PHILADELPHIA COUNTY MEDICAL SOCIETY-
Dr. S. Jackson (late of Northumberland) in the Chair.
Meding for Discussion.
(Reported by Mr. J. Aitken Meigs.)
Upon the causes of the greater mortality of male children, and the
influence operating to change the relative proportion of the sexes
at birth. By G. Emerson, M. D.
Up to the fifteenth year, there is an excess of 15 per cent, in
the number of deaths of boys over that of girls. This excess in
the male mortality is commonly ascribed to the greater exposure,
and rougher sports and amusements of the boys; an erroneous idea,
the fallacy of which is shown in the fact that the majority of the
deaths of the males takes place in early infancy, when no such
exposure and danger consequent to said rough sports can possibly
exist. The deaths of boys, too, from climbing, swimming, &c.,
equal those of the girls from scalding, domestic accidents, &c.
The particular diseases which give rise to death in the two
sexes, are very different in their nature and characteristics. Thus,
males are attacked with violent inflammation of the brain, accom-
panied with serous effusions, convulsions, &c.; inflammations of
the stomach, lungs and other important organs; while females
suffer from hooping-cough, small-pox, measles, thrush, &c. In
boys, the character of the disease is sthenic; in girls, asthenic.
The diseases from which females suffer most are seated in the cu-
taneous and mucous tissues.
Of 100,000 deaths reported by the Registrar-general of Eng-
land, 31,671 were under the fifth year; and of these, 15,006 were
females, and 16,665 were males. Of the above, the number of
deaths from inflammation of the brain were 2550 males, and 2081
females; of dropsy of the brain, 1481 males, 1151 females; small
pox, 213 males, 240 females; hooping-cough, 1115 males, 1445
females; measles, 1048 males, 1028 females, etc.
From these and similar statistics, the inference follows that
the disproportion in the deaths of the two sexes, during childhood,
does not arise so much from exposure to external circumstances,
as from differences in physical organization.
From the fact of boys succumbing so easily and so rapidly to
diseases of a sthenic type, and females to those of an asthenic cha-
racter, we deduce the practical hint of combatting most energeti-
cally the inflammatory symptoms, of the one, as soon as manifest,
and preventing too great exhaustion of the system when symp-
toms of depression begin to appear in the female infants.
The Dr. then spoke of the effects of weather upon infant mor-
tality, and more particularly of the limitation of the effects of hot
weather, to the period of lactation. For interesting facts relative
to this subject, he referred to statistics lately published by himself
in the American Journal of the Medical Sciences.
During the first year of infant life, the season of the greatest
mortality is the three hot summer months. The number 250 re-
presenting the mortality for May, we would have 836 as that for
July. After the second year the deaths are more equally dis-
tributed throughout the months; the number seeming even less in
the hot than in the temperate and cold seasons. The heat, which
at an earlier period was inimical, would now appear to be friendly
to infantile life.
Dr. E. next referred to the influence of certain agencies which
changed the ordinary proportions of the sexes. The general pre-
ponderance of males over females at birth, is about 7j per cent.
In 1833 the singular phenomenon of a reverse proportion was
evident. There wTas not only a deficiency of male births, but
moreover, in the months of April and May of that year, a decided
female excess. Upon further investigations, this female excess
was found to be the product of conceptions occurring in the months
of August and September of 183*2. This, as is well known, was
the period of the first invasion of epidemic Cholera. Looking
abroad for corroboration of this singular fact, it wTas found to hold
good also, in the proportion of births occurring nine months after
the epidemic had appeared at Paris. From this and other inves-
tigations, he arrived at the conclusion, that this change in the
relative proportion of the two sexes at birth, was owing to the
depressing influence of cholera. He has further observed that a
tendency to the above result is always produced by the operation
of any class of depressing agents, W’hile circumstances that tend
to high physical development increase materially the male excess.
In France and Prussia, where the mass of the people labor
much harder than in our own country, and are poorly fed and
clothed, the excess of female births is slightly under 6 per cent.;
in England, 5 percent.; in Philadelphia, 7.5 per cent.; and in
our western country as high as 10 per cent.
Investigations into the comparative proportions of the sexes born
in city and country populations, manifest the existence of a
greater male excess in rural districts. This, from the foregoing
observations, was to be expected, since in cities, intemperance,
foul and vitiated atmosphere, unwholesome diet, and other depres-
sing agencies, operate much more strongly than in the country.
Hence, the Dr. observed, this proportion of the births of the two
sexes, may be considered as a sort of natural thermometer of the
physical comfort and advantages enjoyed by a community.
The institution of polygamy may have originated in a scanty
supply of food occurring at some former period in the community
where such institution exists, and evincing its depressing tendency
by a predominance of the female over the male population. Once
established it would foster itself.
The proportion of the two sexes being under such considerable
control, it remains for the various legislative bodies throughout
the civilized world to benefit and meliorate by their wise enact-
ments the condition of the social cosmos.
Dr. J. Bell desired to suggest to Dr. E. an anatomical fact
which he deemed would go far towards explaining the excess of
male deaths. The male head, he stated, is larger at the period of
birth than the female, and consequently much more liable to
severe pressure during the active throes of labor; and as a conse-
quence of such disastrous pressure of the cranial parietes upon the
encephalic mass, death, or at least disease, insidiously, but surely
terminating in death, must sooner or later supervene. In accord-
ance with this anatomical observation, we find that the majority
of male deaths occur during the early months of the first year of
infantile life. Pregnant women, it is well known, die more fre-
quently from giving birth to male infants, rather than female.
The above facts Dr. B stated upon the authority of Dr. Simpson,
by whom the observations in question—although not original with
him—were brought before the profession. Dr. J. Clarke, of
Dublin, had noticed the same fact, as had recently, Dr. Cheau, in
an essay in the Annales d’Hygibne, et de Medicine Legale, Juillet,
1846. Tiedemann affirms, also, that the difference in the size of
the male and female brain, at birth, is retained throughout life.
Dr. Darrach. The cerebral lobes of the male brain are larger
than those of the female, while the cerebellum of the latter pre-
ponderates over that of the former. Hence the ovoidal form,
which we so much admire, in the female head. During parturition,
the male head, in consequence of its approximation to the spherical
form, is subjected to an almost equal pressure upon either of its
axes, while as respects the female ovoid, the difference between
the pressure upon the conjugate and transverse diameter is con-
siderable. This anatomical fact is sufficient to explain the greater
mortality among the male infants after parturition. The seeming
want of development of the cerebrum is amply compensated, in
the female, by the proportionally larger size of the ganglionic
system, and the more complicated nervous connections existing
between the pelvic ganglia and viscera. The necessity and utility
of this equilibrating preponderance in the sympathetic and pelvic
ganglia, becomes obvious when we reflect upon the function which
the female performs in the grand economy of life. Generation
demands the continued exercise of her strongest sympathies, not
only during the tedious, painful and laborious steps of the process,
but long afterwards, when a living creature, weak and helpless,
looks to her for sustenance, comfort and protection.
Dr. Emerson admitted that some weight might be due to the
opinion, that serious injury was often sustained by the infant brain
during parturition, but that this injury did not explain the cause
of cerebral disease and mortality occurring at more advanced
periods of infancy.
Dr. Coates desired to know why Philadelphia was pre-eminent,
among all other cities in the Union, for the mortality that occur-
red in it from cholera infantum during the second year of infantile
life.
Dr. Darrach. New York, Boston and Charleston enjoy sea air,
while Philadelphia is enveloped almost uninterruptedly in an at-
mosphere maintained at a high temperature. Add to this the
alimentary cause of irregular or improper diet, and we have
efficient explanation of the origin of the cutaneo-abdominal symp-
toms, which are prominent in this disease. As confirmatory of
this opinion, he mentioned the successful results which he had ex-
perienced in the treatment of the malady. Acting upon the sug-
gestion of Dr. Chas. Caldwell, he was accustomed to send his little
patients to Kaighn’s Point, giving them, at the same time, calo-
mel in minute doses. This place is selected as enjoying, from the
peculiarity of its location, the benefits of a sea breeze above all
others situated so high up in the course of the Delaware river.
Old pilots and sailors, residents of this spot, bear testimony to the
fact of the existence of a sea breeze, and speak of it in this re-
spect as a sort of minor Cape May.
Dr. Emerson concurred with Dr. Darrach in thinking that the
continued heat, such as we have in this city, uninterrupted by any
or scarcely any refreshing coolness, was an efficient agent in pro-
ducing the disease. But he would call to the minds of the gentle-
men present the effects of such heat upon the inmates of our
crowded courts and alleys especially, where the disease, in the
majority of cases, originated, and was fostered by unwholesome
food, a stifled and filthy atmosphere, &c. To the presence of re-
frigerating agencies in Boston, and some other ports upon the sea-
board, he attributed their greater exemption from cholera in-
fantum.
Dr. Parrish stated, that according to recent accounts, the mor-
tality in St. Louis, from the disease in question, is greater even
than in Philadelphia. In reference to the malady as existing in
Philadelphia, the Dr. desired to state, that in addition to the causes
already advanced by the gentlemen present, the mode of building
in courts and alleys, and immediately opposite blind walls, was
such as would tend to keep up the disease continually. Such
buildings, moreover, were constantly being erected, even in the
recent portions of the town. As far as he was aware, this cause
did not exist so extensively in New York, or any other of the
places mentioned during the evening’s discussion.
Again, the custom of causing the child to sleep between the
parents, is of itself sufficient, during the hot nights of our summer,
to bring on an attack of the disease. In relation to Dr. Darrach’s
hint at the practical treatment of the disease, he declared the prac-
tice to be an old one, and that Dr. S. P. Griffiths was in the habit
of lancing the gums merely, and sending the little sufferers into
the country. Dr. P. affirmed himself to be a living example of the
propriety of such practice. When young he was attacked with
the disease, and being brought to the verge of the grave, his father
resolved as a dernier resource to try the effects of a change of
locality. Placed upon a steamboat and borne rapidly away over
the bosom of the Delaware; but a few hours sufficed for the fresher
atmosphere he then inspired, to invigorate his whole system, and
breathe anew into him, as it were, “ the breath of life.” From
that moment he rapidly recovered.
Dr. Darrach, regarded solar influence as the efficient cause of
the complaint in our city, unabated as it is by the sea breeze which
daily blows through the crooked lanes and alleys of New York,
robbing them greatly of their heat.
Dr. Jackson inquired of Dr. D. if narrow streets and alleys were
so much warmer than broader thoroughfares ; if they were not in
reality cooler. Nero, it should be recollected, in rebuilding the
city of Rome, after its conflagration, having widened the streets,
and enlarged the public places of meeting, was inveighed against
by the citizens as having let in the sun-light to scorch them, so
much warmer had the city become.
Dr. Darrach remarked in reply, that while Paris, with its narrow
streets and lofty houses,—the latter shielding the former from the
sun,—was comparatively cool, Washington with its broad streets
was proverbially uncomfortable, in consequence of the heat re-
flected from the houses.
Dr. H. S. Patterson, from Dispensary and other experience, had
been induced to believe, that the disease in question was not so
common among the colored as among the white population of our
city ; and that among those Irish emigrants who were exposed to
the same exciting causes, the mortality from the disease was
greater than among any other class of the people. Improper diet,
placing the children early at the table, the hard labor continually
undergone by the mother, and the unwholesome food upon which
she habitually fed, he considered as the predisposing causes ex-
ceedingly active in the production of the complaint among the
negroes and the destitute whites. Whether, upon the one hand,
the facility, with which the negro repels the malady, is purely the
effect of a constitutional peculiarity, transmitted to him by his
African ancestors ; and whether the sudden and continued vicissi-
tudes of our climate, so unlike the comparatively equable seasons
of Ireland, constitute the efficient cause of the greater mortality
among the Irish, are questions of deep interest as regards the
etiology of the disease. Upon this point, and also whether cholera
infantum was on the increase in the neighboring country towns, he
desired information of the gentlemen present, inasmuch as it was
a matter of practical utility to determine the propriety of sending
patients to the surrounding country for relief.
Dr. J. Bell, in confirmation of the influence of high temperature
in producing cholera infantum, adverted to the great mortality in
London, the year before last, from this disease, owing to the un-
usually intense heat of the summer. He regarded fresh air, and
pure Schuylkill water, as having-done more for the prevention of
the disease, in this city, than any other two causes. In reference
to the neglect of suitable hygienic measures elsewhere, he stated
that in fifty towns in England in which the disease was rife, six
only were fairly, not fully, supplied with water, and had a proper
amount of sewerage. He also animadverted at some length
upon the imperfect ventilation which existed in the houses of the
rich, owing to the erroneous plans of building of the present time.
Dr. Darrach desired to make an observation, having some bear-
ing upon Dr. Patterson’s remarks. According to statistics which
he had kept while physician in the Eastern Penitentiary, it was
found that during the winter season, the negro prisoners, princi-
pally, were affected, and with chronic pleurisy ; while during the
summer, the white prisoners, with diarrhoea.
Dr. Jackson remarked that negroes generally were more com-
monly affected with disease of a bilious remittent type, to which
cholera infantum was supposed to be closely allied.