9. The maximum mortality from phthisis occurs in spring, and after this season in winter. The minimum mortality from this disease occurs in autumn and summer. 10. Variations in the state of the atmosphere appear to exert but little influence upon the relative number of deaths from phthisis. 11. Nervous fever is most frequent and fatal in autumn; it is least frequent and fatal in spring. 12. The influence of weather and season upon health varies with the different periods of life. 13. This influence is most marked in the ages of infancy and puberty, but it is least marked in the first septennial period of existence. 14. From the twentieth year upwards, the winter is the most dangerous, and the summer the most favorable season to life and health; and the older the individual the more striking is this difference. The paper of which we next propose to give a brief analysis is one nearly allied to the foregoing, in which medical statistics are brought to bear upon a somewhat singular branch of inquiry, namely the Influence of the periods of the day upon births and deaths. It is perhaps known to our readers, that some researches have been already made in respect to births, although without leading to any satisfactory results. The statistical tables of Ranken, Quetelet, and Buek, although differing from each other in data upon which the calculations are based, agree in representing that more children are born by night than by day. The most exact are those of Ranken, collected from 890 observations in his own midwifery practice, in which the hour of birth is uniformly stated. The tables of Quetelet include 2680 cases, observed in the Hospice de la Maternité, at Brussels, between the years 1811 and 1822. Buek's cases are not so satisfactory, because they have been loosely collected from various sources of private practice: hence but little reliance can be placed on them in reference to the question about to be discussed. Casper's data are derived from 809 cases occurring in the Maternity of Berlin, between the years 1830 and 1833. His results differ from those of Quetelet in the fact that they show a more gradual increase and decrease in the number of births at different periods. We cannot here find room for the number of cases which occurred at each hour, but the following table comprises the total cases which occurred to each observer in terhoral periods; and it shows not merely the absolute number of births, but also the relative proportion on a standard of 1000 It will be seen from this extensive calculation of cases by various observers, that while the number of births between 9 o'clock in the evening and 6 o'clock in the morning exceeds the average (125), those between 9 o'clock in the morning and 6 o'clock in the evening are below the average. The greatest number of births takes place in the hours following midnight, and next to this, in the terhoral period between 3 and 6 o'clock in the morning. There is less agreement respecting the period at which the minimum of births occurs; but this Dr. Casper thinks may be owing to the unequal number of facts collected by the different observers. author then proceeds to show that if the day be divided into sexhoral periods, the differences vanish, and the births then increase in frequency in the following proportions per 1000: From 12 to 6 A.M. 12 to 6 P.M. 6 to 12 296 232 215 257 The Thus they occur most frequently in the hours after midnight; then in the hours before midnight; thirdly, in the hours before noon; and lastly, in the hours after noon. Dr. Casper refers to various hypotheses respecting the cause of this preponderance of births during the night, but none of them appear satisfactory. For the first time, he has endeavoured to determine whether the cause of the difference had any reference to the sex of the child, to its healthy or morbid development, to its maturity or immaturity, to its being a first, or a second, third, or fourth child,-to the delivery having been natural or instrumental. The result of his inquiries is, that none of these conditions have any demonstrable influence whatever on the period of the day at which the birth occurs. The subject, however, has hitherto been regarded only in one point of view, namely, the period at which the act of birth, i. e., the separation of the child from the mother, is completed. The time at which labourpains first appear is obviously material to the inquiry; the exceptions here may have a smaller range than those which exist with regard to the delivery of the child, since this condition is more likely to be under the influence of a natural law. Besides Dr. Casper thinks it not improbable that some practical hint may be derived from an examination of this question, whereby the obstetric practitioner may be able to form a prognosis respecting the probable sex and the probable duration of labour. In illustration of these propositions, he presents us with a table of 787 births arranged according to sex, and according to whether the children were or were not those of primiparous females. We must, as usual, content ourselves with the results. The maximum number of cases in which labour pains come on, occurred in the terhoral period between midnight and three o'clock in the morning; the minimum number of cases were between six and nine o'clock in the morning. The numbers gradually approached each other between these two extremes. The proportion of cases in which labour pains come on at night, is much greater than that in which delivery occurs at night. Thus in the Berlin Maternity, for one day-birth there were 1.05 night-births; while the births in which the pains began by day were 131, those in which they began by night amounted to 1.75. It was also ascertained as a curious fact, that when the pains of labour began by day, the greatest number of male children were born; while when they commenced by night, there was a preponderance of female births. The period at which labour pains came on appeared to have but a slight influence on the duration of labour. The average duration of a labour, from the number which occurred in the Berlin institution between the years 1830 and 1834, was about nineteen hours. In those births in which the pains commenced by day, the average duration was twenty hours; while in those in which they commenced by night it was eighteen hours. With respect to children born living and dead, the following facts were ascertained: Out of 295 still-born children, the proportion in 1000, was for the four diurnal periods of six hours: The maximum, in regard to children born dead, unlike that of the general births, occurs in the six hours which precede midnight; but the minimum falls in both cases in the afternoon hours. The preponderance of night- over day-births, with respet to still-born children, is even greater than with respect to those born living. Influence of the periods of the day on mortality. Proceeding on the principle that nothing connected with human life is accidental or dependent on chance, Dr. Casper next proceeds to examine the question respecting the relative rate of mortality at different hours of the day. This is just as much a legitimate object of medical inquiry as the determination of deaths at different seasons or in different months of the year. Our knowledge must, in all these cases, rest upon similar data, i. e., upon facts accurately observed and recorded. The researches hitherto made on this subject by Virey, Metzler, Quetelet, and Buek are, in the opinion of our author, insufficient to solve the question. The numbers are either too limited, or they have not been collected with sufficient attention to accuracy. Casper's data consist of 5595 deaths, officially recorded in Berlin, by those who are appointed by government to verify death and report the cases. To make the results simple and intelligible, the number of deaths is taken at 100, and the day is divided into four sexhoral periods. It is obvious, if the rate of mortality was the same throughout the day, there would be 25 deaths in each period, but we find the following results: From this it will be perceived, that the maximum amount of mortality occurs in the six hours before noon, while the minimum rate occurs in the six hours after noon. The other two periods of the day appear to be indifferent. It is rather singular as a result, to find that the morning hours are those in which the greatest number of deaths occur; but it must not be forgotten that the period will be in many respects modified by the nature of the disease causing death. We consider it unnecessary to follow our author into his tables of mortality, as they are affected by the various classes of diseases. It may suffice to say, that they are of a most minute and extensive kind. We learn from them, as general facts, that four fifths of all deaths (5591 cases) are due to chronic, and one fifth to acute diseases; and, further, that the number of those deaths from acute diseases is smaller in the morning and larger in the afternoon hours, thus departing from the average results of the total deaths. The author attempts, but in our opinion not very satisfactorily, to account for this peculiarity in acute diseases. He then passes into an analysis of the differences observed in respect to the diurnal deaths for various classes of chronic disease, and discusses certain hypotheses respecting the causes of these differences. He afterwards examines the probable influence of seasons on the deaths at various diurnal periods. Our space is, however, already exhausted, and we shall therefore merely subjoin the general conclusions at which Dr. Casper has arrived respecting the statistics of births and deaths: 1. The greatest number of births occur between nine o'clock in the evening and six o'clock in the morning; while the smallest number occur between nine o'clock in the morning and six o'clock in the evening. 2. The pains of labour commence most frequently between twelve o'clock at night and three o'clock in the morning; least frequently from six to nine in the morning. 3. The influence of night is more marked with respect to the commencement of labour-pains than with respect to complete delivery. 4. Among those births in which the pains commenced by day, the greater number were male children, and vice versa. 5. On an average, delivery was more protracted when the pains commenced by day than by night. 6. The preponderance of nocturnal over diurnal births is more striking in respect to children born dead, than in respect to those born living. 7. The maximum mortality occurs in the hours before noon, and the minimum mortality in the hours before midnight. 8. Individually regarded, the ratio of deaths from inflammations, phthisis, and pulmonary hemorrhage is greater in the afternoon; from fevers and exanthemata, just before midnight; from cerebral apoplexy, during the day; and from diseases of the nervous system in general in the hours which immediately follow midnight. We here close for the present our examination of this volume. Our readers will perceive that we have given an analysis rather than a review of the principal medico-statistical papers which it contains. We have preferred in most cases allowing the author to speak for himself,-by no means pledging ourselves to the unqualified reception of the whole of his views. As we have before remarked, some difference of opinion will necessarily exist among professional men respecting the practical utility of statistical researches of this kind; but as the influence of weather and season upon health and mortality is a universally admitted truth, it is clear that the general influence can only be properly determined by minute researches like those of Professor Casper, on the special influences of heat and cold, high and low atmospheric pressure, dryness and humidity, which, in reality, constitute the complex elements of the weather, and on the various degrees of which, atmospheric changes depend. It would be difficult to point to any researches more accurate, more extensive, or more elaborate than those of the learned author of these essays, and there is no doubt, if ever it be permitted to the medical philosopher to determine the exact influence of the weather on the salubrity of places, and on the healthy condition of the human species, it will be by pursuing the course so well marked out by Casper. It would be absurd to pretend that such researches have yet led to anything like accuracy in prognosis; but in this respect this branch of medical statistics resembles many other parts of medical science. We cannot, however, fail to derive from such a condensation of well-observed facts new, more correct, and more enlarged views respecting the influence of atmospheric changes on health. There are many opinions on this subject which prevail extensively among the public as well as in the profession; some of them have arisen from inexact observations and hasty generalization, and yet they have been allowed to influence practice and hygienic treatment: others appear to have a better foundation in fact. If no other present benefit flow from these statistical researches, we have at least the satisfaction of knowing that they will enable us to distinguish the true from the false; and will teach us to be cautious in relying upon doctrines which have not been confirmed by experience and observation. We hope in the following number of this Journal to present an analysis of that portion of Dr. Casper's work which bears upon many novel and important questions in Legal Medicine. ART. VII. Die Pathologische Gewebelehre von Dr. FRIEDRICH GÜNSBURG. Erster Band. Die Krankheitsprodukte nach ihrer Entwickelung, Zusammensetzung, und Lagerung in den Geweben des menschlichen Körpers, Mit drei Tafeln. Leipzig, 1845. Pathological Histology. By DR. F. GÜNSBURG. First Volume. On the Development, Connexion, and Deposition of Morbid Products in the Tissues of the Human Body. With three Plates.-Leipsic, 1845. 8vo, pp. 287. SEVERAL of the German journals have, for some years past, afforded evidence of the industry and accuracy of Dr. Günsburg as a microscopic investigator; and we gladly welcome the appearance of the present volume, as affording us the means of laying before the readers of this Journal the results of some of his most important labours. The ordinary reader will undoubtedly regard the book as dry and uninteresting; it is exclusively devoted to the microscopic examination of morbid products, containing few illustrative cases, and being totally devoid of the startling and magnificent theories in which microscopists are too apt to indulge. It is divided into four parts, the first being devoted to the consideration of inflammatory products, the second to that of tuberculosis, the third to the typhous process, and the fourth to cancer. The products of inflammation are separately considered according as they affect:1. Serous membranes. 2. Mucous membranes. 3. The external skin. 4. Muscular fibre. 5. Nervous tissue. 6. The organs of respiration. |