Appendix.—On various occasions I have dwelt upon the necessity of acquiring accurate information respecting the degree of mortality due to parasites, and in the present volume (p. [124]) I have referred to the defective evidences supplied by the returns of the Registrar-General in respect of the echinococcus disease. My object is not to cast blame upon those whose duty it is to publish the returns, but rather to call attention to the advantages that would follow if the Registrar-General were supplied with full and accurate information on this head.

Through the courtesy of Mr Noel A. Humphreys I have been furnished with the following official statement of the number of Deaths from Worms in England and Wales, as recorded in the Annual Reports of the Registrar-General throughout a decade of years:

1868186918701871187218731874187518761877
Total172148151160154183188227204225
Including— 
Porrigo15131919191415161713
Scabies161217111412—151213
Tapeworm18131613151315151216
Hydatids20203337413429433151

Considering the prodigious advances in helminthology during the last half century, it is certainly remarkable that under the category of “worms,” as a cause of death, only two kinds of true helminths should be mentioned in the Registrar’s record. It will also strike the experienced hospital and dispensary physician as somewhat remarkable that of the two death-producing parasites above named one of them should be the “tapeworm.” Now death from Tænia is certainly a very rare occurrence, although grave nervous symptoms are not unfrequently due to its presence in man. Thus, I am inclined to regard the 46 reported instances of death from this cause as a redundant estimate. On the other hand, I am surprised to see no specified instances of death from lumbricoid Ascarides, from Oxyurides, or even from Cysticerci, which now and then take up their residence in the human brain.

As regards hydatids I believe the returns to be excessively deficient. In place of an average of 34 deaths annually from this cause in the United Kingdom I am of opinion that at least 400 deaths are due to hydatids. This opinion and the data on which it was founded were communicated by me twelve years ago to the Linnean Society, and I have since become acquainted with facts which lead me to conclude that my original estimate was very much below the mark. The post-mortem registrar of one of our large hospitals has told me that of late years as many as ten deaths might be reckoned as annually due to hydatids in their institution alone. At a smaller hospital I ascertained that the average was about four. Obviously, if these estimates are correct, the Registrar-General’s returns for the United Kingdom do not record a tithe of the annual mortality due to hydatids. Perhaps another half century will elapse before the truth of my deductions be confirmed by the official returns. For me, it must suffice to have pointed to the desirability of securing more accurate records.

By a curious coincidence I had only just sent to press the sheet of this work recording the statistics of hydatid disease in Australia (p. [123]), when a paper dealing with the same subject appeared in the ‘Lancet.’ I refer to the brief memoir of Dr David Thomas, of Adelaide, South Australia, which was published on the 1st of March, 1879. Dr Thomas writes as follows:

“It is well known that Australia presents an extraordinary prevalence of hydatid disease, but, as far as I know, no definite statistics have been published to illustrate the fact. Consequently, some months ago, with the kind assistance of the Hon. W. Morgan, the present Chief Secretary of South Australia, I endeavoured to procure reports from the Governments of Victoria, New South Wales, Queensland, New Zealand, Tasmania, and Western Australia, upon this question. Unfortunately, the mode of registration of the causes of death in most of these colonies was such as prevented the necessary replies being supplied. However, it appears that in Tasmania no deaths were returned from this disease in the ten years 1867–77. During the greater part of the same period no separate classification of hydatid disease had been adopted in New South Wales; but in 1875 four deaths were attributed to hydatids; in 1876, eleven were so returned. In Victoria, however, the record of deaths from this cause is far more complete, and I append a table based upon the returns from that colony.

“One case, in which hydatid of the kidney was present, accompanied by malignant disease of bladder, with stricture, was not returned as a case of hydatid causing death.

“During the decade 1867–77, 2·5 per 1000 deaths were due to hydatid disease. In 183 out of the 307 cases the liver was either solely or conjointly with other organs the seat of disease. Holding the second place in frequency come the lungs in 71 cases, i.e. 53 simple and 18 complicated.”