from the reports as to the form of cardiac disease which conducted to death. It would seem that valvular disease and hypertrophy are usually present and in association with each other; while in a considerable number the heart is returned as "fatty." My own impression is, that atheroma and the calcareous transmutation in the first portion of the aorta most frequently present themselves, and lead on to hypertrophy and dilatation. The heaviest heart I have met with weighed 31 ounces, and there the beginning of the aorta was completely encircled by calcareous deposits.

Aneurism. Of the 15 deaths from this cause, 10 were in males and 5 in females, certainly a high relative proportion in the latter. In 3 of the cases the situation is not given; in all the others the aneurism was aortic: thoracic in 8, abdominal in 2, combined thoracic and abdominal in 1, and not stated in 1. The unfortunate' circumstances of the class from which our female prisoners especially come readily suggests syphilis as the probable cause of aneurism occurring among prisoners, and may explain the relatively high proportion among the women. On this subject Dr. Rendle, of the (then) female prison, in his Report for 1864, thus remarks:-"This disease (aneurism) occurs not unfrequently among female prisoners, and is, I believe, induced by a change in the coats of the large blood vessels, which is of a syphilitic origin."

Pericarditis is recorded as the cause of death in 7 males and 1

female.

4. Digestive System.-In the eye of the prisoner no system deserves more (and, he will say, receives less) attention than this. Its working capabilities, he feels, are in excess of the encouragement afforded to it in the way of food-supply; but so, also, says the honest poor man. However, as a pathological subject in prisoners, its interest is secondary.

Reckoned upon the whole, mortality in both sexes, 8.7 per cent. of the deaths are due to diseases of the digestive organs, the total number being 133 (males 108, females 25). Of these deaths, 52 were due to peritonitis and enteritis, 35 to dysentery and diarrhea (one or two being of a choleraic nature), 27 to diseases of the liver, 10 to hernia, and 9 were of an anomalous nature. Undoubtedly a proportion of the cases where the peritoneum was involved had a tubercular origin, but the list includes one death each from rupture of the stomach, colon, and gall bladder.

Dysentery and diarrhea will be referred to under zymotic diseases.'

Hepatic disease is not prominently fatal among prisoners, but even in cases where death is caused otherwise, post-mortem examination frequently reveals extensive alterations in the appearance and structure of the liver. The 'nutmeg' liver, due either to amyloid or fatty degeneration, is the condition most frequently met with;

and, where the organ is altered in size, enlargement seems to be the almost invariable condition. The advanced state of cirrhosis with contraction and atrophy is rare, when we consider the numbers of wretched chronic drunkards that come under treatment in prison. The circumstances of prison life, involving a regular, though restricted, diet, and abstinence from spirituous liquors, tend to correct rather than to create diseased states of the liver, and we cannot, therefore, attribute to imprisonment the frequent occurrence of pathological changes in its structure. That frequency seems to depend, first, upon the great prevalence of consumption among prisoners, and, secondly, upon habits of dram drinking indulged in prior to conviction. As far as actual deaths are concerned, liver disease shows favorably in females as compared with males, the numbers being 2 among the former, and 25 among the latter. The relative mortality is striking, and I am inclined to refer the difference to the presence among the men of some old soldiers, whose residence abroad has helped to develop the disease in a more active form.

The 10 deaths from hernia were, with one exception, among the men, and are referable, most likely, to their labour. We are not told whether they were operated on or not.

5. Urinary system.-Diseases of the urinary organs caused 55 deaths (10 of them being in females). This gives a per-centage of 3.6 upon the whole mortality, a rate which I am sure fails to represent the influence which renal diseases exert among the causes of death.

From a pathological point of view, degeneration of the kidneys must be looked upon as of the first importance. Whether it presents itself (secondarily) as a morbid condition more frequently than the liver I am not prepared to say, but the aggregate mischief caused by it certainly seems to be greater.

As the origo mali in many dropsical effusions, and even in some cases of heart affection, renal disease must not be overlooked, while secondarily it is a common associate of phthisis and other constitutional diseases of a low type. The enlarged fatty kidney, and the somewhat smaller tough kidney of amyloid degeneration, are met with; the former more frequently, I think, than the latter. Cysts are of no infrequent occurrence.

The bladder sometimes leads on to death by chronic inflammation or through malignant disease.

6. Constitutional and general diseases.-The variety of diseases that come under this heading makes useless for us to attempt any general comparative statement with regard to them. The nature of this various group will readily be understood by reference to the following table, which sets forth the numbers in both sexes, as well as the total mortality due to the individual causes.

Struma or scrofula can scarcely be called a fatal, although a very common, disease among prisoners. Its great frequency among them is rather to be recognised as a constitutional state or cachexia, inherited or acquired, which renders them at once more liable to the accession of diseases, and less able to resist their influence.

Its presence is indicated by a general unhealthiness of aspect, with or without glandular swellings, skin eruptions, or other external manifestations.

Struma goes hand-in-hand with phthisis, and through this channel it acquires its largest connection with the death rate. But when it chooses to act more directly, it presents itself in the form of large abscesses, which often work sad havoc before they extinguish life. Apart from the deaths from diseases of bones and joints (17 in number), the majority of which might be included in the same category, diseases of the strumous class were fatal in 53 cases (45 in males and 8 in females). Of these, 39 deaths were from abscess, the great majority of which come under under the designation 'psoas' or 'lumbar.'

Cancer was fatal in 29 cases: 19 males and 10 females. The seat in order of frequency is given in the following list:

The particular form is seldom given. Diabetes caused 6 deaths, one of them being in a female.

Veteran criminals to the number of 7 became extinct through age and decay, but a number of the old men are carried off by pulmonary and other attacks.

Zymotic diseases.-We now come to consider a class of diseases, the zymotic, which are of peculiar interest to us. We shall first dispose of the enthetic, dietetic, and parasitic orders, by stating that only two deaths (syphilis) were due to the first, one (purpura) to the second, and none to the third.

The miasmatic order (to which we shall refer in our use of the term zymotic disease) claims 66 deaths for the whole 15 years; males, 55; females, 11.

The total number of deaths represents an average annual mortality from zymotic diseases of 4.4 in a mean population of 7551 prisoners, or of .58 per 1000.

Zymotic diseases cause 4.3 per cent. of the deaths from all

causes.

Table VI shows the fatal diseases belonging to this class.

Diarrhea and dysentery.-The latter disease does not often present itself in prison in its true form. Diarrhoea, resulting for the most part from atmospheric influences, but sometimes from dietary changes also, not unfrequently makes its appearance as a passing epidemic. The rarity of death shows that it is not usually severe, but the early application of prisoners when attacked, and the means adopted to check when possible, any general cause of the disease, no doubt exert a favorable influence. Diarrhoea and dysentery together are the main cause of death in the zymotic class, being fatal in 35 out of the whole 66 cases.

The few deaths from infectious and contagious diseases also speak very favorably. It is not to be expected that prisons should be absolutely free of such ; but while a few deaths indicate their presence, they show also that some influence is at work, or some means adopted whereby they are prevented from spreading. Fevers, smallpox, and erysipelas, caused only 28 deaths in the fifteen years in the whole population, and only one death in each of the three years last reported upon.

These results are the more interesting when we remember the large amount of disease, as well as the general low tone of health, which characterise the inhabitants of our prisons. The separation of convicts from the general public (except through the officers), and the means at disposal for complete isolation when individuals are seized with contagious disorders, as well as the habits of cleanliness and regularity enforced throughout the prisons, must exert a powerful and favorable influence in preventing the approach and the spread of zymotic diseases. The importance which diseases of this class have in relation to the question of public health has induced me to make some pointed allusion to them. Exactly a century ago the English prisons could only be looked upon as a very hotbed of pestilence and squalor. The tide had risen high, but its height had been reached, and the sanitary act of 1774 was, thanks to the indefatigable labours of Howard, the signal for its ebb. The hundred years have not been without their work; but that work has proved a triumph, and I believe sanitary science can point to no more signal success than the facts that for the past 15 years, ending with 1870, the convict prisons of England have been entirely free from fatal epidemics, and that the mortality in them from zymotic diseases has been reduced to a minimum.

They now take rank, as Dr. Guy has said, abodes of men."

7. Accidents and Violence.

among the healthiest

The violent deaths were altogether 74 in number, being at the rate of 5 per annum for the 15 years.