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The Pamphlet Collection of Sir Robert Stout: Volume 80a

Class I.—Specific Febrile or Zymotic Diseases

Class I.—Specific Febrile or Zymotic Diseases.

The deaths ascribed to this class of diseases (which for the most part are regarded as specially preventible) during the decennial period was 4,846 males, and 4,513 females, and the annual mortality per 10,000 [unclear: living] ages and at the six groups of ages [unclear: give] Table III. was as follows :—
Ages. Males. [unclear: Females].
All ages 14.690 [unclear: 0]
Under 1 year 228.720 [unclear: 0]
Under 5 years 67.916 [unclear: 0]
5 to 15 years 6.607 [unclear: 0]
15 to 40 years 5.560 [unclear: 0]
40 to 45 years 6.966 [unclear: 0]
65 and upwards 27.015 [unclear: 0]

The above table shows that in early [unclear: life] also at old age, there is considerable [unclear: diff] in the mortalities of males and females, [unclear: t] this would be altogether lost sight of in [unclear: a] bined rate of the two sexes.

This class is divided into six [unclear: order] diseases—viz., miasmatic, diarrheas!, [unclear: mal] zoogenous, venereal, and septic. By [unclear: refer] Table I. it will be seen 2,726, or 56.25 [unclear: per] of the male deaths, and 2,504, or [unclear: 55] cent of the female deaths are [unclear: ascri] diseases of the miasmatic order, and [unclear: the] rates of all ages, and at six groups of [unclear: age] both sexes are set forth in table III. [unclear: T] principal diseases of this order [unclear: experi] in this colony are measles, scarlet [unclear: f] influenza, whooping cough, [unclear: diphtheria], typhoid fever. Smallpox belongs to [unclear: this] of diseases, but happily up to the present [unclear: t] this colony has been entirely free from [unclear: it] growing neglect of the precautionary [unclear: mea] of vaccination must, however, be [unclear: viewed] grave apprehension. For the year [unclear: 1893] number of births registered was [unclear: 18,187] according to the Registrar-general the [unclear: per] tion of successful vaccinations of children [unclear: un] one year of age to the total births [unclear: was] per cent., or only 2 children in every [unclear: 7] and it is well that the people should [unclear: be] minded again and again, of how the law [unclear: in] matter is being disregarded, for as [unclear: has] said by the same authority, "if [unclear: small] should unfortunately be [unclear: introduced], occurrence by no means [unclear: impossible], although the greatest care be [unclear: exercised], present inattention to vaccination may [unclear: be] cause of bitter regret."

The deaths attributed to the diseases [unclear: m] were as follows :—
Dlseases. Males Females [unclear: A]
Measles and Rubeola 345 290 [unclear: 0]
Scarlet fever and Scartelina 72 70 [unclear: 0]
Influenza 443 363 [unclear: 0]
Whooping Cough 631 605 [unclear: 0]
Diphtheria 535 612 [unclear: 0]
Typhoid and other fevers. 785 550 [unclear: 0]
Total 2,711 2,490 [unclear: 0]

The deaths from the affections named [unclear: t] considerably from year to year, and [unclear: eve] groups of years. For example, during [unclear: the] half of the period under review, the number deaths was 1,887 but in the second half [unclear: as] and this large increase is found to be due [unclear: man] to the epidemic of influenza (which [unclear: has] vailed during the last five years) and [unclear: b] epidemic of measles in 1893. From this [unclear: it] be evident that death-rates calculated [unclear: for] five years 1835-39 would be much more [unclear: far] able to the colony than if based on the [unclear: de] which took place in 1800-04. [unclear: However], average annual rate for each disease for [unclear: the] years seems the most suitable to exhibit [unclear: is] present article. Before proceeding to do however, there is one feature in the above [unclear: th] to which attention has to be directed. It is [unclear: a] that the deaths of females exceed the [unclear: deaths] page 11 [unclear: males] from two of the affections—viz., whooping [unclear: cough] and diptheria, and as the same feature has [unclear: been] exhibited in the vital statistics of other countries it may be regarded as a permanent characteristic, although the cause is still matter of conjecture.

Measles.—Of the 635 deaths ascribed to this disease 525 took place in one year (1893). It is also found that of the male deaths 263, or over 76 per cent., were of boys under five years of age, while of the female deaths 194, or 77 per cent., were of girls of the same age. The aggregate death rate of males was 1.047 per 10,000 ring, and of females 1.008. (To save needless repetition it may be stated that when a death rate mentioned it is the proportion to 10,000 living at all ages, or at particular groups of ages, unless otherwise indicated.) But as the disease is almost limited to childhood, an aggregate rate is of very little value for comparative purposes, hence a table will be given later exhibiting the death rate for this and the other miasmatic diseases at all ages, and at six successive age group.

Scarlet Fever.—The deaths attributed to this affection have been so few during the decennium an average of fourteen per annum—that it is not safe to draw conclusions as to the future from any ratios based upon them. Like measles it is mainly disease of childhood, most of its victims falling before the age of puberty. The death rate for males is found to be .219 for males and .243 for females.

Influenza.—In 1890 this colony, in common with many other countries, was visited by influenza in an epidemic form. In previous years a few deaths had been ascribed to this disease; the total for the five years—1885-89—being forty-three, but it is held by authorities that there is fair grounds for doubting whether the influenza deaths of those years were of the same nature and due to the same causes as the deaths since registered as due to influenza. In 1890 the deaths attributed to this affection were seventy; in 1891, 210; in 1892, 144; in 1893, 106; and last year, 233; but it is believed that the deaths really, caused by this disease were far more numerous, owing to the fact of many deaths being registered as caused by bronchitis, pneumonia, and other diseases of the respiratory system, which originated in attacks of influenza, and were complications of that complaint. The following is a statement of the deaths at various ages attributed to this disease :—
Ages. Male. Females. Total
All ages 443 363 806
Under 1 year 83 57 140
Under 5 years 109 77 186
5 to 15 years 15 10 25
15 to 40 years 64 87 141
40 to 65 years 154 78 232
65 and up 101 111 212

It will be noticed that the deaths of females exceed that of males at two groups of ages, fifteen to forty, and sixty-five and upwards. In Victoria for the year 1891 a similar feature was observed in respect of the deaths between ages fifteen and forty-five, but there was no excess of female deaths at ages sixty-five and upwards. In New South Wales, for the same year, the male deaths are the more numerous at all ages, except sixty-five to seventy-five. In England and Wales for 1891 there was an excess of female deaths at age five to fifteen, and sixty-five and Upwards. The larger number of deaths among females than among males over sixty-five in England has been held to be due to the fact that more females than males survive to the later ages of life; but this explanation will not hold good in this colony, where the males outnumber the females at this age period by about 2,500 in a total of about 14,000. The aggregate death rate of males was 1.345, and of females 1262. During the last five years when influenza was epidemic the aggregate rate for males was 2.452, and for females 2.247. The deaths from this disease for the present year are, we understand, below the average of the last five years.

Whooping-cough.—The deaths from this disease numbered 1,136—namely, 531 males and 605 females—and the aggregate death rate was 1.612 for males and 2.104 for females. The mortality from this affection is at its maximum in the first year of life, when the deaths were 349 males and 354 females. After the first year is passed the mortality falls gradually year by year, and after the tenth year becomes quite insignificant. The fact that this disease is more fatal to females than to males has already been noted, but the solution is still wanting.

Diphtheria.—It has been held by some authorities that the returns of deaths under this heading are not very reliable, there being apparently no thorough agreement among medical men as to the precise use of the term, and especially there being a difference in opinion as regards its relation to croup. On this account it has been thought best to exhibit the deaths from each alleged cause side by side, although croup is regarded as a disease of the respiratory organs in the classifications now in use.

Diphtheria Croup
Ages. Male. Female. Total. Male. Female. Total.
All Ages 535 612 1,147 374 293 667
Under 1 year 15 17 32 43 32 75
Under 5 year 230 211 441 160 197 357
5 to 15 year 269 351 620 106 92 198
15 to 40 year 29 46 75 8 3 11
40 to 65 year 5 4 9 1 1
65 and up 2 2

A comparison of the figures under the two headings will show that, though there may be no very clear line of demarcation between the deaths attributed to diphtheria and those attributed to croup, the two names cannot be regarded as merely synonyms of one and the same malady. For it will be observed that, taking the ages under forty, the mortality under diphtheria is greater among females at all ages except between one and five than among males, whereas the exact opposite is the case with the mortality under croup. The death rate from diphtheria is found to be 1.624 for males and 2.128 for females. In the case of croup, the proportions are : Males, 1.135; females, 1.019.

Enteric (or Typhoid) and other Fevers.—The deaths ascribed to typhus, relapsing, and simple fever have been so few in this colony, and the consequent death rates so insignificant, that all have been grouped together with typhoid. The mortality for the decennial period was 785 males and 550 females,—making a total of 1,335, the largest number ascribed to any single affection of the miasmatic order. It is found, however, that whereas the deaths in the first half of the period numbered 691; those in the second half were 644 only; so that when the increased number living in the latter period is considered, there has been a decrease in the death rates from this class of fever. Typhoid is unlike some of the other miasmatic affections in that it is most fatal during mature life, reaching its maximum at the age period 15 to 40. The aggregate rate for all ages is 2.383 for males and 1.912 for females. The following is a table of the death rates due to the several diseases dealt with :—

DISEASE. All Ages. Under 1. Under 5. 5-15. 15.40. 40.65. 65 & up.

Average Annual Death Rates of Males and Females from the Chief Miasmatic Affections (and the Deaths registered as Croup) per 10,000 living at successive age periods for the 10 years 1885-94.

Diarrhæal Diseases Order 2.—These include cholera, sporadic and epidemic, diarrhæa, and dysentery. A few deaths from simple sporadic cholera are registered every year, but up to the present the colony has been free of the more fatal type. The deaths ascribed to this order of affections were 1,777 males and 1,459 females, and the death-rate for all ages was 5.394 for males and 5.073 for females. These bowel affections are most fatal at the two extremes of life—infancy and old age, but especially the former, the mean annual mortality in the first year of life for the decennium having been 146.100 among male and 126 720 among female infants. By reference to Table III. it will be seen how the mortality falls, until a minimum is reached at the age period five to fifteen, after which it again rises continuously to the end. The deaths from diseases of this order have fluctuated considerably from year to year, the extremes being 475 in 1887 and 193 in 1893. Again the deaths in the first half of the period numbered 1,898, in the second 1,338, and in consequence the death rates for the second quinquennium are considerably less than for the first. For male infants under one year of age the rate fell from 162.01 to 129.52, and for female infants from 146.32 to 106.28 per 10,000 living at that age. Metrological conditions are regarded as having considerable influence on the causation of this order of affections.

Malarial Diseases Order 3.—These include remittent fever and ague, the bane of many countries, but in this colony the deaths in the period numbered 31 only—viz., 19 males and 12 females.

Zoogenous Diseases Order 4.—These include hydrophobia, glanders, splenic fever, and cow-pox, but from all of these the colony may be said to be yet free, seeing that in ten years the deaths entered in this order numbered three only, and these are ascribed to cow-pox and other effects of vaccination.

Venereal Diseases Order 5.—The deaths ascribed to this order of diseases were 114 males and 59 females. Of the deaths, more than one-third of the males and over two-thirds of the females were of children under five years of age. Medical authorities in Great Britain are of opinion that statistics of deaths of this order are page 12 untrustworthy. One medical statist (Dr. Long-staff) going the length of asserting that "With-out doubt the figures relating to alcoholism, venereal disease, and perhaps insanity are almost valueless." We have reason to believe many medical men in this colony hold similar opinions, and as we entirely concur with these views, further consideration need not be given to the figures at the present time.

Septic Diseases Order 6.—The chief diseases included in this order are erysipelas, pyæmia and puerperal fever. The deaths classed in this division were 209 males and 477 females. Of these 37 per cent, of the male deaths, but only 15 per cent, of the female deaths took place at ages under 15. Judging from the figures for the decennium, the death-rate appears to be declining. As this reduction might be thought to be due in some measure to the decline in the birth rate, it may be well to state that the decreased mortality is shared in by both sexes. The deaths in the first five years being 126 males and 264 females; in the second 83 males and 213 females.

In England Dr. Longstaff has been able to prove that a certain relationship exists between erysipelas and puerperal fever, the mortality from the two affections varying concomitantly.

Class II., Parasitic Diseases.—The chief affections of this class are thrush, hydatids, and worms, and the deaths in the ten years were 128 males and 109 females. Over 72 per cent, of the deaths were of children under five years of age, and nearly all these deaths are attributed to thrush or worms. Of the deaths at ages five and over—sixty-five in number—the large majority are classed under hydatids. The death-rate from diseases of this class for both sexes will be found in Table III., but it may be added that if periods of five years are taken there has been a considerable decrease in the deaths from the infantile affections, but an increase in those of adult life—the increase being greatest in the female sex. The numbers coming under observation are too few, however, for much dependence being placed on their analysis.

Class III., Dietetic Diseases.—The chief headings in this class are want of breast milk and intemperance. The deaths classed in this division numbered 401 males and 223 females, and it is found that over one-third of the male deaths and more than one-half of the female deaths were of infants under one year of age. It certainly sounds strange to find any considerable number of deaths attributed to starvation in this colony, but in the case of 135 male and 123 female infants this appears to have been the assigned cause during the last ten years.

The deaths directly ascribed to intemperance were 252 males and 93 females, and the death-rate for the ages at which the deaths took place are as follows :—
Death Rate per 10,000 living At each Group of Ages
Age. Male. Female.
15 to 40 0.548 0.339
40 to 65 2.394 1.122
65 and up 2.945 0.708

As has been already hinted at, there is so much chance of deaths from intemperance being disguised under the name of the local disease to which it gave rise—cirrhosis of the liver and the like—that but little reliance can be placed on the recorded deaths. Again, there is little doubt that many of the deaths ascribed to accident and suicide are primarily due to alcoholic excess.

Class IV.—Constitutional Diseases.—The deaths ascribed to the various diseases which are grouped together under this class number 5,892 males and 4,906 females, and the average annual death rate of this important class per 10,000 living is found to be 17.885 for males and 17.059 for females. As stated previously, the deaths in this class have been subdivided into four divisions. The deaths recorded against each are given in Table I., and the death rates in Table III. On further consideration, since these tables were made up, it seemed desirable that the deaths attributed to phthisis should be considered and dealt with by themselves. This has been done, and the results will be given in a later paragraph. Meantime, we will deal with the diseases in the order of their classification.

Rheumatism and Gout.—The mortality from rheumatic fever, rheumatism, and gout was 253 males and 259 females. By reference to Table III. it will be seen that the rate for females is considerably higher than that of males from age five to sixty-five, and this results in the general rate for females also being in excess of the male rate at all ages. This feature does not appear in the statistics of other countries we have examined, and it may only be accidental in the present instance. Dr. Newman asserted in 1883 that "rheumatism in all shapes is the great scourge of the colonist." This is no doubt true as regards the physical suffering it entails, but, directly, it never has been a specially fatal disease in this colony. In view of the hardships and exposures of the early settlers and gold-miners, one would have been inclined to look for a gradual reduction in the death rate from rheumatic affections; but such is not the case,—the death rate for the five years 1890-94 exceeding that of 1885-89 by 11½ per cent. in the case of males and 3.64 per cent, in the case of females. Can it be that these affections now kill more persons where formerly they only wounded ?

Cancer.—The deaths ascribed to cancer and other malignant tumours were 1,521 males and 1,268 females, and the average annual death rate per 10,000 living at all ages is found to be 4.617 in the case of males, and 4.409 in that of females; but a glance at the distribution of deaths from cancer in Table I. will show that a general rate for this disease must be very misleading. For it is found that over 91 per cent, of the male deaths were of persons 40 years of age and upwards, and that of the female deaths 11 per cent. took place at ages 15 to 40, and 88 per cent, at ages 40 and upwards. To obtain anything like correct results the deaths at groups of ages must be compared with the number living at corresponding ages and the death-rates divided in this manner are set forth in Table III. It has been shown that the rate for all ages is a little higher in the case of males than for females—this is contrary to the general experience in other lands, but may be accounted for here by the excess of males over females at all ages, but especially at the higher ages when cancer is most frequent. It is not possible for us to enter at any length into the alleged increase of cancer in the present article, but so much public attention has been given to the mortality from this disease that it may be of some interest and service if the deaths ascribed to cancer during the last fifteen years are grouped in three periods of rive years each. This has been done in the following table and for each sex. The age grouping adopted is decennial, with this exception, that all the deaths under 25 years of age are grouped together.

Deaths From Cancer in New Zealand in Groups of Years.
Males. Females.
Ages. 1880-4. 1885-9. 1890-4. 1880-4. 1885-9. 1890-4.
Under 25 15 20 26 14 4 14
25 to 35 16 16 17 24 34 33
35 to 45 53 58 70 87 90 110
45 to 55 129 172 227 123 157 211
55 to 65 895 191 322 85 140 209
65 to 75 54 117 191 45 86 110
75 and up. 24 36 58 17 31 39
Totals 386 610 911 395 542 726
At the first glance these figures [unclear: would] to indicate a considerable increase in the [unclear: d] rate from cancer, but it has to be remember that the population has also increased, [unclear: not] in numbers, but in age, and as cancer has [unclear: b] shown to be a disease of mature life, a [unclear: large] crease in the number of deaths from this [unclear: c] was to be expected. But to obtain the [unclear: requ] proportions we must compare the [unclear: deaths] each period and for each age interval [unclear: with] numbers living in the same period and at [unclear: c] sponding age intervals, and this is done [unclear: in] following table for ages 25 and over :—
Annual Death Rate From Cancer [unclear: in] Zealand Per 10,000 Living at [unclear: Each] Period.
Ages. Males. Females.
1880-84 1885-89 1890-94 1880-84 1885-89 [unclear: 1890-94]
25 to 35 .714 .687 .727 1.525 1.835 [unclear: 1]
35 to 45 2.648 2.995 3.550 6.952 6.506 [unclear: 1]
45 to 55 10.159 10.800 12.875 18.079 16.871 [unclear: 1]
55 to 65 19.762 26.951 31.328 28.445 33.787 [unclear: 1]
65 to 75 31.680 46.541 54.439 35.782 47.730 [unclear: 1]
75 and up. 47.486 48.044 55.844 44.690 52.659 [unclear: 1]

As was to be expected from the scanty [unclear: d] these rates of mortality do not run [unclear: v] regularly, and the figures for the age [unclear: inter] 25 to 35, and 75 and over, may be regarded of small value. At the other age intervals [unclear: f] male rates manifest a continuous, though [unclear: n] uniform increase, but the rates for [unclear: females] found to be very erratic. There is [unclear: neither] continuous increase nor decrease in the [unclear: r] for the three periods at any of the age [unclear: intern] except one—viz., 55 to 65, and this shows [unclear: a] tinuous but irregular increase, and [unclear: except] this age interval, and possibly the next [unclear: high] it can hardly be maintained that there has [unclear: b] any material increase in the death [unclear: rates] females from cancer during the last 15 [unclear: years]

The large increase in the male rates, [unclear: o] trasted with the stationary character [unclear: of] female rates up to age 55, and the small [unclear: incre] after that age would seem to indicate [unclear: th] much (though it may not be all) of the [unclear: inc] in the male mortality is apparent and not [unclear: r] due to improved diagnosis and more [unclear: can] statement of cause. For, as has been [unclear: statedly] the Registrar-general of England, "the [unclear: c] cerous affections of males are in a much [unclear: larg] proportion, internal or inaccessible, than [unclear: th] of females, and consequently are more [unclear: diff] of recognition, so that any improvement [unclear: k] medical diagnosis would add more to [unclear: the] than to the female figures." It may be [unclear: mentio] that the alleged increase in cancer has been [unclear: a] and exhaustively investigated by Mr. [unclear: Geo] King, an eminent British actuary, [unclear: and] Newsholme, Medical Officer of Health [unclear: f] Brighton, and formed the subject of a [unclear: jo] paper read before the Royal Society, [unclear: London] May, 1893. The conclusions arrived at by [unclear: th] gentlemen may be summarised as [unclear: follows]:—
(1)Males and females suffer equally in [unclear: tho] parts of the body common to man and [unclear: women]
(2)The apparent increase in cancer is [unclear: confin] to what may be called "inaccessible [unclear: cancel]
(3)The increase in cancer is only apparent [unclear: a] not real and is due to improvement in [unclear: diag] and more careful certification of death. [unclear: Thi] is shown by the fact that the whole of the [unclear: in] crease has taken place in inaccessible [unclear: canc] difficult of diagnosis, while accessible [unclear: cancer] easily diagnosed, has remained practically stationary.
The subject cannot be pursued farther here but we think enough has been said to quality page 13 dogmatic assertions as to the large increase in the death rate from cancer in this community. The facts as yet available do not allow of any valid deductions being drawn, and we must be content to wait and watch. It may be of interest now to record and compare the death rate from cancer in this colony for the last ten years, with the rates deduced by the gentlemen named for England and Wales for the three years 1888-90, and this is done in the following table :—
Annual Death Rate From Cancer Per 10,000 Living at Each Age Period (1) In New Zealand for the Ten; Years 1885-94; and (2) In England and Wales for the Three Years 1888-90. (In Messrs. King and Newsholme's table the rates given are per million living.
Ages. Males. Females.
N.Z. 1885-94. E. and W. 1888-90. N.Z. 1885-94. E. and W. 1888-90.
25 to 35 .707 .948 1.699 1.859
35 to 45 3.275 3.338 7.034 8.979
45 to 55 11.890 11.690 17.553 22.028
55 to 65 29.543 25.305 35.099 35.682
65to 75 51.142 44.052 46.742 52.090
75 and up. 52.576 43.935 48.101 52.754

From these figures it would appear that at age and over, the males in this colony are more subject to cancer than Englishmen; on the other hand it would appear that English females are more subject to the disease at all ages than our colonial women; but, as already hinted at, all our results regarding the rate of mortality in this colony must be regarded as tentative or provisional, and not as valid deductions, on what is admittedly a most difficult subject.

Tubercular Diseases.—The mortality from the affections we have included in this division was 3,787 males and 3.109 females, and the general death rate at all ages is found to be 11.495 for males and 10.810 for females. The deaths ascribed to tubercular affections as distinguished from phthisis—e.g., tabes mesenterica, tubercular peritonitis, hydrocephalus and the like, numbered 917 males and 796 females. These diseases are mainly, but not exclusively, fatal at the early ages, as will be seen from the following death rates based upon them :—
Ages. Males. Females.
Under 1 38.47 31.20
Under 5 13.05 10.49
5 to 15 1.77 1.92
15 to 25 1.69 1.95

At higher ages the rates are unimportant and need not be quoted.

Phthisis.—In a former paragraph it was mentioned that on account of the large mortality ascribed to phthisis it appeared desirable to treat it separately, and in the following table the deaths for the decennial period and the death rates are exhibited :—
Ages. Deaths. Death Rate per 10,000 living at each age period.
Male. Female. Male. Female
All Ages. 2,870 2,313 8.701 8.043
Under 5 39 58 .913 1.399
5 to l5 55 119 0.666 1.467
15 to 25 629 791 10.549 13.057
25 to 35 762 652 16.325 16.533
35 to 45 557 359 14.252 12.625
45 to 55 474 219 14.125 10.446
55 to 65 264 88 15.203 8.850
65 to 75 78 21 12.952 5.008
75 and over 12 6 6.712 4.123

Of the total of male deaths, 743, or over 25 per cent., are registered as having been born in the colony, and of the total of female deaths, 1,009, or over 43 per cent., are so registered, and this excess of deaths in colonial-born females deserves further investigation. The death rates from phthisis are seen to be high at all ages, with the exception of those under 15. In the rate for males the maximum is reached between the ages 25 and 35, then it falls to the age interval 45-55, and again rises for one interval, and falls rapidly at age 75 and over. In regard to females it will be observed that the maximum death rate is reached in the same age interval which contains the male maximum—25-35—and here also the rates in the two sexes come very near to each other—16.325 for males, 16.533 for females. After the maximum is reached the female rate falls successively in each later age period, instead of being interrupted as the fall in the male rate is. Comparing the death rates of the two sexes it is found that from birth up to 35 years of age the female rate exceeds the male, and considerably so at age periods 5 to 15 and 15 to 25. At age 35 and over the relation is reversed, and the male mortality for the remaining periods is the higher. Owing to the large mortality ascribed to phthisis, it is important to know whether the death rate due to it is increasing, decreasing, or stationary. To give some light on this point, the death rates for the three quinquennial periods 1880-4, 1885-9, 1890-4, have been calculated for all ages and for nine groups of ages, and we present the results for the first and last quinquennial periods herewith.

Average Annual Death Rate from Phthisis in New Zealand to 10,000 Living at Each Age Period.
Ages. Males. Females.
1880-4. 1890-4. 1880-4. 1890-4.
All Ages. 9.230 8.361 9.009 8.044
Under 5 1.849 .665 2.280 1.429
5 to 15 .723 .735 2.110 1.287
15 to 25 11.003 9.792 13.593 13.641
25 to 35 17.130 15.606 19.572 15.834
35 to 45 15.290 14.301 15.423 12.327
45 to 55 15.671 12.421 11.171 10.293
55 to 65 17.890 15.372 11.043 8.449
65 to 75 11.734 13.396 6.361 3.345
75 and over 11.872 8.665 7.886 5.770

It will be seen from these figures that, with three exceptions (and two of them so small as to be of no importance), a decrease has taken place in the rate of mortality at each age period and for both sexes. The one exception which is of any value is in the male rate and for the ages 65 to 75, where there has been an increase of about 14 per cent. The death rate at this age interval for the five years 1885-9 is 12.331, so that it would appear there has been a successive, although slight, increase in the rate during the last fifteen years. It may also be pointed out that the interruption in the sequence of declining death rates at ages 55 to 65 is manifested in each quinquennial period of years, so that this feature can hardly be regarded as accidental. What may be called the law of phthisical mortality appears to be the same here as in Great Britain—viz., that in the earlier stages of life the female sex, and in the later stages the male sex, is the more liable to death from phthisis. The actual rates in the two countries are, however, very different.

Rates for England and Wales Per 10,000 Living at Each Age Period, for the Ten Years 1871-80 (from the Supplement to the Forty-fifth Report of the Registrar-general).
Ages. Males. Females.
All Ages 22.09 20.28
25 to 35 36.99 35.43
35 to 45 41.20 34.01
45 to 55 38.60 24.64
55 to 65 31.95 17.77
65 to 75 19.24 10.93
75 and over 6.03 4.07

A comparison of the above rates with those already given for New Zealand will show at a glance how much we owe to our superior climate and surroundings.

Other Constitutional Diseases.—The chief affections in this class are anæmia and diabetes. The deaths ascribed to the first cause were 100 males and 91 females, to the second, 169 males and 102 females. These figures are far too few to yield results of much value, but it may be stated that these affections are in the large majority of cases fatal to persons of mature age. Taking the figures from year to year the death rate from anænia and suchlike affections appears to be about stationary, while that of diabetes appears to be on the increase for both sexes. The death rates for the whole of the affections in this division are set forth in Table III.

Class V., Developmental Diseases.—The chief headings in this class are premature birth, cyanosis, congenital defects, and old age. The deaths ascribed to the various affections which are grouped together in this class numbered 2,641 males and 2,038 females. Of the male deaths 1,450, or 55 per cent., were of infants under one year of age, and 1,166 or 44 per cent, were of old men, aged sixty-five and over. Of the female deaths 1,057, or 52 per cent., were of infants, and 959, or 47 per cent., were of women, aged sixty-five and over, so that the affections of this class are most fatal at the extremes of existence. It will be noticed that the deaths of male infants greatly exceed those of female infants, and it may be remarked that despite the decline in the births the death rate of infants under one year of age from affections of this class appears to be on the increase. For the five years, 1885-9, the rate for males was 147.23, and for females 110.07; whereas for the five years 1890-4, the rate for males was 159.00, and for females 129.58. On the other hand, the rates for the same periods in respect of deaths ascribed to old age exhibit a decrease from 164.35 to 140.31 in the case of males, and from 182.00 to 163.29 in the case of females. There can be little doubt that much of this decline is due to the more precise designation of the causes of death of old persons, but we are of opinion that these proportions are capable of being still further reduced.

Class VI., Local Diseases.—The deaths attributed to the various orders of disease which are grouped together to form this large and important class were 16,335 males and 11,909 females, and the proportion of these to the total deaths from all causes was close on 45 per cent, for males, and practically 46 per cent, for females. The general death rate of males is found to be 49.583, and of females 41.617; but it varies greatly in the different orders, as will be seen by a glance at the figures in Table III.

We will treat of the several groups in the order of their classified arrangement.

Diseases of the Nervous System. Order 1.—The affections included in this order relate to the brain and spinal cord, their membranes, and page 14 the nerves. The chief headings are apoplexy, paralysis, and convulsions, and the mortality ascribed to this order of diseases was 3,991 males and 2,783 females. Of the male deaths, 1,221, or over 30 per cent., were of boys under five years of age; and of the female deaths, 987, or over 35 per cent., were of girls under five years. About three-quarters of these children are registered as having died of convulsions under one year of age; but the registration of a death from this cause may mean little more than that the children died in a fit, the cause of which was not ascertained. The chief causes of the mortality over five years of age are inflammation of the brain and membranes, apoplexy, and paralysis. The death-rate, owing to the inclusion of convulsions in the group, is high in infancy (see Table III.), after which it falls rapidly, and attains its minimum at the age-period, five to fifteen; after this it rises rapidly with each successive advance of age. It should also be noticed that at every age-period the male rate is higher than the female rate; but had the age grouping been five yearly, the female rate would have been in excess at the period when puberty is being established. It may be of interest to state that when the death rates for the five years, 1880-4, are compared with those for 1890-4 a decrease is shown in the male rates at every age-group, but in the case of the rates for females an increase has taken place at ages sixty-five and over.

Diseases of Organs of Special Sense. Order 2.—These comprise affections of the ear, nose, and eye, and the deaths numbered forty-nine males and forty-one females. Fifteen deaths of each sex were of children under five years of age.

Diseases of Circulatory System. Order 3.—The affections included in this group relate to the heart and its membranes, and the chief headings are valvular disease, fatty degeneration of heart, syncope, aneurism, and embolism. The deaths attributed to the various diseases were 3,063 males and 1,746 females. Of the males, 2,497, or 81 per cent., were aged forty years and over; and of the females, [unclear: 1] 71 per cent., were of these ages. The [unclear: m] death rate for males falls between the [unclear: fif] fifteenth year, but in the case of females in the earlier period. When the minimum passed there is an uninterrupted rise [unclear: i] successive age-periods until for age seventy and over the rate reaches 163.320 in [unclear: the] males, and 102.390 in that of [unclear: females] death rates have been calculated for each [unclear: of] last three quinquennial periods, and [unclear: wh] general decrease may be said to have [unclear: been] fested at ages under fifty-five, at and [unclear: over] five there has been an increase in [unclear: the] rates for both sexes, but the increase [unclear: is] marked in the case of males aged [unclear: seventy] years and over. It may be that the [unclear: ep] of influenza in the last five years has [unclear: contri] towards this result. It was our intention [unclear: t] investigated the deaths ascribed to [unclear: v] disease, fatty degeneration of the [unclear: heart,] aneurism, but time has not permitted.

Males.Females.Causes of Death.All ages.Under 1 year.Under 5 years.5 to 15.15 to 40.40 to 65.65 and upwardsAges not specifiedAll agesUnder 1 year.Under 5 years.I 5 to 15.15 to 40.40 to 65 65 and upwards Class.

Table I.—Showing the Number of Deaths Registered in New Zealand During the Decennium 1885-1894, Classified According to Classes, Orders, and Diseases.

page 15

Diseases of Respiratory System. Order 4.—The affections grouped together in this order [unclear: e] late chiefly to the bronchial tubes, the lungs, [unclear: and] the pleura. The deaths ascribed to the [unclear: var] ious causes were 4,654 males and 3,278 [unclear: females] the largest mortality attributed to any [unclear: order] of diseases; and by reference to Table II. [unclear: the] proportion of these deaths to the total deaths [unclear: from] all causes will be seen. In Table I. it is [unclear: shown] that of the male deaths 1,954, or 42 per [unclear: cent] of the total, were of children under five [unclear: years] of age (indeed, 1,205, or close on 26 per cent., were infants under one year of age). At [unclear: age] forty and over the number of male deaths was 1,926, almost the same number as the deaths under five years. Of the female deaths 1,516, or [unclear: 16] per cent., were of children under five years [unclear: 1908], or 27½ per cent., being under one year). [unclear: At] age forty and over the number of female deaths was 1,048, or 32 per cent. of the total, a considerably smaller proportion than was found to be the case among males, indicating that the affections of this group am more fatal to the mile sex between the ages of five years and forty, than they are to the male sex.

The average annual death-rate for the whole order is given in Table III., but the large number of deaths ascribed to bronchitis (viz., 1,675 [unclear: ales] and 1,367 females) and pneumonia (viz., 1,729 males and 1,078 females) has induced us to [unclear: deal] these two affections by themselves. Before exhibiting the death-rates of each it falls to be mentioned that the number of deaths disrobed to these two affections in the last five [unclear: ras] was considerably greater than in the first five of the decennial period. For example, the Maths ascribed to bronchitis in the first period Cumbered 1,398, in the second, 1,644; again, the deaths assigned to pneumonia in the first quin-quennium were 1,292, in the second, 1515, and it is presumable that much of this increase was due primarily to influenza.

Annual Death-Rate from (1) Bronchitis and (2) Pneumonia Per 10,000 Living at each Age-Period for the Ten Years 1885-94.
Ages. Bronchitis. Pneumonia.
Male. Female. Male. Female.
All Ages 5.08 4.75 5.25 3.75
Under 1 year 76.51 61.72 30.90 28.26
Under 5 years 21.78 17.41 13.21 10.30
5 to 15 years .41 .52 .92 .99
15 to 25 years .12 .43 1.78 1.67
25 to 35 years .21 .56 2.59 2.84
35 to 45 years .92 1.13 4.53 3.62
45 to 55 years 2.71 2.96 7.42 3.91
55 to 65 years 9.67 11.87 13.25 6.64
65 to 75 years 32.71 39.83 23.58 16.22
75 and over 112.98 120.94 35.80 26.80

It will be noticed that while the general death-rates of males from both affections come near each other, in detail they show very great differences. Thus in pneumonia the maximum is in the first year of life, whereas in bronchitis the mortality in this period, though high, is much less than that experienced at ages seventy-five and over Another feature is that the death-rate from bronchitis is less than the rate from pneumonia at all age-periods under sixty-five-seventy-five, and as has been said, "the pneumonia mortality unequally spread though it is over the several periods of life, is much less so than is the case with the mortality from bronchitis" The same remarks are applicable to the female mortality, only the differences in the death-rates are greater. Another feature to be noticed is this, that the female mortality for each age-period higher than five-fifteen is in excess of the male. In England the female mortality is greater than the male at ages five to twenty years only. Again it will be noticed that the excess of the male over the female mortality at age forty-five and over is very much greater in pneumonia than in bronchitis. Indeed, at one age period, fifty-five-sixty five the male mortality from pneumonia may be said to be double that of the female sex, whereas in bronchitis—at all ages where the deaths are at all numerous—the mortality of the two sexes exhibit smaller differences.

male.Female.Causes of Death.all Ages.Under 1 Year Under 5 Year 5 to 15.15 to 4040 to 65.65 and Upewards.All Agres.Under 1 Year.Under 1 Year.Under to 15.15 to Years. 40 to 65. 85 and Upwards.atic Diseases" "rtheal"

Table II—Proportion of Deaths From Various Causes to 100 Deaths From All Causes, at all Ages, and at Six Groups of Ages During the Ten Years 1885-94.

Diseases of the Digestive System. Order 5.—A large number of affections are grouped together in this order, chiefly relating to diseases of the stomach, liver, and intestines. The deaths numbered 3,070 males and 2,514 females, and it is found that 47 per cent, of the male mortality and 45 per cent, of the female was of children under five years of age, the chief affections which proved fatal to them being dentition and diseases of the stomach and bowels. On reference to Table III. it will be seen that the male mortality is in excess of the female as a whole, but that at ages fifteen and over the female mortality is the higher. The mortality of mature life is ascribed to gastritis, obstruction of bowels, peritonitis, cirrhosis, and other liver diseases. In the case of peritonitis, the female exceeds the male mortality at all aces after puberty considerably; but in the case of diseases of the liver the relation is reversed. Taking a general view of the mortality attributed to this group of diseases, for the last fifteen years a decrease is exhibited in most of the age periods, though not in all.

Diseases of the Lymphatic System. Order 6.—The deaths ascribed to this group of affections numbered 56 males and 57 females, and these numbers are so few that they need not be commented upon.

Diseases of the Urinary System. Order 7.—The chief headings in this group are inflammation of the kidneys, Bright's disease, and diseases of the bladder and prostate. The deaths ascribed to the various affections numbered 1,169 males and 501 females; 96 per cent, of the male and 92 per cent, of the female mortality was of persons aged fifteen and over. By reference to Table III. it will be seen that the male is in excess of the female mortality at all aces, but especially so at age sixty-five and over. Judging from the deaths in the last ten years, the mortality of this order appears to be on the increase, and this accords with the experience in England.

Diseases of the Reproductive System. Order 8.—The number of deaths attributed to the diseases of this group numbered 16 males and 917 females. In regard to the female mortality, It is found that during the last five years—and at all ages under forty-five—there has been a decrease (very decidedly so at ages twenty-five to thirty-five), but at the age interval, forty-fife to fifty-five, and higher, the figures indicate a slight increase.

Diseases of the Locomotive and Integumentary Systems. Orders 9 and 10.—The mortality for the ten years was 262 males and 132 females, the majority being persons under fifteen years of age.

Class VII. Violence—The mortality ascribed to this class of causes was 4,448 males and 1,014 females, giving an average of close on 445 males and 101 females per annum. The general rate of mortality was 13501 for males and 3526 for females. From this it will be seen that the male mortality was close on four times as great as in the female. The excess of the male over the female mortality is very considerable even in early life, but at ages fifteen to sixty-five it is about six times as great. The mortality ascribed to accident or negligence was 3,910 males and 904 females. Of the assigned causes of accidental death, drowning, fractures, and burns or scalds are the chief. For the five years 1885 9 the page 16 general death rate of males was 12.329, bat for the next five years it fell to 11.447, and the reduction would have been greater but for the deaths which took place at the wreck of the s.s. Wairarapa last year.

The deaths ascribed to suicide numbered 492 males and 87 females, and the death rate is given in Table III. for the decennial period. For the last five years it is found that the death rate for males is slightly over the rate for the five years 1885-9, more especially at the age interval twenty-five to thirty-five, and at ages fifty-five and over.

The average death rate for all ages in 1885-9 was 1.424, and in 1890-4 the rate was 1.557. As stated in a former paragraph the figures relating to suicide cannot be relied upon, and little improvement can be looked for under the present system of finding and certifying the cause of death. Taking the figures as extracted from the annual return, the death rate for each sex is given in Table III.

The deaths ascribed to homicide and execution numbered 46 males and 23 females. Of the latter 11 are registered as under five years of age In England and Wales, and for the ten years 1871-80, the death rate of males from violence at the undernoted ages is given by the Registrar-general as follows. The death rate for this colony is put opposite for easy comparison :—
England & Wales. New Zealand
1871-80. 1885-94.
All ages. 11.16 13.50
Under 5. 13.50 12.18
5 to 10. 5.27 5.49
10 to 15. 5.96 5.49
15 to 20. 7.61 10.82
20 to 25. 9.24 10.82
25 to 35. 10.31. [unclear: 14]
35 to 45. 12.78. 18
45 to 55. 15.84. [unclear: 20]
55 to 65. 19.70. [unclear: 26]
65 to 75. 22.12. [unclear: 30]
75 and over. 28.48. [unclear: 48]
SEX.ALL AGES.AGES.Under 1 year.Under 5

Table III.—Average Annual Death Rates From Various Causes to 10,000 Living at all Ages and At Six Groups of Ages During the Ten Years 1885-1894.

England & Wales, 1871-80 New Zealand, 1885-[unclear: 18]
25 to 35 10.31 [unclear: 14]
35 to 45 12.78 [unclear: 18]
45 to 55 15.84 [unclear: 20]
55 to 65 19.70 [unclear: 26]
65 to 75 22.12 [unclear: 30]
75 and over 28.48 [unclear: 48]

From this it will be seen that the [unclear: ma] from violence in this colony is [unclear: consider] excess of what it is England at all [unclear: ages] under five years of age.

Class VIII. Ill-defined and Not [unclear: Sp] Causes.—The deaths entered in this class [unclear: hav] already adverted to, but it may be stated, [unclear: f] that the deaths are in about the same [unclear: prop] to the total deaths as obtains in [unclear: Engla] Wales.

It is also found that 76 per [unclear: cent] male deaths and 82 per cent, of [unclear: the] deaths are of infants under one year [unclear: of a] it is a serious reflection to think [unclear: that] many deaths the cause could not be [unclear: ascend] It is satisfactory to note, however, [unclear: that] stantial decrease in the mortality [unclear: in] class has taken place during the last [unclear: five] For 1885-9 the general rate for males [unclear: was] but for 1890-4 it was 4.457 only. For [unclear: l885] female mortality was at the rate of [unclear: 5.699] the last five years it fell to 3.854. [unclear: We] that no small portion of this reduction [unclear: is] the efforts made by the Registrar-general by year to obtain a more definite [unclear: statete] cause from medical men in all doubtful certified by them. In cases not certified medical man, the position is very [unclear: unsatis] and should be remedied as soon as possible

Throughout this article but few [unclear: comp] have been made, and mainly for [unclear: this] that the suitable materials are not [unclear: available] death rate from cancer is an [unclear: exception;] of the death rates for England come [unclear: down] the year 1880, and important changes [unclear: h] doubt taken place in many of the rates [unclear: since]

Comparison with the death rates of [unclear: A] would have been useful and [unclear: interesting;] general rate for all ages, and in most [unclear: c] persons without distinction of sex, is, [unclear: as] shown, not of much value. The fact is, [unclear: the] rates in this colony may be said to be [unclear: sui] or a class apart, and hence there is [unclear: no] standard with which to compare them.

In several cases the numbers dealt [unclear: with] been too small for much confidence [unclear: being] in the results; but in other casts [unclear: the] deduced are likely to be near the [unclear: truth,] events, a beginning has been made, and [unclear: those] take up the subject after this will [unclear: have] ground work to go upon. In such a [unclear: nu] calculations as had to be made for [unclear: this] some small errors may have crept in, but [unclear: co] able care has been taken to prevent them. Ruskin says, "The work of science is [unclear: to] ute facts for appearances, and [unclear: demonstrate] for impressions," and we trust that [unclear: soc] has been done in this article tending in [unclear: this] tion. The rates and ratios [unclear: published] article and the accompanying [unclear: tables] selection only of results which [unclear: have] calculated out in connection with [unclear: the] but enough has been published, we hope, [unclear: to] an interest in it, and to enable medical [unclear: n] others interested in the health and [unclear: happ] the people to see somewhat more [unclear: clearly] before the lines along which improvement desirable, and indeed necessary. The [unclear: p] is, as Dr. Farr stated years ago: "[unclear: How] the people from hereditary disease, [unclear: va] and criminality . . . and to [unclear: develop] mass the athletic, intellectual, [unclear: aesthetic,] and religious qualities, which have already distinguished some of the breed. There is [unclear: a] image in the future, to which the [unclear: natioc] aspire, the first step towards it is [unclear: to] the health of the present generation."