AN ADDRESS 
— ON TIIE — 
REGISTRATION OF DISEASES, 
Re-printed, with Additions, from the Transactions of 
The N. Y. State Medical Society, 
for the Year 1859, 
BY WILLIAM C. ROGERS, M. D., 
GREEN ISLAND, ALBANY CO., N. Y. 
TROY, N. Y.: 
D. H. JONES, PRINTER, 216 RIYER STREET. 
1859. AN ADDRESS 
O.V THE 
REGISTRATION OF DISEASES, 
Re-printed, with Additions, from the Transactions of 
The N. Y. State Medical Society, 
for the Year 1859, > 
BY WILLIAM C. ROGERS, M. D., 
GREEN ISLAND, ALBANY CO., N. Y. 
T RoW N. Y .: 
D. IT. JONES, PRINTER, 216 RIVER STREET. 
1859. This Address was read before tlie Albany County Medical 
Society, at its Annual Meeting in November, 1858, and 
referred by the Society to the State Society, with a recom- 
mendation to publish, and printed by the State Society in its 
Volume of Transactions for the year 1859. ADDRESS. 
“If the different sciences offer to us a varying degree of precision, it is from no 
want of certainty in themselves, but in our mastery of their phenomena.”—Auguste 
Comte. 
Investigations into any department of inquiry, to be successful, must 
be conducted according to a method specifically adapted to attain the end 
in view, and sufficiently simple and practicable to assist in the greatest, 
and embarrass in the least possible degree in the attainment of that end. 
The instrument should be no heavier than the hand can wield, or the eye 
direct with ease, certainty and effect. In metaphysical philosophy the 
methods are as numerous as the philosophers themselves, and the results 
attained satisfactory to no two students of the same school. In positive 
philosophy the study of phenomena and their laws is daily overcoming 
obstacles utterly insurmountable by any previous method, and producing 
results more commensurate with human wants. The application of the 
same method to the study of disease, made within the present century 
certainly within the memory of many members of our profession now 
living, has produced, and is daily producing, results as-satisfactory and as 
promising for the future as has the application of the same method to the 
study of celestial and terrestrial physics. 
In the latter departments of investigation, positive science has been the 
result- and in the department of practical medicine it simply remains far 
the profession at large, for each member of the profession in the daily dis- 
charge of his duties, to understand and apply this method in order to in- 
crease our knowledge of the natural history of disease and its treatment, 
and to answer affirmatively and satisfactorily the oft-reiterated question, 
“Is there certainty in medicine?” 
In order to apply the positive method of investigation to the solution 
of the problems of disease, the first step is to accumulate fads as to the 
occurrence, the topography, the meteorology, the phenomena, the dura- 
tion, the terminations, the concomitants and the sequelae,of disease ; the 
modifying influences of age, sex, occupation, and of habits of life ; and 
the great means by which these facts are 4© be accumulated is regis- 
tration. 4 
In order to substantiate this assertion, let us examine into the manner 
in which the use of a complete system of registration will enable us to 
attain some few of the above-mentioned results. 
The greater the number engaged in registration the more important the 
results, since a greater number of facts will be recorded, and if some plan 
be adopted by which these isolated facts can be collected and grouped 
according to tbeir affinities, important results will unquestionably be ob- 
tained. The practical working of the plan now adopted by the State 
Society will eventually furnish us with an accurate medical topography of 
the State, but this result can be more speedily and more satisfactorily at- 
tained by the adoption of this system of registration by each County 
Medical Society in the State. 
The medical topography of each county will thus be determined accu- 
rately by the facts and figures of the physicians of that count)", and 
the tabulated results of these figures, and not the vast mass of undigested 
figures themselves, transmitted to the proper officers of the State Society, 
accompanied by a full meteorological record, will doubtless lead to the ear- 
ly discovery of striking and important coincidences, and, in time, lead to 
the discovery of laws which will throw a flood of light upon many obscure 
points in theoretical and practical medicine; and especially is this true in 
reference to those epidemic and contagious diseases which one year reign 
with virulence in one portion of the State, and in a year or two thereafter 
suddenly break out with renewed virulence in another and perhaps distant 
part, and destroy many valuable lives before the causes, the pathology and 
the treatment thereof are clearly understood by the physicians who are 
called to combat this, to them, new and untried foe. 
Did the transactions of the State Society present each year all the facts 
and figures of the epidemics of the preceding year, the experience of those 
who had been called to combat these diseases would become the common 
property of the profession, which would thus be more completely armed 
for the emergency which may arise at any season. 
In confirmation of this opinion, I would state that Dr. Heartt, of Water- 
ford, Saratoga County, N. Y., expressed himself under great obligation to 
articles Nos. 6, 7 and Id, in the last volume of the Transactions of the 
State Society, on the subject of Cerebro-Spinal-Meningitis, for information 
as to the nature and treatment of this terrible disease which prevailed as 
an epidemic at Waterford during the winter and spring of the present 
year, 1858. Article No. 6, by Dr. Thomas, is valuable for its brief his- 
tory of the disease, a statement of its pathology and treatment in this 
country and in Europe, and analysis of its diagnostic signs and symptoms. 5 
Article No. 7, by Dr. Kendall, is valuable for its faithful history of cases 
and their treatment, while Dr. Squires’ article, No. 13, is valuable for its 
history of forty-three cases, and the post mortem appearances presented 
by three cases, tables showing the duration of the disease, and a statement 
of its various terminations. These papers are of very great value, both 
to those who may be called upon to combat an epidemic of this fearful 
disease, and to the future historian of epidemics. 
Papers and addresses on the history of medicine, on the code, and on 
kindred topics, are all valuable in their place ; but histories of epidemics, 
their supposed causes, signs, symptoms, terminations, sequelm and treat- 
ment, are ‘doubly valuable, and their publication in the Transactions of 
the State and County societies, would increase their value-, add to the repu- 
tation of the profession, and serve to re-establish the regular practice of 
medicine in the confidence of the public. 
The necessity for a system of registration has long been felt, but how 
it was to be obtained was unknown. Great dependence was placed upon 
hospital reports, of in and out patients, and upon the Medical and Surgi- 
cal reports of the armies of various countries. Says the editor of the 
Brit. & For. Med. Chi. Rev., January, 1837, p. 262 : 
“ It is only by the contribution of particular facts and of general re- 
sults that much good can be done to medicine. The time has arrived 
when a general and well arranged system of hospital reporting must begin 
to attract serious attention.” P. 262. 
Says the editor of the British Medical Almanac for 1837 : “The first 
step in medical statistics, after having determined the mortality, is to 
ascertain the number of attacks of sickness at different ages, to which a 
population is liable, and the numbers constantly ill. Hospitals throw no 
light on these questions or on the absolute mortality or duration of cases.” 
Quoted in B. & F. Med. Ch. R, 1837, p. 263. 
The same editor recommends “ the stating with accuracy the duration 
of the disease ; the number of days the patient lia4 been ill before admis- 
sion; the number of days he continues under treatment. Accuracy is 
above all things to be desired, and next to accuracy comes method. It is 
clear that thp time is arriving when the medical officers of hospitals will 
find their best interest in rendering the facts which occur in these institu- 
tions as extensively useful as possible to the profession. System will 
enable them to offer those facts in the best form, at the least trouble.” 
Ut. supra, p. 265. 
How well this latter prediction of Dr. Johnson, the then editor of the 
British Medico-Chirurgical Review has been fulfilled will be apparent to 
every reader of the Medical Journals of the day. Every well supported 6 
Journal in this country and in Europe, devotes many pages of each issue 
to hospital reporting, and one has been recently established in this country 
for the express purpose of reporting the practice of the Philadelphia Hos- 
pitals, and is receiving a constantly increasing patronage from a profession 
which is now as clamorous for facts as it was formerly for new and splen- 
did theories. 
The want of a system for accumulating facts in medicine and surgery 
is clearly presented in the above, extracts ; and hospitals, though evidently 
inadequate.to furnish solutions for all the problems which statistics can 
alone furnish, are relied upon in the want of facts and figures from other 
sources, and their officers urged to present reports and cases. So earnest 
was the editor of the Med. Chir. Rev. on this point, that he begged of 
the medical attendants of the hospitals to present their figures, no matter 
how many or how dull, so long as accurate, and they should have a 
place; but he is compelled to add in another paragraph, in alluding to 
the indolence of hospital physicians: 
“Four out of five of the medical officers of our present institution do 
not publish reports of their practice or their cases, simply because it is not 
an integral part of their duties and is not volunteered.” Op. Citat., Oct. 
’35, p. 558. 
Convinced that the hospitals were not to be relied upon, he recom- 
mends that the facts presented by such hospital reports as were published, 
be united with the reports published by the private practitioner, and that 
statistics thus obtained form the basis of calculations. On this subject he 
says: 
“We would suggest the combination of statistical reports, that is, sum- 
maries of facts, and individual cases. For the purposes of general utility 
we would say that statistical records and collections of cases calculated to 
display the general laws of disease or treatment, are preferable to individ- 
ual instances of rare complaints. The latter are too often chosen because 
they excite curiosity and interest. The accomplished physician or sur- 
geon is too apt to measure the attainments, the appetites and the wants of 
his profession by his own. Things familiar to him he too readily concludes 
to be equally familiar to all, and hence the prevalence of transcendental 
pathological papers in our journals and transactions. One sound and uni- 
versal induction is worth much more, in a useful point of view, than the 
most extraordinary fact or the most imposing theory. Such should be the 
aim of those who write for the real instruction of the public—of our clin- 
ical reporters. It is with facts that they have‘essentially to do, and their 
object should be to transfer the experience of the ward to the report.” 
B. & F. Med. Chir. Rev. Oct. 1835, pp. 549, 550. 7 
I have made these long quotations because they state the want of a 
system of registration, sucli as I am here to advocate ; because they sug- 
gest a very imperfect method of supplying that want, which imperfect 
method will compare favorably with the system now recommended by 
the State Medical Society, and which has been used, in part, successfully 
by my father in medicine, Dr. Brinsmade, of Troy, for the past thirty 
years, and because it is consoling to echo such old, such distant yet mag- 
nificent thunder as that of the leading Medical Journal of the world, 
wrhose editor was, twenty-five years ago, wiser in his day and generation 
than very many members of out profession to-day. 
The question of the comparative liability of the sexes to certain diseas- 
es common to both, must be settled by statistics, and these statistics can 
be obtained by registration alone. In order to substantiate this assertion, 
allow me to present some calculations based upon the facts and figures 
accumulated by Dr. Thomas C. Brinsmade, of Troy, N. Y., the present 
President of the State Medical Society, and embodied in his “ Vice Pres- 
ident’s Address ” for the year 1857. Trans. N. Y. State Med. Soc., 
1858, pp. 256, 556 inc. 
Assuming diarrhoea, cholera morbus and dysentery to be the archetypes 
of those zymotic diseases which we are called upon most frequently to 
treat, let us examine the numerical ratio of the sexes affected by these 
diseases. 
1. Diarrheea.—During the 10 years from 1848 to 1857, inclusive, Dr. 
Brinsmade records 3,147, of which 1,592 were males, and 1,555 females. 
Liability of the sexes the same. 
The healthiest year of the 10 was 1848. Humber of cases, 245 ; 
males, 106; females, 139; ratio, 1.33 females to 1 male. The most un- 
healthy year was 1849. Number of cases, 486; males, 270; females, 
216 ; ratio, 1.25 males to 1 female. 
Can we infer from these figures that during epidemics males are more 
subject to diarrheea than females, and vice versa in healthy seasons ? 
2. Cholera Morbus.—During the same length of time there were re- 
corded 685 cases of cholera morbus, of which 322 were males, and 363 
■were females; ratio, 1.13 females to 1 male. The smallest number of 
cases of cholera morbus was recorded in 1848, 1850 and 1855, when 151 
were treated, 59 being males, and 92 females; ratio of females to males, 
1.56 to 1. 
The greatest number of cases were recorded in 1849, 1854 and 1856, 
w7hen 308 cases were recorded, of which 148 were males, and 160 
females; ratio of females to males, 1.08 to 1. 8 
Can we infer from this that-females are more obnoxious to cholera mor- 
bus, at all seasons, than males ? 
3. Dysentery.—During the 10 years 536 cases were recorded; males, 
214; females, 322 ; ratio of females to males, 1.5 to 1. 
So striking a disparity as this would lead us to infer that females are 
more liable to this disease than males; and if so, can we account for the 
fact from the well known sympathy which exists between the uterus and 
the rectum? Many of the principal emmenagogue remedies used by the 
profession contain aloes, which also enters into the composition of most of 
the quack nostrums, which, as the advertisements say, “ must not be taken 
during the first three months of pregnancy.” Does the liability of the 
sex to this disease depend in any great degree upon the occasional or 
habitual use of this drug ? Does the irritable condition of the rectal and 
uterine nerves, induced by the specific action of this drug, predispose the 
sex to dysentery and abortion ? Does the use of aloes as a purgative for 
girls predispose them to dysentery and abortion in after life? 
The question of the comparative liability of the sexes to disease, and 
exemption therefrom, at different periods of life, is one of great interest, 
and can receive its solution from statistics alone. The subject is one which 
has received comparatively little attention, from the want of data suffi- 
cient to form the basis of reliable calculations. Though the figures pre- 
sented by Dr. Brinsmade’s tables are comparatively small, they are yet 
sufficient to show how completely all problems of this nature may be 
solved by the numerical method of investigation. Diarrhoea, cholera 
morbus and dysentery furnish us with many interesting calculations. 
1. Diarrhoea.—Whole number of cases recorded, 3,147; males, 1,592; 
females, 1,555; excess of males, 37. 
1 6 10 20 30 40 60 60 70 SO 90 
m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. m. f. 
123 140 316 393 57 81 90 89 255 170 425 336 143 163 107 92 51 51 22 25 3 5 
TABLE 1. 
From 1 to 10 there were 1,115 cases, which is one-third the whole 
number. Males, 496; females, 619; ratio of females to males, 1.25 to 1. 
From 10 to 20 there were 179 cases, which is one-eighteenth of the 
whole number. During this, the period of adolescence, the liability of 
the sexes the same—90 males, 89 females. 
From 20 to 50 there were 1,497 cases; males, 823; females, 674; 
ratio of males to females, 1.33 to 1. 
From 50 to 90 there were 667 cases; males, 326; females, 341; 
excess of females, 15. Liability of the sexes about the same; very 
slightly in favor of the males. The above table develops the fact that the period of the greatest exemp- 
tion from diarrhoea extends from the 5th to the 20th years ; and not only 
is this true of diarrhoea, but of many other diseases of entirely different char- 
acter. This is contrary to the generally received opinion, but I believe that 
registration will show that the period of adolescence is the period of the 
most uniform and perfect health. The dangers of dentition once past, the 
powers of nature are so completely engrossed in the conservation and 
perfection of the growing man, that the ordinary causes of disease produce 
but slight and temporary effects; and I am of the opinion that if our life 
was as spontaneous, as true to nature, and as uniformly cheerful, in man- 
hood as in youth, the period of our greatest usefulness would be the period 
of our greatest health. Ninety-nine out of every hundred diseases that 
flesh is heir to, are the result of gross violations of the known laws of 
health, which a little care, a little attention, a little study would enable us 
to avoid. Diseases are invited by unphysiological living; never sent in 
judgment of any but physiological sins. 
Second. Cholera Morbus.—Whole number of case3 treated, 6S5. 
Males, 322 ; females, 363 ; ratio of females to males, 1.13 to 1. 
TABLE II. 
1 [5 10 20 
30- 40 50 60 70 
80 90 
m. f. m. f. m. f. m. f. 
m. f. m. f. m. f. m. f. m. f. 
m. f. m. f. 
6 2 25 16 29 29 26 28 
52 59 68 94 60 63 35 34 13 24 
7 12 12 
Under 1 males more liable to c. m. than females, in the ratio of 3 to 1. 
10 “ “ “ “ “ “ IX 1. 
From 10 to 30 the liabilities are equal. 
30 to 40 females more liable than males in ratio of 1 2-5 to 1. 
40 to 70 the liabilities are equal. 
70 to 90 females more liable than males, in the ratio of 2 to 1. 
Third. Dysentery.—Whole number of cases treated, 536. Males, 
214; females, 322 ; excess of females, 10S. Ratio of females to males, 
1.5 to 1. 
TABLE III. 
1 5 
10 
20 
30 40 60 
60 
70 
80 90 
in. f. m. f. 
m. f. 
m. 
f. 
m. f. m. f. tn. f. 
m. f. 
m. f. m 
. f. in. 
16 26 33 42 
16 14 
20 
28 
27 69 50 78 33 25 
12 23 
4 11 2 
6 1 
From ] to 5 ratio of females to males, 1 2-5 to 1. 
5 to 20 “ “ “ 11-5 to 1. 
20 to 40 “ “ “ 14-5 to 1. 
40 to 50 “ “ “ 1% to 1. 
50 to 90 “ «« “ ' 1% to 1. 
It will be seen from this table that the period of the greatest liability to 
this disease is from the 20th to the 50th years, which is the period of child- 
bearing, and of the greatest uterine derangements. I think that in this 
disease there can be no doubt as to the influence of sex in predisposing to 
repeated attacks, and the records or the memory of every practitioner 
will furnish cases in which an attack of dysentery has excited and induced 
abortions and miscarriages. 
Next in numerical importance to the three leading zymotici just con- 
sidered, stand the two leading pneumonici, bronchitis and pneumonia, the following calculations for which are based upon the ten years from 1848, 
to 1857, inclusive : 
Bronchitis.—Whole number of cases, 3,372. Males, 1,556; females*. 
1,816. Excess of females, 260. Ratio of females to males, 1.16 to 1. 
TABLE 4. 
1 5 10 20 30 
40 50 60 70 80 90 
m. f. m. f. m. f. m. f. m. f. 
in. f. m. f. m. f. m. f. m. f. m. f. 
106 156 263 436 109 162 98 110 223 261 
450 416 169 113 69 71 50 54 16 29 2 4 
Under 1, females more liable than males, in the ratio of 1.1-5 to 1. 
From 1 to 5 do do do do 1.3-5 to 1. 
5 to 10 do do do do 1.1-2 to 1. 
10 to 20 the liabilities are equal. 
20 to 30 females more liable than males in the ratio of 1.17 to 1. 
30 to 40 liabilities slfsrhtly in favor of the females. 
40 to 30 males more liable than females in the ratio of l’£ to 1. 
50 to 70 the liabilities are about equal. 
70 to 90 females more liable than males in the ratio of 1.28 to 1, 
From these tables we perceive that during infancy and childhood the 
liabilities of the sexes are in the ratio of 1.56 females to 1 male. During 
adolescence the liabilities are equal, and the difference up to 40 is so 
slight as to merit little attention. Under' 50, males are more subject to 
this disease in the ratio of 1£ to 1. From 50 to 70 the liabilities are 
equal, but during extreme old age the females suffer far more from this cause 
than the males. The exemption of both sexes from this disease during 
the 10 years from 10 to 20, is remarkable, the ratio being one-six- 
teenth the whole number of cases. 
These conclusions in reference to bronchitis are corroborated in many 
respects by the conclusions derived from the following table, from “ the 
report of the out cases of the Birmingham Infirmary, for the year 1834,” 
to be found in the Med. Chir. Rev., July, 1835, pp. 241, et seqr.: i 
above. 
Under, - - -- -- -- 
- - - - 10 
20 
30 
40 
50 
GO 
GO 
Total. 
m. 
f. 
m. 
f. 
m. 
f. 
m. 
f. 
m. 
f. 
m. f. 
m 
. f. 
m. 
f. 
Acnto Bronchitis, - - - 
- - - - 54 
72 
13 
12 
8 
2G 
1G 
19 
13 
19 
8 7 
4 
3 
11G 
158 
Chronic do. - - - ■ 
3 
3 
5 
5 
14 
11 
20 
14 25 
15 
34 
51 
98 
Total, ------- 
- - - - 54 
72 
1G 
12 
il 
31 
21 
33 
24 
39 
22 32 
19 
37 
167 
256 
"Whole number of cases 423. Males, 167; females, 256. Ratio, 1.5 
females to 1 male. 
Under 10, 54 males, 72 females. Ratio of females to males, 1.3 to 1. 
20, 16 do 12 do. do males to females, 1.3 to 1. 
30, 11 do 31 do. do females to males, 3 to 1. 
30 to 00, 67 do 104 do. do do do 1.6 to 1. 
Above 60, 19 do 37 do. do do do 2 to i. 
These calculations cover a period of but one year, and are entirely in- 
sufficient to form the basis of reliable inferences, and yet in some points 
they strikingly corroborate Dr. Brimsmade's facts and figures, extending 
through a period of twenty years. Especially is this true in reference to 
the exemption of both sexes from bronchitis during the ten years, extend- 
ing from 10 to 20. According to this report the number treated between 11 
these years is 23, which is one-eighteenth of the wdiole number. Ac- 
cording to Dr. B’s. figures the number treated was 208, which is one- 
sixteenth of the whole number. 
Pneumomia.—Whole number of cases, 318 ; males, 180 ; females, 138 ; 
excess of males, 42 ; ratio of males to females, 1.39 to 1. 
1 
5 
10 
20 
SO 40 
50 60 
70 
80 
90 
m 
f 
m 
f 
m 
f 
m 
f 
m f m f 
m f m f 
m f 
m f m f 
16 
12 
24 
13 
29 
15 
IS 
8 
24 10 36 30 
21 21 4 12 
5 8 
2 9 
1 0 
TABLE 5. 
From 1 to 5 males more liable than females, in ratio of 1 1-3 to 1. 
5 to 20 do do do do 2 to 1. 
20 to 3) do do do do 2 2-5 to 1. 
30 to 40 do do do do 1 1-2 to 1. 
40 to 50 liabilities equal. 
50 to 90 females more liable than males in ratio of 2 3-5 to 1. 
The exemption of both sexes from this disease during the 10 years, 
from 10 to 20, is very remarkable, the number being 26, which is one- 
twelfth the whole number. When we remember that this is the age of 
detestability for both sexes, the age of the most thoughtless exposure of 
their persons in all hours, weathers and seasons, the numerical ratio in 
this disease and bronchitis to the whole number of cases, is certainly most 
remarkable, and can only be accounted for on the supposition that the 
vitality of the system is so great as to resist the causes of these diseases 
with almost uniform success. 
Next in numerical importance, though certainly first in the intensity of 
suffering which it entails, is neuralgia, to which the female is particularly 
obnoxious. 
Neuralgia.—WEiole number of cases, 1,164. Males, 356; females 808. 
Excess of females, 452. Ratio of females to males, 2.27 to 1. 
TABLE 6. 
1 5 
10 
20 
30 40 50 60 70 
80 90 
m. f. m f. 
m. f. 
m. f. 
m. f. m. f. m. f. m. f. m. f. 
m. f. m. f. 
4 5 
26 26 
34 67 
65 132 109 291 61 110 29 73 14 34 
5 19 11 1 
From 1 to 10 the liabilities of the sexes are equal, 
10 to 20 females more liable than males, in ratio of 2 to 1 
20 to 00 “ “ “ “ 2 4-5 to 1 
30 to 50 “ “ “ “ 1 7-10 to 1 
60 to 60 “ “ “ “ 3 to 1 
60 to 70 “ “ “ “ 2 2-5 to 1 
70 to SO “ “ “ “ 4 to 1 
SO to 90 males “ females “ 11 to 1 
From this table we perceive that infancy is exempt from this disease ; 
that op to the period of puberty the liability of the sexes is the same ; that 
from that period during the whole time of child-bearing, and until the 
grand climacteric of woman’s life is past, her liabilities to this disease are 
from two to three times as great as man’s. It is well to bear in mind, in 
this connection, that 209 cases of hysteria, and 268 cases of dysmenorrhoea 
diseases peculiar to females, and accompanied, in the great majority of 12 
cases, by much nervous derangement, and consequent suffering, might be 
added to the above figures to furnish a just estimate of the painful neu- 
roses to which the sex is most especially liable. 
We are told that the devout Jew, on entering the synagogue, turns his 
face towards the holy city, and prefaces his devotions with this thanks- 
giving : “Oh! Lord, God of Abraham, Isaac and Jacob; I thank thee 
that I am not a woman !” 
Had he practiced medicine, and studied diseases statistically, he would 
have found abundant reasons for his most hearty and devout thanks- 
givings. 
But in estimating the influences of sex in predisposing, causing and in- 
ducing disease, there remains yet another element which enters into the 
calculation, and which affects its results in a very great degree, and that 
element is occupation. Ho one can deny for an instant that her sedentary 
habits of life, and the confining nature of her employment has much to do 
with woman’s liability to disease, and it is an interesting and instructive 
fact, that those men whose occupations partake most of the nature of the 
occupations of woman, suffer most—and justly, in some instances—from 
the same diseases which make her life a martyrdom. In other countries, 
where woman has more liberty of choice, greater freedom from conven- 
tionalisms and a wider range of masculine occupations, her liability to 
these neuroses is but slightly greater than man’s. 
The influence of occupation upon all the functions of life, is far greater 
than many of us suppose. That occupation which requires long continued 
patient and laborious toil, develops a patient, persevering and determined 
frame of mind, a mind equal to the surmounting of great and lasting ob- 
stacles, just as it develops a corresponding demand for food, a correspond- 
ing assimilating power and a strength of body equal to the strength of pur- 
pose and the scope of mind. And the diseases to which a person thus oc- 
cupied, and thus affected by his occupation, is most liable, differ essentially 
in degree, if.not in kind and character, from those which affect the clerk, 
the cigar-maker, the tailor or the book-keeper. But into this branch of 
my subject I have neither the time nor the data to enter, but beg to state, 
in this connection, that it is only by registration, practiced by the profes- 
sion for many years, that the influence of occupation in predisposing to 
disease, can be accurately determined. And I am furthermore, of the 
opinion that the time will come when the profession will so completely 
understand this subject, as to be enabled to prescribe the occupation best 
adapted to relieve chronic affections, and to protect those predisposed from 
diseases which other occupations might invite and develop. 13 
Says Dr. Chas. Frick, of Baltimore, in an address introductory to a 
course on materia medica, delivered before the medical class of the Uni- 
versity of Maryland, October 7th, 1858: “Rest, abstinence and other 
dietetic measures—the whole doctrine of hygiene and regimen of body 
and mind—form as essential a department of materia medica and therapeu- 
tics, as any of the drugs that will be presented to your notice.” P. 13. 
To this catalogue may be added occupation, an element of the materia- 
medica which has heretofore received but an insignificant measure of time 
and attention. 
Scarlatina.—-Whole number of cases recorded, 302. Males, 119; fe- 
males, 183. Ratio, 1.54 females to 1 male. 
TABLE 7. 
1 
5 
10 
20 
30 
40 
50 
Total. 
m. f. 
m. f. 
m. f. 
TO. f. 
m. f. 
m. f. 
m. f. 
m. f. 
6 4 
57 68 
39 51 
9 26 
3 17 
5 14 
3 
119 183 302 
Under 1, ratio of males to females, 1.5 to 1 
From 1 to 5, “ females “ males, 1.2 to 1 
“ 5 “ 10, “ “ “ “ 1.6 to 1 
“10“20, “ “ “ “ 3 to 1 
“ 20 “ 30, “ “ “ “ 5 to 1 
“ 30 <•' 40, “ “ “ “ 3 to 1 
The above figures in many respects strikingly corroborate the fact, and 
figures presented by Dr. J. F. Meigs in his “ Practical Treatise on the 
Diseases of Children,” (‘2nd edit. 1853). He had seen 173 cases, of 
which 101 occurred in children under 5 years of age. In the above 
table 302 cases are presented of which 135 were under 5 years of age. 
The total mortality under ten years of age in the city of Philadelphia for 
a period of 30 years was 2171, of which 132 were under one year of age, 
411 between one and two, 1130 between two and five, and 510 between 
five and ten. Op. Cit. p. 487. 
The influence of sex, Dr. M. observes, has not been determined with 
certainty. Dr. Tweedie (Cycl. Prac. MedArt Scarlatina) says it is 
most common in girls. 
M. M. Rilliet and Barthez state it to be most common in boys. Dr. 
Meigs noted the sex in 184 cases under 15 years of age, 90 of which were 
males and 94 females, and remarks “ the truth is, probably, that under 
puberty it attacks the two .sexes with equal frequency, while after that age 
it is most common in females.” (Op. Cit. p. 487.) 
With this uncertainty and discrepancy among authors of the highest 
standing it is necessary that this question should be definitely settled, a 
consummation to be attained only by statistics, such as Dr. Brinsmade has 
presented to the profession. 14 
From the above table females would appear to be more liable to the 
disease than males in the ratio of 3 to 2. Under 5 the liabilities are sub- 
stantially the same. After that age it is decidedly dangerous to be a female, 
especially during epidemics of this most serious disease. 
The influence of the seasons on this disease is most remarkable and is 
strikingly exhibited by Dr. B.’s Tables for the 10 years ending 1857. 
During this period there were treated by him 302 cases occurring in the 
different months as follows : 
January 
53, 
May 15, 
September 
3, 
February 
44, 
June 7, 
October 
15, 
March 
51, 
July 16, 
November 
32, 
April 
21, 
August, 6, 
December 
39, 
If we divide these months into seasons, the numbers stand as follows : 
viz. 
Dec., Jan., Feby., 
Mar., A pi., May, 
136. 
87. 
June, July, Aug., 
Sept., Oct., Nov., 
from which it appears that nearly one half of the cases of this disease occur 
in winter, rather more than one third in the Spring, about one tenth in the 
summer and one sixth in the fall. 
The question of the season in which this disease is most prevalent is 
unsettled, and can only be settled by registration. 
Measles.—Whole number of cases recorded 2G4 ; Males 136 ; females, 
128 ; Liabilities about equal. 
29, 
50. 
TABLE 8. 
1 
5 10 20 
30 
40 
Total. 
m. f. 
m. f. m. f. m. f. 
m. f. 
m. f. 
m. f. 
10 9 
42 51 56 36 14 15 
9 10 
5 7 
136 123 264 
Under 1, liabilities equal. 
“ 5, ratio of females to males, 1.2 to 1. 
“ 10, “ “ males to females, 1.5 to 1. 
After 10, liabilities equal. 
The exemption of children under 1 is remarkable, and confirms the ob- 
servation of Stewart, Dis. of Children, p. 416,- that “measles more fre- 
quently attacks children after the period of dentition than before,” though 
children newly born have been known to suffer from the disease. 
The influence of the seasons upon this disease is clearly shown in Dr. 
Brinsmades’ Tables, and confirms the observation of preceding observers. 
During the 10 years from 1848 to 1857 inch, the prevalence of the 15 
disease during the months was as follows: viz. 
January 27, 
February 28, 
March 42, 
April 42, 
May 30, 
June 17, 
J uly 15, 
Au«r., 2, 
Sept., 1, 
Oct., 6, 
Nov., 26, 
Dec., 28. 
Divided into seasons the numbers stands as follows : 
Dec., Jan., Feby., 
Mar., Apl., May, 
83. 
114. 
June, July, Aug., 
Sept., Oct., Nov., 
34. 
33. 
From which we may infer that Measles is emphatically a disease of 
the Spring and winter, by far the largest proportion of cases occurring in 
the Spring. 
Sydenham states that the epidemic measles of the year 1670 “ set in 
early as usual, i. e. at the beginning of January. They gained strength 
every day until they reached their height about the vernal equinox: 
after this they gradually decreased at the same rate, and by the month 
of July were wholly gone.” 
Sydenham’s Works Latham’s Ed. Vol. I, p. 218, quoted by Haviland 
op. cit. p. 85. 
This quotation is strikingly corroborated by Dr. Brismade’s observation 
for 10 years. 
The greatest number of cases of measles recorded by Dr. B. in any one 
year was in 1857, when the disease was epidemic throughout this section. 
Whole number of cases recorded 97. 
January 3, 
February 7, 
March 35, 
April 33, 
May 13, 
J une 4, 
July 2, 
Stewart remarks, Bis. of Children p. 416, this disease “usually shows 
itself as an epidemic during the cold and changeable weather at the close 
of the winter.” 
Measles appeared as an epidemic in 1854 in London, when 1399 
patients fell victims. The following exhibits the relative mortality of the 
seasons:— 
Spring, 
Autumn, 
Winter, 
Summer, 
476; 
369 ; 
344; 
210. 
The greatest number of deaths in that year was during the 16th week 
(April) when 52 fatal cases were recorded : the least number of deaths 
was during the 40th week (Oct.) when 10 fatal cases wrere put on record. 
Haviland, op. cit. p. 84. 16 
Rhazes, who first describes this disease and diagnosed it from Small 
Pox says, “ when the summer is excessively hot and dry, and the autumn 
is also hot and dry, and the rains come on very late, then the measles 
quickly seize those who are disposed to them.” We have here a de- 
scription of the kind of season most favourable to the development of this 
disease, which almost invariably prevails after the long, cold rains of 
changeable seasons. Haviland, op. cit. p. 85, 86. 
Croup.—Whole number of cases recorded 185. Males 89 : females 96. 
TABLE 10. 
1 
5 10 20 
Total. 
m. 
f. 
m. f. m. f. m. f. 
m. f. 
9 
12 
40 66 33 18 1 
89 96 J85 
Under 1, females more liable than males in ratio of 1.3 to 1. 
*< 5 << (i u u u <( u “14“] 
“ 10, males “ “ “ females “ “ “ 1.8 “ 1. 
Watson, Wood, and Meigs note the exemption of children under 1 from 
this disease. Of 86 cases of spasmodic croup noted by Meigs (J. P.) (op. 
cit. p. 66,) 8 were under 1, 29 under 2, 18 under 3, 17 under 4, 9 under 
5, 2 under 6, 2 under 7 and 1 under 8 years of age, giving 8 under 1 and 
73 under 5. Of these 86 cases 48 were boys and 38 girls. 
The influence of the seasons is shown in the following table : 
Jan., 
Feb., 
Mar., 
April, 
May, 
June, July, 
Aug., 
Sep., 
Oct., 
Nov., 
Dec., 
Total. 
19 
14 
28 
12 
14 
9 10 
3 
12 
13 
23 
28 89 
96 185 
In the above tables all cases of Croup, whether spasmodic or Pseudo- 
Membranous are included under the generic title Croup. The observa- 
tion of others that males are more liable than females to this disease is not 
confirmed by the above. 
Cholera Infantum.—Whole number of cases 240 : Males 11G : females 
124. 
TABLE 11. 
1 5 
10 
Total 
m. f. m. f. 
m. f. 
m. f. 
44 39 70 85 
2 
116 124 240 
There is but little here worthy of remark. The ratio of the sexes is so 
nearly the same as to show no peculiar liability of either males or females. 
In the following table we have exhibited the comparative frequency and 
comparative liability of the sexes to Cholera Infantun, Diarrhoea and Dy- 
sentery during 10 years. 17 
TABLE 12. 
1848. 
1849. 
1850. 
1851. 
1852. 
1853. 
1854. 
1855. 
1856. 
1857. 
m. 
f. 
m. 
f. 
rn 
. f. 
m. 
f. 
m. 
f. 
m. f. 
TO. f. 
m. 
f. 
in. f. 
m. 
f. 
c. In.- 
.—11 
17 
12 
12 
6 
8 
10 
16 
16 
3 
8 12 
19 21 
3 
10 
15 5 
16 
20 
Diar.— 
-100 
131) 
269 : 
209 
131 
142 
137 
141 
147 147 
182 136 
270 216 
154 
162 
114 134 
131 
131 
Dys.—- 
—34 
'43 
50 
60 
22 
29 
IS 
38 
21 
40 
39 22 
11 37 
7 
19 
16 9 
25 
34 
The same remarks holds true of the three diseases, that, during certain 
seasons (epidemics?), from some unknown causes, the liability of one of 
the sexes is very greatly increased. Why this should be so can only be 
discovered by the careful observation and research of many “ ministers 
and interpreters of nature” anxious to solve every problem which falls 
legitimately within the domain of human reason. 
Thermometrical observations are invaluable in the philosophic study of 
disease, and should be made by all recorders at certain fixed hours of the 
day and night. A reference to the plates accompanying and illustrating 
Dr. Brinsmade’s address, abundantly establish this position. Barometric 
observations, to be of use, must be studied in connection with the hours of 
the accession and recession of certain acute, and of the exacerbations of 
certain chronic diseases. A reference to Dr. B.’s tables abundantly for- 
tifies this position. In table II, the mean thermometer and barometer 
readings for twenty-one years are given in connection with the numerical 
ranges of diarrhoea, cholera morbus, bronchitis and pneumonia; but no 
law, not even the remotest approach to a coincidence, can be discovered 
by comparing the mean range of the baromoter with the numerical range 
of these diseases. Had the barometer readings for every day during that 
long period, been studied in connection with the daily record of all diseas- 
es, or of a certain class of diseases, and especially in connection with the 
hours of the accession and recession of certain acute diseases, results as 
striking, as important, and doubtless, as conclusive as those exhibited by 
the thermometer range, would have been developed. In proof allow me 
to present the following quotations from Haviland’s “Climate, Weather 
and Disease,”—London, John Churchill, 1855, 1 vol., 8vo :—“The win- 
ter was northerly and droughty, cold, with rough winds and snow; then 
paraplegia (apoplexy, &c.,) began to show itself, and attacked many, and 
some died suddenly. Such is the simple and interesting statement made 
by Hippocrates : let us compare it with what Dr. T. Moffat has observed 
and recorded : ‘ Of the number of cases of appoplexy which occurred in 
the years 1850 and 1851, fifty per cent, took place on days of decreasing 
readings of the barometer, and fifty per cent, on days after such readings; 
one hundred percent occurred with fall of temperature, and they all took 
place with a direction of wind S. E. to S. W. points of the compass; of 
seven sudden deaths, five occurred with wind from N. W., with hail show 
ers.’” Op. cit., p. 49. 18 
“ As in the time of Hippocrates, so do.es it appear new, that apoplexy 
and paralysis are most fatal between the end of autumn and the beginning 
of winter. At the time of its greatest mortality, the barometer did not 
range more than half an inch in the week; and in the week when the 
last number of deaths was registered, the variation was greater, and the 
mercury higher, by nearly an inch, than it was in January. Between the 
autumn and winter, atmospheric pressure is certainly less than at other 
times of the year ; and this fall of the barometer is coincident with the 
maximum of death from the above causes.” Op. cit., pp. 51, 52. 
To show the importance of meteorological observations in connection 
with registration of diseases, I beg to present the following suggestive ob- 
servations and quotations, the importance of the subject amply apologizing 
for the length of my paper. 
I cut the following from the New York Tribune for October 30, 1858 : 
“ Meteorological conditions as influencing disease.—Dr. Moffat, of Eng- 
land, in a paper read before the Meteorological Society, has shown by a 
series of very elaborate tables, that an apparent connection is discover- 
able between the first appearance, increase, decrease and disappearance of 
atmospheric ozone with the decrease and increase of the readings of the 
barometer and thermometer, and the state of the weather generally. Also 
that prevalent diseases form groups corresponding with certain meteorolo- 
gical conditions. In the formation of these tables, Dr. M. paid strict at- 
tention to all the lesser fluctuations of the barometer and thermometer, be- 
ing convinced that there exists a great necessity for so doing, from the 
slightest variations in the reading of the barometer being followed by a 
change in the direction of the wind, and the appearance and increase, or 
decrease and disappearance of ozone.” 
Of the influence which ozone or electrized oxygen may have in predis- 
posing and causing disease, we may form some opinion from the facts stat- 
ed in the following quotation from a review of Scourettenrs work on 
“ Ozone, or Chemical, Meteorological, Physiological and Medical Re- 
searches into the nature of Electrized Oxygen,” by Lewis H. Steiner, of 
Baltimore, in the March number of the Am. Med. Monthly, pp. 200, et 
seq., vol. ix., No. 3. 
“ Boeckel, of Strasburg, showed that there was an intimate relation be- 
tween the development of cholera, in 1854—55, in that city, and the di- 
minution or disappearance of ozone. In July of the former year the cho- 
lera -was very fatal, and but little ozone was detectable in the atmosphere. 
On the 17th, when there was total deficiency of this substance, the disease 
was especially violent. This deficiency was not only in the air of the 
city, but of that of the adjoining country. During August the cholera 19 
was particularly violent, and the ozonometric indicatator was zero. On 
15th of September, indications of ozone began to make their appearance, 
and the cholera sensibly diminished. When the former became very 
marked, then coryza, bronchitis and pneumonia became common. In the 
month of June, 1855, during the first four days, three nights were, accord- 
ing to the ozonometer, zero, and the cases of cholera which he saw broke 
our, between midnight and 6 A. M. ‘ Boeckel concludes that the want of 
ozone constituted the predisposing cause, while the contagious miasma 
produced the disease which was then further propagated.’ Drs. Robert 
and Conraux, of Newdorph, near Strasburgh, have also noticed this same 
apparent relation between the want of ozone in the atmosphere and the 
raging of cholera. Simonin, Sen., noticed such a relation at Nancy, in 
1854, but notin 1855. Wolf, the director of the observatory at Berne, 
from'an examination of the official list of deaths at Aarau, concludes that 
cholera is at least externally favored by the diminution of ozone.” Am. 
Med. Mon., vol. ix., No. 3, pp. 213, 214. 
There is much more on the subject of the relations existing between.the 
presence of ozone and the prevalence of certain inflammatory diseases 
which I should like much to present, but sufficient has been given to show 
the necessity of extensive and accurate observations to determine the 
efforts produced by this imponderable agent. There is another idea pre- 
sented in this connection which to me looms up prophetic of the future so- 
lution of that most difficult of all subjects to investigate, the miasmata pro- 
ductive of disease. It has been determined from repeated experiments that 
ozone is a powerful disinfectant and deodorizer. 
“Meat that was in a putrescent state, being plunged in a flask contain- 
ing ozone, was quickly disinfected ; horse dung which gave off a powerful 
ammoniacal odor, when plunged into ozone lost this odor; water from a 
maceration tub in the amphitheatre of a military hospital at Metz, was 
agitated in a flask with ozone, and made inodorous. Ozone is thus shown 
to be a great purifyer of the air from miasmatic materials, and it renders 
the surface of the earth inhabitable although there is incessant decomposi- 
tion of organic material ; but as ozone is an energetic excitant of the 
animal system, its accumulation would be very detrimental ; this is pe- 
vented by the law that oxydizable miasmatic material is destroyed by 
ozone, while in their turn they destroy it.” Am. Med. Mon., Yol. ix, 
No. 3, pp. 211, 212. 
Now the idea which presents itself here is this ; if we are enabled to de- 
tect the presence of so imponderable an agent as ozone in the atmosphere, and 
to determine accurately the effects, for good and for ill, which it produces, 20 
may we not hope to be enabled, at no distant day, to detect the presence of 
that other equally imponderable agent, the miasm arising from decomposing 
vegetable matters, and to counteract, measurably at least, its deleterious in- 
fluences ? It is legitimate to infer that we may. Human reason, under 
the guidance of positive philosophy, has triumphed over difficulties as 
great, if not greater than this. And the question arises, who is to accom- 
plish this consummation so devoutly to Ire wished ? I know of no one 
except that pack-horse and drudge of all the sciences, the physician. He 
has moved the world in times past—he does it now—he is expected to do 
it in the future, and he will. 
A few remarks upon the method of keeping a register and I am done : 
Registrations to be of service in the study of disease, must be accurate 
and reliable, and must therefore be made daily. However much we .may 
trust to memory in the other transactions of professional life, in the mat- 
ter of registration, where the object is to obtain positive data which may 
lead to positive results, possibly to the discovery of the laws of disease, a 
knowledge of which is so essential to rational treatment, the importance of 
the subject demands the utmost care that no uncertainties enter as elements 
into our calculations. We must, therefore, record our cases each day, 
when all the circumstances attending them are fresh in our minds, and 
when there is the least possible chance for error. If we are unable to 
diagnose a disease on our first visit, the register should be made complete, 
but the column headed disease should be left blank until such time as the 
complete developement of the disease enables us to diagnose it accurately. 
Should two diseases be presented together, in the person of one patient, 
the registration should include both diseases. 
I have latterly adopted the plan of keeping a “prescription book,” in 
connection with my register, and of referring from one to the other for a 
history of my cases, and though I have pursued the plan but a few 
months, find it of very great service. I do not record the prescription in 
every single instance, but where I find that the prescription of remedies 
after a certain formula has been followed by beneficial effects, I record the 
formula and refer to the recorded case, and am thus more completely 
armed for the next case of the same disease. 
The physician’s register should be to him what the merchant’s ledger is 
to him, a book for constant study and perusal, and thus will he pursue his 
profession as a profession, and not as a trade, since by constantly referring 
to his cases, and the means employed in their treatment, he is as constantly 
renewing and reinforcing his experience, and perpetually reminding himself 
of the great object of his profession, the relief and the prevention of suffer ing. If he studies his ledger to the neglect or exclusion of his register, he 
becomes a mere tradesman in his profession, and from falling into the hands 
of any such, in any time of need, “ Good Lord, deliver us.” 
The one great object of registration is the accumulation of facts, and no 
fact, however small, is insignificant in the study of natural or morbid phen- 
omena. Let us then be content to accumulate facts, great and small, even 
though we are unable to interpret them, or even to see their remotest and 
feeblest affinities. The accumulation of facts is the great end of modern 
labor in the various departments of our profession. TVe have no splendid 
and visionary theories, thank God ! Our fiicts theorize themselves and 
our science advances accordingly, and if we cannot see the mutual relations 
of the materials we heap together, another generation will seize upon them, 
and erect a temple of theoretical and practical medicine, as faultless as the 
Parthenon, and as lasting as the necessities of man. 
Says Auguste Comte: 
Some of the most important arts are derived from speculations pursued 
during long ages, with a purely scientific intention. For instance, the 
ancient Greek astronomers delighted themselves with beautiful speculations 
on conic sections ; those speculations wrought, after a long series of gen- 
erations, the renovation of astronomy ; and out of this has the art of navi- 
gation attained a perfection which it never could have reached otherwise 
than through the speculative labors of Archimedes and Apollonius; so that 
to use Condorcet’s illustration, 'the sailor who is preserved from shipwreck 
by the exact observation of the longtitude, owes his life to a theory con- 
ceived two thousand years before, by men of genius, who had in.view 
simply geometrical speculations.’” Positive Phil. vol. 1, pp. 20, 21. HEADINGS OF A REGISTER, TO BE USED IN THE ORDIN- 
FLUENCES OF AGE, SeX, NATIVITY, AND HABITS OF 
Date. 
Name. 
Age. 
Sex. 
Nativity. 
M. | F. 
U S. I FOR. 
Jau’y 1. 
J. Smith. 
25. 
1. 1 
1 1- 23 
ARY REGISTRATION” OP DISEASES, IN’ WHICH THE INT- 
Life, and the Duration and Diseases are to re noted. 
Habits. 
Disease. 
Cured. 
Duration. 
Remarks. 
T. | INT. 
1 1. 
Pneumonia. 
Jau’y 14. 
13 days. 
| Right upper lobe.