victims of the disorder are exceedingly numerous in all parts of the world, wherever it exists.

In considering the mortality of scarlet fever, several questions force themselves on our notice, some of which have been already answered incidentally. I allude to the subjects of age, of sex, and of season.

Two questions still remain: first, the influence of locality on the fatality of scarlet fever; second, the relative mortality of scarlet fever in comparison with other epidemic diseases.

To examine these questions, I have had recourse to the pages of the Registrar-General, and have referred, therefore, only to the disease as it occurs in our own country. The table below shows the comparative mortality from scarlet fever, in towns and rural districts. To insure correctness, each statement of deaths was obtained from a population of a million.

The mortality from scarlet fever in a million of people is, therefore, greater in towns than it is in rural districts.*

* While giving the above table as expressing the facts supplied, I think it fair to state, that later records show a less prominent mortality from scarlet fever in towns as compared with country districts. My

The following table indicates the different rates of mortality per million from scarlet fever, in eleven districts of England, during the years 1838, 1839, 1840, 1841, 1842, 1847, 1848. The last column will supply at a glance the comparative mortality.

The above table needs but few observations. It indicates an extraordinary mortality in the northwestern counties, which still obtains. The fever does not fall, however, on the whole country at the same time, but is, at similar periods, absent to a great extent in one locality, and extensively present in another.

The subject of the relative mortality of scarlet fever in reference to other epidemic diseases, possesses peculiar interest; and I have taken some pains to illustrate it by several tables. The first of these shows the relative mortality of seven epidemic dis

friend Dr. Greenhow, indeed, is of opinion that the mortality of towns is absolutely not greater: and that the annual mortality from scarlet fever in the healthiest country district in England is higher in proportion to the population than in either Liverpool, Birmingham, or London.

eases. The returns are, for England in the years 1838, 1839, 1840, 1841, and 1842, and for London in 1843. The calculations are based on the numbers of deaths in a population of a million, as in a previous table.

In special years, the relative position of these mortality figures is somewhat changed.

In the next table, the relative mortality in a total of 79,256 deaths from six epidemic diseases occurring in London during the period of twelve years, from 1840 to 1851, is exhibited:

In the following and final table the subject of relative mortality is carried further, by a calculation based on 462,227 deaths from seven epidemic diseases, occurring during a period of eleven years, viz.,in England in 1838, 1839, 1840, 1841, 1842, 1847,

and 1848, in London in 1843, 1844, 1845, and 1846,

The figures thus quoted, place scarlet fever as second only in this country amongst the communicable diseases, in relation to mortality; nor does more recent investigation at all modify this relative order. On the contrary I believe that were the returns under the head "typhus" more correctly made, the disease scarlet fever would now stand highest on the list. It is unfortunate that the terms "typhus,' typhus," and "typhoid," are used too frequently in a generic sense to chronicle asthenic pneumonia, uræmia, and various other maladies having a tendency in their later stages to assume what is called the "typhoid " type. There is, consequently, in all our records of disease, a preponderance given to typhus which, extensive as that disease is even now, it does not altogether deserve. It is so very important to see a rectification of this error in our statistical records, and the error is one to be so readily rectified by a little more attention to details of diagnosis on certificates of death, that I offer no apology for exposing it here, and for suggesting the means of its removal.

ON THE TYPES OF SCARLET FEVER.

It will be a good day when the three so-called distinctive forms of scarlet fever, viz., scarlatina simplex, anginosa, and maligna, shall be considered as one; for although it is strictly true that there are certain cases which, from the first to the last, adhere to one character, yet there appears to be no definite rule in respect to the conditions under which such definite forms are manifested.

I have kept notes these ten years of every fact that I have observed bearing on this subject, but without arriving at any absolute reason why differences of type should be maintained so persistently in different cases. True, I shall in a later part of this essay offer a possible reason for the typical forms; but in the present place I confine myself to the simple statement of observed facts. That there is no difference in the quality or quantity of poison in the respective types is clear; for I have three instances before me of fatal scarlatina maligna, ending in a few hours, in which the disease was contracted from communication with cases of the mildest kind. On the other side, I have evidence of examples in which exposure to malignant scarlet fever has excited the mildest type in other persons disposed to the malady. The unity of the poison is, moreover, further shown in the circumstance, that the frequent after effects of the acute disorder, viz., uræmia and dropsy, may occur after any type. This is the general rule; but I should add to it, nevertheless, that in so far as my experience teaches