are in the same portion of country, previous to the searlet fever epidemic, a larger number of females than of males in the population.
Again, the calculation given at page 58, which shows that scarlet fever is most prevalent in the first ten years of life amongst males, and that after ten the preponderance passes over to the female side, illustrates the same law. For, in the child part of our population-using the word population in its general sense-males number most; but in the youth and adult population, there are more females than males, owing to the fact, that youths and men are exposed to more causes of mortality, and are drafted into other countries in larger numbers, than girls and women: so scarlet fever, as the results given above illustrate, follows this law of number; for our tables show, that whilst more males die under ten years from the disease than females, after the age of ten the mortality begins to take the lead on the female side, and to continue steadily in the same course as life advances.
Still more, our calculation from the 102,382 cases
with which we opened this argument, although it gives a slight excess on the male side, viz., 938, supports the same law. For the majority of these cases occurred in patients under ten years ; in the period of life, that is to say, when the body is most susceptible of the disease, and when the male population is larger than the female.
I think I have put down sufficient now to show that sex has no influence, predisposing or otherwise, on scarlet fever ; but that male and female are alike susceptible if they are alike exposed.
The influence of meteorological conditions in relation to scarlet fever is a next point of peculiar interest. In the years 1852-3, I made extensive inquiries touching this matter, with special reference to barometrical and thermometrical changes, the presence or absence of elasticity, the direction and force of the wind, the humidity of the atmosphere, and the effect of season on the course and prevalence of the disease.
The only reliable fact affirmative in kind, as bearing on the effect of meteorological conditions, was in relation to season only. Here I arrived at valuable information which bore out, in the strictest sense, the opinions of preceding writers. The concurrent testimony, in fact, of almost all writers on the disorder, teaches that it is most common in autumn, next so in the summer, next so in the winter, and least so in the spring. In three epidemics which I witnessed in different parts of this country, the disease always commenced in the summer, became