DEATHS from Consumption in the Counties. 1865. Percentages.

The following table is intended to show the influence of seaboard and inland residence upon the percentage of deaths from consumption during the past ten years:

DEATHS from Consumption by Counties and Regions, 1856-65. Numbers and Percentages.

Grouping together the inland and seaboard counties in the same way we have as the result in 1865 :

To determine the number living to one death in each year of the ten years, 1856–65, we have taken the population of 1860 as a basis. The average is as follows:

Inland counties,

Seaboard counties,

290 persons.

245 persons.

This shows that 118 persons die from consumption in the seaboard counties to every 100 in the inland counties.

The Geographical Distribution of Consumption has in previous years engaged the attention of the medical profession in Massachusetts, and has been a subject of frequent discussion in these reports. In 1854, Dr. Henry I. Bowditch addressed inquiries to the members of the Massachusetts Medical Society in every town of the State, asking replies to a series of questions of a broad and general character, as to the prevalence of consumption in their vicinity, the influence of soil, of the weather, of exposure to the various winds, of elevation above the sea, of proximity to the sea, of occupation of the people, &c., &c. The result of these inquiries was reported to the Massachusetts Medical Society in a very original and instructive communication in which the author presented evidence for his belief that moisture, and particularly soil moisture, was prominent among the causes of consumption in many localities, and that removal from such places to dry and elevated ground was a remedial and preventive measure of the highest importance.

Subsequently, the late Dr. A. A. Gould, published in the State Registration Reports for 1861 and 1862, an analysis of the United States census for 1850 and 1860, showing very clearly the greater

prevalence of consumption in the Northern than in the Southern States, and a regular series of declining percentages, corresponding with the degrees of latitude, from New England to the Gulf of Mexico. The subject is one which may well engage the attention of the people of Massachusetts, and if by continued investigation in these reports, additional light can be thrown upon the causes of this terrible destroyer of life, and means suggested by which it may be in any degree averted, time and labor will be well spent.

The last table, showing the greater prevalence of consumption in the seaboard than in the interior counties, is striking in its result, and yet inconclusive. If the inland counties were all distant from the sea, and the Atlantic counties all immediately exposed to its influence, it would prove much; but this is not the case. The division is as good a one as could be made by counties, yet it is obvious that large portions of Bristol, Essex and Plymouth are not under sea influences, while populous portions of Norfolk and Middlesex really are. Moreover, we have reason to believe from Dr. Bowditch's investigations that certain localities of very limited extent supply a morbific influence, whatever it may be, which determines disease and death. It therefore seemed necessary to make smaller divisions of territory the subject of statistical comparison; the smaller the better, provided the period included was sufficient to furnish significant numbers. With this view we have prepared the following table exhibiting the mortality from consumption in each town of the State for ten years, 1856-65, taking the census of 1860 as a basis for the calculation of percentages, and for the number living annually to one death by that disease. In presenting this table it seems proper to make certain statements, that all who refer to it may form their own estimate of its value, and of the possible errors it may include.

1st. It does not correspond with the official reports of deaths by consumption in the several years. The official report is 46,013 persons; our tabulation, including the State Almshouses, 45,561 persons; making a difference of 452, or about one per cent. of the whole. This discrepancy we can only explain by the general statement that the results are drawn from a careful examination of about seven thousand pages of original manuscript returns from the clerks of towns. These returns are not always clearly written, the nomenclature of disease is imperfectly under

stood by the writers, and deaths are often credited to two distinct affections. For these reasons it does not seem possible that any two persons tabulating these records could arrive at precisely the same result. Our own examination shows a number slightly less than the official report in every year, and in almost every county for every year.

2d. Allowance may be made for incorrect diagnosis on the part of physicians. It is exceedingly probable that many deaths of children reported from consumption would have been more properly placed under some other heading. It is also probable that a certain number of cases reported as "disease of lungs," should have been called consumption. "Disease of lungs" is intended only to comprise such diseases of those organs as are not otherwise mentioned in the very full statistical nosology furnished to the towns. As, however, the whole number reported under this head in ten years was only 493, the error from this latter source cannot be very great.

3d. The correctness of the reports of town clerks may be questioned. We can say on this point that, although often not clearly written, they almost invariably show that they have been drawn up with much labor and care, and with a conscientious desire to give all the information in the writers' power. This is frequently attested by explanatory notes.

This column represents the order in which the towns appear with respect to mortality from Con. sumption, No. 1 being least, and No. 333 greatest.