In the first list of twenty-five towns containing 67,289 inhabitants, there were in ten years 1,380 deaths from consumption. In the second list of twenty-five towns containing 100,741 inhabitants, there were in ten years 4,812 deaths from consumption. In the first list one death occurred annually to 487 persons living. In the second list one death occurred annually to 209 persons living.

This difference it will be seen is exceedingly great. The results seem equally remarkable when single towns are compared; as for instance Northbridge and Upton, adjoining towns in Worcester County, of nearly equal size and with a similar population, or Weston and Wenham, not very distant from each other, and both occupied by farmers. We have earnestly endeavored to discover

in what respects each of the above groups of towns has common characteristics, and to find broad distinctions separating one group from the other. That we have failed to satisfy our own mind is perhaps not surprising, since the solution of such a question requires an intimate knowledge of a multitude of facts which we do not possess. That causes are in existence for the results above given seems certain, and we commend the comparison of towns and districts to observers throughout the State, confident that what is now obscure will, at some future day, which we hope and believe to be not distant, be apparent to every one. One thing we cannot help regarding as proved by the foregoing analysis. Consumption is very unequally distributed throughout Massachusetts. This conclusion seems unavoidable unless we reject all death returns as valueless, since the disease in question is so marked and positive in its later signs that it seems impossible that it should be mistaken for anything else by observers of average intelligence.

An examination of the reported deaths from consumption in Massachusetts in three periods of five years shows that this disease is becoming less destructive.

MORTALITY from Consumption in Three Periods of Five Years.

If it should be objected to this view that the last period was one of war, when the mortality was excessive, thereby reducing the percentage of any disease, attention may be called to the fact that the whole number of cases in these last five years is only 761 (a little more than three per cent.) greater than in the first fiye years, and actually 301 less than in the middle five years, in spite of the increase of population within these periods.

The cause of this diminished mortality is to be found chiefly in the advance of medical science. The intimate nature of the disease is better understood. Formerly, a patient with consumption was regarded as affected with a local disease of an inflamma

tory character, and was kept in-doors, carefully protected from the air, and imperfectly nourished. In the light of the present day the disease is understood to be of a general and not of a local character, and to require the utmost amount of fresh and open air, daily exercise out of doors, except in very severe and stormy weather, and as much nourishing and stimulating food as can possibly be digested. By such means life is prolonged, and in some instances the disease itself arrested.

The prevention of consumption in those disposed to it by inheritance or otherwise, is in a still greater degree within our power. The free admission of sunlight to our dwellings, and an abundant supply of pure air both by day and by night, are real protections against consumption; and we think it the duty of all who believe these to be established facts, to proclaim and publish them in every possible way.

In this connection we venture to make another observation, which is, that one of the most important discoveries of modern times in its influence upon human life and happiness remains yet to be made in some simple and easily adjusted contrivance by which the fitness, or the degree of unfitness for respiration, of the air of buildings of all sorts, may be measured. The temperature we know, the degree of moisture is almost equally attainable, but the measure of purity, of freedom from the products of respiration and of the combustion of various kinds of fuel, and other noxious material with which the air we breathe is constantly mixed, these we have at present no means of indicating with any approach to accuracy. The temporary mental impressions made upon those who feed their lungs upon unwholesome air are utterly untrustworthy, but the results are often distinctly seen in subsequent disease, and especially consumption.

Pneumonia.-Seven hundred and sixty-six males and 725 females, and two, sex not stated, died from this cause in 1865; 1,493 in all. This is 308 less than last year, but differs only by three deaths from the average number for five years past. The percentage to all deaths from specified causes is greater by 70 per cent. than the average for twenty-four years and eight months. The percentages to all specified deaths in the counties stand as follows:

Here is to be remarked a greater prevalence of the discase in the interior. The influence of the ocean in equalizing temperature is probably the cause of the diminished mortality from pneumonia in the Atlantic counties.

As regards season, it appears that the greatest mortality was in February, (214;) next, March, (206,) January, (190,) April, (160,) December, (133.) Through the other months the disease. follows the mean temperature; July and August reporting 49 deaths each. The season of melting snow is most fatal. The ten years table furnishes similar results.

As regards age, the greatest mortality (554 cases,) occurred under five years. Five hundred and thirty-five cases occurred over fifty years of age; leaving only 404 cases between the ages of five and fifty.

Pneumonia attacks all ages, and the youthful and robust quite as freely as the old and the feeble, but that it is an especially fatal disease at the extremes of life is apparent from the figures above quoted. In fact, in the whole catalogue of diseases perhaps no one can be found in which strength and vigor of constitution are of so great account in promoting recovery.

Puerperal Fever and Childbirth.-Two hundred and two deaths from these causes are reported in 1865. Thirty thousand two hundred and forty-nine children were born alive. The ratio of deaths of mothers to children born alive, is therefore 66 to 10,000. In estimating mortality from the accidents of childbirth, it is thought best to omit any account of stillbirths, as the reports collected only once a year are obviously imperfect in this regard. Two intervals of five years give the following result:

10

Occupations.-Table XI. shows the occupation of those above twenty years of age who died during the year. The facts here given will perhaps be put to some good use in the course of a long series of years, but that they throw any clear light upon the healthfulness of different pursuits we do not perceive. In countries where from youth to age the same calling is followed by almost every individual, such inquiries will have much greater value than in Massachusetts, where change of occupation during life is the rule rather than the exception. Could we know the numbers and average age of the living among these various classes of persons, it would add greatly to the value of the table above referred to.