DISEASES—PHTHISIS PULMONALIS, ETC.

IN treating of diseases in the district under consideration it is manifestly impossible—were it desirable —vithin the limits of this paper, to go over a complete system of nosology. I can only refer to the diseases which are most common there, and to any modifying influence which endemic circumstances 'seem to have over them.

By far the most common cause of death in Shetland, according to the Registrar-General’s Report already quoted, was old age, of which 149 persons died in 1862—being 30*77 per cent, of all the deaths, or 470 for every 100,000 living persons; while in Scotland the same year the proportion was 280, and in England, 133, for same number of living persons, old age being in the former division of the nation the second, and in the latter the fourth most common cause of death. This goes far to confirm the other arguments advanced for the salubrity of the islands, and the longer term of life enjoyed there. But old age is a cause of death, not properly speaking a disease. To begin with what may be called the most important, because the most fatal and incurable of all diseases in this country, viz., Phthisis: very discrepant opinions have been expressed as to its prevalence in Shetland. Thus, so able an author as Dr Hibbert declares, “Phthisis pulmonalis, pneumonia, croup, and scrofula are, as we might expect, very common.” Dr Edmondston also appears to think it a common disease, and states, “Consumption is certainly of more frequent occurrence in Zetland at present (1809) than it appears to have been at any former period.” It has long been my humble opinion that phthisis and other tubercular diseases, instead of being “very frequent” in Shetland, are there comparatively rare. On this subject, Dr Cowie, of Lerwick,1 a gentleman of large experience and extensive practice, writes me, “As regards scrofula and phthisis, my impression is that these diseases are not common here, but the statistics of different localities in every part of Britain, or at least in Scotland, would be required before any credit could be given to a mere individual opinion.” On applying to statistics, I find they abundantly confirm the “impression” of Dr Cowie and myself, and show that phthisis is in Shetland the second most common cause of death, being next in this respect to old age, which, however, carried off (in 1862) nearly three times as many as the first-mentioned disease—the numbers being, by phthisis 52, by age 149. In both England and Scotland, phthisis is the most common cause of death. For every 100,000 persons living, there died in 1862, of phthisis, in

Thus phthisis is shewn to be half as common in Shetland as in the Town districts, not far from half as common as in all Scotland, and very considerably less frequent than in the Insular and Mainland Rural districts. Taking all tubercular ailments, we have in 1862 deaths for every 100,000, being in

The other diseases of a tubercular origin are shewn to be very much less common than phthisis. Thus all the diseases of this class together are less than half as common in Shetland as all Scotland together. Scrofula and tabes mesenterica are about six, and hydrocephalus seven times as frequent in Scotland as in Shetland. Probably the large proportion of deaths (21 per cent.) in Shetland, the cause of which is not certified, and the greater difficulty of non-professional persons detecting other tubercular diseases than phthisis, may account for their apparent extreme rarity. As far as I have been able to ascertain, these diseases are very uncommon; and their seldom occurrence, as compared with phthisis, may be accounted for by the fact that many of those who die of the latter disease have taken unwell when out of Shetland, and returned home to die. It is not uncommon for sailors, shopmen, clerks, students, and female domestic servants, who have enjoyed perfect health in their native islands, to fall into consumption while employed at sea, or in the large cities of the south, and to return to their native islands when far advanced in disease. It is pleasing to be able to add that not a few even of such severe cases recover. As far as I can learn, phthisis seems to run a much more chronic course in Shetland than throughout the kingdom generally. There is little danger of the number of deaths from phthisis being understated, since a true case of it can be easily recognised by a sensible sick-nurse or elderly relative of the patient. I would rather apprehend inaccuracy from the number being overstated, as it is common for the peasantry to characterise most wasting diseases, which produce death by asthenia, as “decline” or “decay."