THE
CLIMATE AND STATISTICS
OF
CON SUMPTIO N.
A PAPER READ BEFORE THE
AMERICAN GEOGRAPHICAL AND STATISTICAL SOCIETY
BY HENRY B. MILLARD, M. D.
MEMBER OF TIIE SOCIETY.
WITH EXTENSIVE ADDITIONS BY THE AUTHOR.
NE W -YO R K:
WILLIAM RADDE, 300 BROADWAY.
WM. RADDE, 635 Arch Street, Philadelphia.-OTIs CLAPP, Boston.-R. & H. LUYTIES, St. LOUiS.HALSEY & KING, Chicago.-J. M. PARKS, Cincinnati.-JOHN B. HALL, Cleveland.
BALLIERE, 219 Regent-st., London.-TURNER, 97 Picadilly, Manchester.
1861.




ENTERED ACCORDING TO ACT OF CONGRESS, IN THE YEAR 1860, BY
WILLIAM RADDE,
IN THE CLERK'S OFFICE OF THE DISTRICT COURT OF THE UNITED STATES FOR
THE SOUTHERN DISTRICT OF NEW-YORE.
HENRY LUDWIG, Printer and Stereotyper, 39 and 41 Centre Street.




TO
JOHN F. GRAY, M. D.,
TIIS LITTLE VOLUME
IS
RESPECTFULLY AND GRATEFULLY
Z e b i c a t e b.








P R E F A C E.
IN the preparation of the following pages, the
author has endeavored to present in a concise form,
the results of the most valuable investigations in
regard to the existence of consumption under the
various and numerous circumstances in which it
occurs, and, in connection with them, such comments and explanations as he thought might be
useful and interesting.
As the disease in question is one which seems
immutable in its character, he has made use of
whatever information and statistics he has regarded as reliable, without reference to their newness; though, at the same time, he has spared no
exertions to obtain the most recent facts and re



6                   PREFACE.
ports in reference to it, and has constructed as
many new and original tables as the material
within his reach would permit.
In two or three instances, paragraphs, particularly in reference to climate, have been taken
almost literally from medical reviews, without
reference being made to the source whence they
were derived.
In conclusion, among many who have extended
facilities to him towards the completion of his
work, the author begs to return his grateful acknowledgments to W. WHELAN, IM. D., Chief of
the Bureau of Medicine and Surgery, U. S. Navy,
Washington, D. C., HENRY I. BOWDITCH, M. D.,
Boston, Mass., and JAMES R. WYNNE, M. D., of
New-York.
HENRY B. MILLARD.
28 EAST TWENTY-EIGHTH STREET,
New- York, December 1, 1860.




PAGE
INTRODUCTION............................................................  9
L
THE GENERAL PREVALENCE OF CONSUMPTION................................. 12
II.
ITS PRESENT, COMPARED WITH ITS FORMER PREVALENCE...................... 16
III.
ITS PREVALENCE IN THE UNITED STATES AND ENGLAND COMPARED............ 19
IV.
STATISTICS OF ITS PREVALENCE IN VARIOUS CITIES, REGIONS, AND STATES OF
THE UNITED STATES.....................................................  21
V.
RARITY AND ABSENCE OF CONSUMPTION IN CERTAIN COUNTRIES AND CLIMATES. 38
VI.
STATISTICS OF ITS PREVALENCE IN VARIOUS CITIES, COUNTRIES, AND CLIMATES
THROUGHOUT THE GLOBE................................................. 35
VII.
TIlE COMPARATIVE PREVALENCE OF CONSUMPTION AT SEA AND ON LAND...... 50
VIII.
THE MORTALITY FROM CONSUMPTION AT DIFFERENT MONTHS AND SEASONS OF
THE YEAR...............................................................  59
IX.
COMPARATIVE PREVALENCE OF CONSUMPTION IN TIIE CITY AND COUNTRY...... 62
X.
INFLUENCE OF LIGHT AND DARKNESS UPON ITS EXISTENCE....................  64




8                                  /CONTENTS.
XI.                                    PAGE
ITS PREVALENCE AMONG DIFFERENT RACES...................................  67
XII.
ITS PREVALENCE AMONG TIlE VARIOUS TRADES AND PROFESSIONS.............  71
XIII.
CONSUMPTION AMONG THE RICH AND POOR........7....................... 7
XIV.
ITS PREVALENCE IN MANUFACTURING Tows................................  so80
XV.
COMPARATIVE PREVALENCE OF CONSUMPTION AMONG TIIE TWO SEXES........  87
XVI.
ITS PREVALENCE AT DIFFERENT AGES OF LIFE............................... 102
XVII.
CONCLUSIONS.............................7...........................    107




THE CLIMATE
AND
STATISTICS OF CONSUMPTION.
OF the various departments of statistics none is of
greater importance than that which relates to the
records of mortality. Prosperity is checked, for the
time, in its advancing march when men fall victims
by thousands to epidemics; and familiar diseases, desolating households in their insidious progress, often
palsy individual effort. Upon physical well-being is
dependent prosperity, and through communities and
individuals the ruddy tide of health must flow, for
the intellect and energies to accomplish their best
achievements.
There are certain facts pertaining to the nature,
causes, and treatment of diseases, in regard to which
2




10               INTRODUCTORY.
the limited experience of a single individual, no matter how varied his opportunities, nor how correct his
judgment, can have but little weight; but which can
be determined only by statistics drawn from large
masses of cases, embracing extended periods of time,
and derived from various localities. Thus accumulated, medical statistics constitute one of the strongest
safeguards of public health. Presenting, with terrible distinctness, to our eyes, the ravages of death,
otherwise half unnoticed and unsuspected in their
extent, which are ceaselessly going on in our midst,
they render us more solicitous and more on the alert
for our safety; and demonstrating the influence of
climate, of age, of atmospherical conditions, and employments in the production of disease, aid us in
understanding its causes and nature, and thus furnish
us, to a certain extent, with weapons for protection.
M4r. J. C. Kennedy, in his interesting paper on statistics, read before this society, remarks: 1"NVere the
preventable deaths which annually occur in this city
of New-York to take place in any one week, they
would throw a pall over every street and lane, and
strike such a terror into the minds of the people as to
paralyze industry and stagnate trade."  This, too,."Apart from the consideration involved in the great
amount of preventable sickness (not unto death)




INTRODUCTORY.                 11
whereby such a vast amount of labor and earnings
are lost and misery inflicted."
Besides, these stern battalions of facts do no little
service in destroying theories relative to the nature
and treatment of disease, often worse than harmless,
and more the offspring of fancy than the fruit of reason, into which the practitioners of a somewhat uncertain art are often tempted and led astray, while
venerated theories of Centuries' growth have received their death-blow from an array of a few simple
figures.
No disease has given rise to so many and such
varied theories concerning its character and treatment as consumption, and in none other, from its
nature and importance, can statistics be expected
to be of greater use. In regard, first, to



1.2            GENERAL PREVALENCE
— THE GENERAL PREVALENCE OF CONSUMPTIONT.
IT has been estimated that about one-sixth of all the
deaths among the human race occur from this disease.
This estimate, large as it may appear, seems stiil
larger when we consider that it refers, not simply
to the deaths among adults, but includes, also, those
occurring during infancy —a period by far the most
fatal of our existence. In New-York city it destroys
about one-third more lives than all the other diseases
of the respiratory organs together-as bronchitis, congestion and inflammation of the lungs, catarrh and
influenza, whooping cough, croup, and asthma. Compared with the mortality it occasions, the ravages of
war and famine, the devastations of the plague,
cholera, and yellow fever, seem insignificant. No
climate exempt from its sway, no age from its grasp
— exercising its relentless rule in the frosty climes
of the North, in the scorching heats of Africa, and
in the more genial atmosphere of the Temperate
Zones-it plants its fatal seeds alike in the bosom
of the unborn babe, of the tender infant, and in the




OF CONSUMPTION.               13
frame of the man trembling on the extreme verge of
old age.
These facts prompt us to inquire under what principal conditions the deaths from consumption occur:
under what varieties of climate; whether it is most
prevalent on sea or on land; at what seasons it is
most fatal; its comparative prevalence in city and
country; the influence of light and darkness upon
its existence; its prevalence among the various races
and among the various callings and conditions of
mankind; among the two sexes, and at the various
periods of life. And here I would state that, in
using the word consumption, I refer to that variety
of phthisis characterized by a deposition of tubercles
in the respiratory organs-the ordinary phthisis pulmonalis of writers.
There have been various estimates of the mortality
from this disease: one writer attributing to it a third
part of all the deaths in the world; most staticians,
however, placing it at a little less than one-sixth of
the entire mortality.
Dr. Caspar, in 1847, from a table of 60,000 deaths,
occurring from various diseases and within a period
of 20 or 30 years, in Berlin, Paris, Stuttgart, Philadelphia, Hamburg, London, Boston, and Baltimore,




14             GENERAL PREVALENCE
found the ratio of deaths by consumption to the
deaths by other diseases as 1 to 5.8.
In a table recently constructed by myself, of
2,771,728 deaths from all diseases, occurring at various
times between the years 1804 and 1860, in England
and Wales, Paris, St. Helena, Algiers, Boston during
a period of 35 years, Portsmouth, Baltimore, in the
United States Army for 13 years, Charleston for a
period of 25 years, Brooklyn, Memphis, Chicago for
8 years, the Canton of Geneva, Berlin, Salem, NewOrleans, Russia, Italy, New-York city for 57 years,
Limerick, Philadelphia for 10 years, —I find that
483,588 deaths, or 1 in 5.7, were caused by consumption-the ratio agreeing very nearly with that obtained by Dr. Caspar.
These estimates, formed as they are from deaths
occurring in almost every variety of climate, and in
almost every accessible latitude, and comprising every
class of people, might be considered as giving the
true proportion of deaths from  this disease. Probably they are nearly accurate estimates of the mortality from consumption in civilized countries during
the last 50 years; but they cannot be considered
exact as regards the mortality from the disease
throughout the whole world, since there are countries in which, as we shall see, consumption is quite




OF CONSUMPTION.             15
unknown, and some cities in which it prevails even
more extensively than in any of those from which
we have derived our estimate, either of which, if included, might considerably modify it.




16            PRESENT AND FORMER
I. —ITS PRESENT, COMPARED WITH ITS FORMER
PREVALENCE.
It would be interesting to compare the present mortality from consumption with that which existed in
ancient times, and to trace its progress and watch
the fluctuations in its increase and decrease down to
the present day. Unfortunately, though the disease is
fully treated of by the Latin and Greek medical
writers, they give no exact accounts of the extent of
its prevalence, and we are obliged to satisfy ourselves
with the conclusion that it- was then, as now, one of
the most common and formidable of maladies.
The science of medical statistics is one of very
recent origin, and, in judging of the comparative
prevalence of consumption now and in early periods,
we have, to assist us in forming conclusions, only
isolated returns from large cities, few of them extending farther back than fifty years. There is, however, no reason for supposing, the world over, that
there has been, unless within the last 10 or 15 years,
any material increase or diminution of the disease
for centuries.  The returns of the city of London,




PREVALENCE COMPARED.            17
which have been kept for 230 years, show that, from
1629 to 1740, it caused a 6.6 part of all the deaths;
while from 1740 to 1830 it caused a 4.6 part, or nearly
a third as many more. During the first period, the
mortality amounted, in nine years, to no more than a
ninth part, ranging from that to one-fourth; during
the last, varying from  one-sixth to one-third.  It
seems to have increased from 1700 to 1830, causing, at the beginning of this period, one twentysecond part, and at the close, one-third of the deaths.
Since 1830 the deaths have seldom exceeded a sixth
part of the whole. From the year 1847 to 1858,
however, out of 607,676 deaths by consumption,
70,135 (11.5 per cent., or only 1 in 8.6) were from
consumption: a ratio which might lead us to suppose
that the disease was on the decline in that city, had
there not been, as was stated above, at one time
during the period between 1629 and 1740, a still
smaller proportion-namely, 1 in 9.
A similar diminution in the amount of the disease
seems to have existed throughout all England and'Wales during the same period, the deaths from
consumption being generally estimated at a little
more than one in six; from 1838 to 1843 the proportion being 1 in 5.4. From 1847 to 1858, out of
4,526,747 deaths, it caused 559,974-12.3 per cent., or
2*




18      PRESENT AND FORMER PREVALENCE.
only 1 in 8. It is probable that this vast diminution
in the amount of the disease during the last 10 years
is not entirely of a transitory character, but that, as
is certainly very much to be hoped, it has its basis,
in part, at least, in improved sanitary measures, in a
better understanding of the nature, and, consequently, a more intelligent treatment of the disease.
In New-York city, from 1804 to 1820, the deaths by
consumption were 1 in 4.2; from 1820 to 1835, 1 in
5.4; from 1835 to 185(), 1 in 6.5; and from 1848 to
1859, 1 in 8.46. These figures, however, do not give
the exact proportion of the increase and decrease of
the disease in New-York and London, as the relative
mortality undoubtedly depends very much on the
diminished or increased mortality from other diseases.
There is no doubt, however, that in New-York it has
steadily declined since 1805. In Boston, from 1810 to
1818, the ratio of deaths by consumption was about
1 in 7; after that there was a gradual decrease of the
disease till 1845, when it caused about I death in 6.5.




PREVALENCE IN THE UNITED STATES AND ENGLAND. 19
III. —ITS PREVALENCE IN THE UNITED STATES AND
ENGLAND COMPARED.
OF the 2,777,728 deaths mentioned above, 716,819
occurred in the United States; of these 117,879 (16.4
per cent., or 1 in 6.08) were by consumption. As this
table is, however, made up principally from returns
from cities —unlike the English returns, into which
enter the reports of all the rural districts-it cannot
be regarded as furnishing the exact proportion of
deaths by consumption in the United States.  According to the mortality reports of the United States
census for the year 1850, the deaths by consumption
that year were 33,576, or 1 in 9.63. Owing, however,
to the imperfect and faulty system of registration
which exists in our country, these data furnished by
the census probably cause as great a deviation from
the exact proportion as existed in the first estimate.
The vast majority of the deaths entering into the first
estimate occurred before the year 1850. Perhaps a
diminution in the amount of the disease throughout
the country may account for something of the discrepancy.




20  PREVALENCE IN THE UNITED STATES AND ENGLAND.
In England and Wales, as has been mentioned,
the total number of deaths from 1838 to 1843 was
1,634,435, of which 1 in 5.4 were by consumption;
from 1847 to 1858 causing 1 death in 8. All these
estimates, so far as they can be relied upon —and
they undoubtedly approximate correctness-show a
smaller proportion of consumption in the United
States than exists in England.
No country in the world possesses such a variety
of climate and surface as our own, and in none are
its inhabitants exposed to greater variations and vicissitudes of temperature: heat and cold, droughts and
deluges following each other with alarming rapidity.
It is just such a climate and country as this that we
are taught to believe is created by nature for the
especial development of consumption; yet England,
with her more equable climate, presents a higher
proportion of deaths from  this disease.  The only
cause that can be assigned for its excess in the latter
country is the great humidity of the atmosphere-a
fact which might serve to substantiate in some degree
the theory of those writers who regard humidity as
one of its most prolific causes.




PREVALENCE IN VARIOUS CITIES, &C.     21
IV.-STATISTICS  OF ITS PREVALENCE  IN  VARIOUS
CITIES, REGIONS, AND STATES OF THE UNITED
STATES.
IN examining the statistics of consumption in some
of the principal cities of the United States, we find
that mere temperature, or the difference of a few
degrees in latitude, has very little to do with its
prevalence. In New-York city, which has a mean
annual temperature of 500, the proportion of deaths
is, as we have seen, 1 in 8.46; while in Charleston,
which is situated 80 farther south, and has a mean
annual temperature of 640, 1 to 6.7. The climate,
however, is as variable as that of New-York city, and
the annual amount of rain about the same. In Philadelphia, with a mean temperature of nearly 540, the
deaths by consumption are 1 in 8.9. In Providence,
with a temperature the same as New-York, the proportion is 1 in 6. In Baltimore, with a temperature
of 56~, 1 to 6.16. In Chicago, which has a mean
temperature of 480, it is 1 to 10.92. In New-Orleans,
the mean temperature of which is 60~, we possess the
returns only for the year 1850; the proportion that




22      PREVALENCE IN VARIOUS CITIES, &C.,
year was 1 to 11.7. In Memphis, in 1859, it was 1 to
11.3. In Brooklyn, from 1848 to 1859, 1 to 8.11.
In presenting the statistics of consumption in the
United States Army, were the proportion of deaths by
this disease to that produced by other diseases given,
an erroneous idea of its prevalence would be conveyed, as a large part of soldiers attacked by consumption are discharged, to die or recover at home.
I have given instead the number in every 1000 men
treated for this disease.
Dr. Forrey, in his "Climatology of the United
States," shows that the amount of catarrh and influenza in the various posts of the army depends not
so much on diurnal variations of temperature as upon
the difference of the mean temperature of winter and
summer-the amount of these diseases increasing as
this difference is greater. Thus, in the posts remote
from the ocean and inland seas, this difference is
about 560, and the number of cases per 1000 men
treated per annum for these diseases is 552; at the
posts on the New-England coast, where the difference
is 380, the number of cases of catarrh and influenza
is 233 per 1000 men; while at the posts on the peninsula of Florida, which have but a variation of about
110 between the mean temperature of winter and
summer, only 143 cases per 1000 men occur. The




OF THE UNITED STATES.           23
same proportion between the amount of the abovementioned diseases and the variation in temperature
exists at the other posts.
Catarrhal diseases and phthisis pulmnonalis are frequently supposed to go hand in hand; but, contrary
to the opinions often entertained on this point, those
conditions of climate which are most productive of
such affections of the air-passages as catarrh and
influenza do not seem to be most favorable to the
development of consumption.  The latter disease,
indeed, so far from  being connected with, seems
often quite independent of the causes which produce
the former. Thus, we find that while, at the posts
on the New-England coast, the difference between the
mean temperature of winter and summer is 38~, at
the posts on the northern chain of lakes it is 430; at
the posts on the Lower Mississippi 240; and in the
peninsula of East Florida 11~. And there is a proportionate difference in the amount of catarrhal diseases: there being treated annually, in the first of
these series, 233 cases among each 1000 men; 300
per 1000 in the second series; 218 in the third, and
only 143 in the fourth, the number of cases of consumption treated at each of the series is the samenamely, 9 in every 1000 men; and at the posts remote
from the ocean and inland seas, where the difference




24      PREVALENCE IN VARIOUS CITIES, &C.,
in temperature and the amount of catarrhal diseases
is much greater than at any of the other series, the
amount of consumption is much less-there being but
5 cases per 1000 men. On the contrary, we find that
the greatest number of cases-namely, 13 per 1000
men-is treated on the stations on the coast, from Delaware Bay to Savannah; and the next greatest, 11
per 1000, at the stations in the south-western part of
the United States, the difference in the temperature of
winter and summer being about 340, or 11~ less
than in the northern, and 17~ greater than in the
southern stations.  I shall have occasion to refer
again to the comparative prevalence of catarrhal
diseases and consumption.
In the AMedical Reports of our Army the whole of
the United States is divided into about twenty-four
departments, the military posts in each being from
two to twelve in number, and located in almost every
variety of climate and situation. I have endeavored
to group together the various series of posts with reference to the amount of consumption in each, and to
certain climatic characteristics possessed in common.
These reports show that the greatest number of
cases among our troops occurs at the stations situated
on the Atlantic coast, between 300 and 350 of
north latitude-including the city of Charleston-at




OF THE UNITED STATES.           25
the posts in Georgia, Louisiana, Mississippi, and Alabama, situated on or near the Gulf of Mexico, and
including the city of New-Orleans, and the posts on
the Gulf coast of Florida-the number of cases
treated annually being, in the first series of stations,
9.2; in the second, 7.2; and, in the third, 6.9 per
1000 men.  The climate of each of these series is
characterized by a very high temperature-the average annual temperature being about 80 —abundant
rains, and excessive moisture.
The series of posts where, next to those mentioned
above, it prevails most extensively, are those of the
Harbor of New-York, of North and South California,
and those of the department between the eastern
slope of the Alleghanies and the Mississippi, and
36~ and 40~ of north latitude, —the ratio of cases
per 1000 men being respectively, 5.9, 5.6, and 5.2.
These posts have many characteristics in common:
situated between 320 and 400 of latitude, they have
a mean annual temperature of from 500 to 560, a
moderate amount of rain, and are alike subject to
great diurnal variations of temperature.  There is
very much less rain in California than in New-York,
though the atmosphere is quite moist, and the climate is milder and much more equable-the difference, in South California, between the mean temperature of winter and summer being only T~.




26      PREVALENCE IN VARIOUS CITIES. &C.,
The stations on the coast of New-England, between
the great lakes and the Atlantic Ocean-so far from
each other as to be influenced by neither of these
bodies of water, those situated on the great lakes,
and those between the great lakes and the Rocky
Mountains, are all north of 400 latitude, have only
a moderate amount of rain, less than the preceding
class of stations, some of them a very high elevation, are exposed to great variations of temperature,
are cold and comparatively dry, and have a low
temperature —from 380 to 450. These stations present the next largest proportion of cases of consumption-namely, from 4.1 to 4.8 per 1000 men, the
smallest number occurring at the posts which have
the highest elevation and the smallest amount of rain.
We find the next smallest proportion of cases —
3.8 per 1000 men-in Southern and Western Texas,
the stations of which are situated in latitude from
250 to 330 north, having a warm climate, the average annual temperature being about 680, a moderate amount of rain, and rather a dry atmosphere.
Many of these stations have a high elevation, and
most of them are subject to great and sudden
changes of temperature.
In the departments which have a cold equable
climate, a high elevation, and a large amount of rain



OF THE UNITED STATES.           27
namely those in Washington and Oregon Territories3.2 cases per 1000 are treated. 2.4 per 1000 occur
in the posts which have a moderate amount of rain,
a moderate temperature, between 510 and 560; these
posts are situated on the Atlantic coast, between
350 and 40~ latitude, and between the Atlantic slope
and the Mississippi, and 390 and 40~ of latitude. 2.3
cases occur in those stations which have a high
temperature, the average annual temperature being
730, the diurnal variations of which, as well as the
difference between the temperature of winter and
summer, are slight, a small amount of rain, and a
moist salt air. These stations include those on the
Atlantic coast of Florida. Only 2 cases per 1000
men occur in those stations which have a high temperature, a dry climate with only a moderate amount
of rain and moisture: these stations being situated
between 340 and 350 north latitude in the Indian
Territory.
Probably the smallest proportion of cases of consumption which exists in the United States-viz.,
1.3 in every 1000 men-is found in New-Mexico, a
country which has a high elevation-from 3,000 to
8,000 feet-a moderate temperature, and an atmosphere
altogether remarkable for its extreme dryness. The
annual amount of rain at the various stations is from
11 to 19 inches. So great is the rarity and dryness




28      PREVALENCE IN VARIOUS CITIES, &C.,
of the atmosphere that sensible perspiration is almost unknown, even under the severest physical
exertion, and caravans cure their beef without salt
by hanging slices from their wagon-boxes till it is
sufficiently dried. A writer, speaking of the prevalence of consumption here, says: "I have seen but
two cases, and each was developed before leaving
the United States."
Thus we find, in the examinations of the returns of
all these stations, that the amount of consumption is
greatest where there is the highest temperature and
the greatest amount of rain; next, in the stations
which have a moderate temperature and a moderate amount of rain, but the climates of which
are moist and characterized by great variations in
the diurnal temperature; third, in the stations with
rather a low temperature, a moderate amount of rain,
and a somewhat drier climate than the preceding
class; fourth, at the posts which have a high temperature, a mild dry climate, generally a high elevation, but subject to great variations of temperature;
fifth, in those which have a cold equable climate,
a high elevation, and a large amount of rain;
sixth, in those which have a high temperature, a
moist salt air, and very equable climate; seventh, in
the stations with a high temperature, a dry climate




OF THE UNITED STATES.          29
with a moderate amount of rain and moisture, and
last and least in those which have a high elevation,
a moderate temperature, and a dry atmosphere.
Ihe following table, constructed from the mortality reports of the United States census of 1850,
is presented, not because it can be considered as
giving a correct statement of the real amount of consumption, but because it is of value in representing
the relative amount in the different States. Certain
disproportions in the amount of the disease in some
of the States can be accounted for only upon the
supposition that there are important errors in the
returns, which would, of course, impair the value of
the whole, except so far as they served to afford an
approximate idea of the prevalence of the disease.
The table will, however, be found to show an amount
of consumption in some of the States agreeing very
nearly with the proportion shown to exist when
giving the statistics of the United States Army.
It is to be hoped that, ere long, our national government will bestow the attention which the importance of the subject demands upon the registration
of deaths throughout the United States, and that we
shall have returns of mortality throughout the
country equal in accuracy to those which are made
in England and throughout the Continent.  Ob



30        PREVALENCE IN VARIOUS CITIES, &C.,
viously  such  returns, friom  a country  so vast and
varied  as ours, would be of the greatest value in
determining many points in regard to the influence
exerted by climate upon certain diseases.*
Proportion of Deaths from Consumption in the various States
and Territories of the Union in the year 1850.
STATES.                 DEATHS BY CONSUMPTION.
Alabama...................... 1 in 25.8
Arkansas........  22.8
California'.....................  I. 100. 5
Columbia, District of..............    6.2
Connecticut....................         5.9
Delaware........................ I.. 10.2
Florida'................. 1.. 21.6
Georgia........................ 35.5
Illinois......1............ I..  13.5
Indiana.........................  11.8
Iowa..........................        12.8
Kentucky......   11.6
Louisiana..... 18.6
MaIine.........................   4.4
* Since the above was written the American Association for
the Advancement of Science. at their meeting held the past
summer at Newport, have taken measures, by the appointment of
a committee for the purpose of arranging a complete system of registration, to renmedy the imperfect system which at present exists.




OF THE UNITED STATES.                   31
STATES.                     DEATHS BY CONSUMPTION.
Maryland........1..........               in 8.7
Massachusetts.............  I..   5.6
Michigan..... 6.8
Minnesota......................    29.0
Mississippi.........................26.1
Missouri......................... 18.8
New-Hampshire...................     4.5
New-Jersey.......................  7.0
New-Mexico3.......................  72.3
New-York.............. I.  6.8
North Carolina..1..18.0
Ohio..................... 11.3
Oregon.............................  9.4
Pennsylvania........................  8.1
Rhode Island....................    4.7
South Carolina... 1.. 30.1
Tennessee......................... 13.5
Texas........................ 27.2
Utah..................                       20.6
Virginia............................ 11.7
Vermont4........................ 4.1
Wisconsin..                             1..10.0
The very small proportion of deaths from consumption this
year, in this State, is undoubtedly connected with the circumstance that the population whence the returns were derived-being
made up to a great extent, in 1850, of emigrants drawn thither by
the gold mania, which prevailed so extensively at this time, from
various parts of the Union, most of whom were over twenty-five
years of age-was, as a whole, much older than the population




32         PREVALENCE IN VARIOUS CITIES, &C.
of the other States. The whole number of deaths reported this
year was 905, of which 9 were by consumption.
2 Whole number of deaths 29; by consumption 1. Data too
small to form the basis of any conclusions.
3 Whole number of deaths 1157; from consumption, 16. These
figures are probably a correct representation of the amount of consumption which exists in this State-the smallest, it may be seen,
of any except California.
4The census returns of this State for the years 1857 and 1858
showed a similar fearful mortality from this disease: the proportion of deaths being 1 in 4.5.
It may thus be seen-and the conclusion is supported  by  other returns-that the ravages of consumption are far more extensive in the New-England
States than in any other part of the Union.




RARITY AND ABSENCE.                 33
V.-RARITY  AND  ABSENCE  OF CONSUMPTION  IN
CERTAIN CLIMATES AND COUNTRIES.
THERE are some regions of the globe which enjoy a
complete immunity from consumption; such regions
are generally situated in a high latitude, and, indeed,
we find, in proportion to the intensity and long continuance of the cold, a proportionate decrease in the
amount of consumption. In Iceland, from 1827 to
1837, there was not a single case, and, according to a
writer who has made the diseases of that country his
study, it is entirely unknown. I am also informed, by
those who have passed a long time in those regions,
that in Greenland and Labrador they had never known
among the Esquimaux a single case of consumption,
and that catarrhal and bronchial affections are almost
never met with.*  It seems also to be a very rare, ri may oe interesting to state here, that similar statements
with regard to the absence of catarrhal affections in cold regions
have been made by various writers and voyagers, Sir E. Parry
amongst them.
We are not, however, to attribute entirely to the influence
exerted by the climate, the immunity from consumption enjoyed
3




34              RARITY AND ABSENCE.
disease in upper Russia, and in Western Siberia,
and seldom  exists in the Steppes of the IKirghisthe vast tract of Central Asia between 440 and
550 of north latitude, consisting chiefly of barren
plains which abound in salt lakes. The disease is also
unknown in  Finmarck.   In  Alexandria, situated
in 310 of latitude, with an atmosphere saturated
with saline vapor, consumption is almost wholly unknown; and in Teheran, Persia, situated in north
latitude 35~, with an elevated position, and rarified
air, it is very rare.  In  Beyrout, Syria, on the
Mediterranean, in latitude 330 north, and with a
moderate amount of rain, of 4,298 cases, treated at
the English Dispensary in 1843, there were but
5 of consumption.  In  Algiers, situated between
350 and 370 north latitude, with a moderate temperature, there were in 1839,'40, and'41, out of
6,678 deaths, 234 by consumption, or 1 in 28. In
1852-3 the deaths by consumption were 1 in 14.1
-an amount nearly double that which prevailed
eleven years before, but in each series a very small
proportion.
by the inhabitants of these regions, but partly to their diet,
which consists almost exclusively of fat and animal oils, these
affording to the system that supply of nourishment which, from
the very commencement of the disease, the weakened and deranged organs of nutrition refuse to yield.




PREVALENCE TIIROUGIIOUT TIIHE GLOBE.  35
VI.-STATISTICS  OF ITS PREVALENCE  IN  VARIOUS
CITIES, COUNTRIES, AND  CLIMATES  THROUGHOUT
THE GLOBE.
THE medical statistics of the British Army, extending
as they do over a considerable number of years, and
derived from  large bodies of men, afford us much
valuable information in regard to the prevalence of
consumption, as well as of diseases of the lungs
generally, in different parts of the world, and serve to
give a correct impression in regard to the influence
of certain varieties of clinate upon tile disease.
Thus we find that, in the United Kingdom, out of
44,611 troops, 5.5 men per 1000 were attacked by
consumption. Ill the West India Islands-or that part
of them designated as the 7Windiward and Leeward
Command, situated between 100 and 190 north latitude-during the same period, out of 86,661 troops,
1023, or 12 per 1000 men were attacked.  The
amount of all pulmonary diseases in these two
climates bear a like proportion to each other: in the
former causing 7.7, and in the latter 10.4 deaths in
every 1000 men. A great allowance imust, however,




36         STATISTICS OF ITS PREVALENCE
be made in these comparisons, from the circumstance of the estimate of the two classes of -diseases
in the United Kingdom, being formed exclusively
from the dragoons and dragoon guards, a class of
soldiers among whom consumption is hardly half as
prevalent as among the foot guards and infantry of
the line, while that of the West Indies is formed from
the troops indiscriminately. It is evident, however,
that consumption is really much more prevalent
among the British troops in the West Indies than at
home.
These returns show that the views generally entertained with regard to the efficacy of these islands,
or of a warin climate by itself, in arresting the
development and progress of consumption, are erroneous.  The islands of this command, however,
present a great variety in their physical configuration and climate, some of them, having a moist soil
and damp  atmosphere, some a dry climate and
variable temperature, while others are covered with
swamps and marshes. They have an average annual
temperature of from'790 to 82~, and but a slight
annual variation-40 to 13~.
In two of the stations of the Mediterranean-Gibraltar and Malta, long noted as salutary retreats
for the consumptive patient-the disease is actually
more prevalent than in Canada, with its long cold




THROUGHOUT THE GLOBE.           37
winters and great vicissitudes of climate, and, making
due allowance for the number of cases sent home,
nearly as prevalent as in the United Kingdom.
In Canada, 6.5 men per 1000 are attacked, and 3.8
die of consumption; in Malta, there are 9.S cases, and
4.3 deaths per 1000 men; and, in Gibraltar, 7 per
1000 are attacked, and 3.62 die-though if in the
deaths by this disease in Gibraltar were included the
cases which are sent home, the amount would be
much larger. Not only, too, are the forces in the
Mediterranean better barracked than those in Canada,
but nearly half the troops in the latter place (at the
time this comparison was made), being under 25 years
of age, were much younger as a body than those in
the Mediterranean, and so much the more liable
therefore to consumption. The amount of diseases of
the lungs in general is, however, less than in the
United Kingdom and Canada —the proportions being
as follows:
CASES      DEATHS
PER 1000 MEN. PER 1000 MEN.
In the United Kingdom....  148        7.7
Canada.................  148         6.7
Gibraltar.................  141      5.3
Malta.................   120         6,0
The prevalence of diseases of the lungs in Malta is
shown by their having caused, for a period of 13




38         STATISTICS OF ITS PREVALENCE
years, as many as 5.1 deaths in every 1000 of the civil
population, or about one less than among the troops;
the same ratio within a fraction in which these
diseases exist in Sweden; a circumstance which
shows conclusively that these complaints may be as
prevalent in those countries which have a mild temperature as in those situated in high latitudes and
which are subject to cold and great vicissitudes.
In Malta, however, the weather, though often fine,
by no means presents that undeviating character so
often ascribed to it. The island is rocky and partly
undulating, elevated in the centre, and open and
exposed on the south and east sides, and, consequently, the coldness and variableness of the
weather during the winter and spring are experienced
to their full extent. " I have seen," says a writer,
"the thermometer stand all day at 32~, with a
fresh breeze from the North." In winter and spring
fresh breezes from every point of the compass are
common, which occasionlly increase to heavy gales.
In 1842, 30 per cent., or 1 in 3~ of the patients
at the Naval Hospital here died of consumption,
about the same proportion observed in former years.
In Gibraltar, too, according to statistical tables
kept for 16 years, east winds prevail 184 days, and




TIIROUGHOUT TIIE GLOBE.         39
west winds 1'7  days annually.  In  the winter
months the cold is keenly felt.
In the Isle of Mauritius, situated  in  200 of
south latitude, with a mean temperature of 780,
though with a variable climate, 3.9 men in 1000 (a
fraction more than in Canada) die of consumption,
or about 1 death in 8.8 is caused by it; while in
the Ionian Islands, which are situated between 36~
and 400 north latitude, on an average of 20 years,
5 per 1000, or 2 less than in Gibraltar, were attacked, and there was also a smaller proportion of
deaths by the disease-3.3 per 1000.  The proportion of deaths by all classes of pulmonary diseases is
also less, being only 4.8 per 1000, though the climate is more variable, the alternations of temperature more rapid, and the weather more tempestuous
than in Gibraltar or VMalta.
In the Bermudas, with great uniformity of climate,
and a mean temperature of 71~ to 75~, 8 per 1000
men were attacked, and 5.1 died. In Newfoundland the deaths were only 4 per 1000; in the Cape
of Good Hope, with a mean temperature of 60~,
there were 3 deaths per 1000; and in St. Helena,
the temperature of which is 61~, about 2 —one-ninth
part of the total mortality.
While, on the one hand, consumption is rare or




40        STATISTICS OF ITS PREVALENCE
unknown in those countries situated in a high latitude, on the other, we find that it frequently exists
in its minimum among the British soldiers stationed
in tropical countries.  In the Madras Presidency,
which is situated between 80 and 200 north latitude, the proportion of deaths by consumption
among the British troops has been variously estimated at from.77 to.71 per 1000 men. One writer,
however, has placed the proportion of consumption
among the English troops in all India as high as
1.9 per 1000 (an estimate probably much too high).
Of ten regiments stationed in India generally, during
a period of fourteen years, there were but 2.8 cases,
and 1.8 deaths by consumption per 1000 men.
I-Toere, however, as in all tropical countries, the
progress of the disease is much more rapid than
at home: in the British regiments it is said to be
chiefly prevalent among two classes of soldiers —
youths from the manufacturing towns of England,
with constitutions debilitated from labor in the
fac tories, and badly nourished Irishmen, whose
systems had become impoverished and deteriorated before enlisting in the army, from insufficient
or unwholesome food.  According to Boudin, out
of 17,420 admissions into the hospitals, there were
only 14 deaths by consumption.




THROUGHOUT THE GLOBE.            41
In Bengal, which is situated between 200 and
31o of north latitude, \I. Collas states that among
the Topas, next to cholera, it is the most prevalent of all fatal diseases; except among this class,
and the weavers of Cashmere-who are more liable
to the disease from the nature of their occupation,
which requires a sedentary and stooping position,
and is pursued generally in cellars badly ventilated,
and the atmosphere of which is filled with particles
of floating'dust-it is very rare.
Another writer, M. Martin, says, however, that
while in England the ratio of cases is about 6.4,
and the number of deaths 5.3 per 1000, in Bengal
the number of cases is only 1.8 per 1000 men, and
the proportion of deaths too small to be calculated.
Ceylon is situated between 50 and 90 of north
latitude. It has a hot and moist climate, though
the temperature is not so high as on the neighboring
continent.  The soil is for the most part clayey,
and the rains are profuse.  Here, consumption is
much more prevalent than in India, there being 5.3
attacked, and 3.2 deaths by it per 1000 men;
among the Europeans it causes about 1 death
in 7.
In Senegal, situated in 100 north latitude, and
having the warmest and most variable climate on
3 -




42         STATISTICS OF ITS PREVALENCE
the globe, it is difficult to estimate the amount of
consumption among the troops, so great and rapid
is the mortality from diseases peculiar to the climate, but a number of those spared by endemic
maladies fall victims to the disease, and a large
share of the mortality among the natives is caused
by it.
In Sierra Leone, with an annual temperature of 810,
and 189 inches of rain annually, there were, from
1853 to'54, 433 admissions into the hospital, of
which only 9 were cases of consumption; and of 113
deaths, it caused only 4. This does not, however, give
a correct idea of the liability to the disease in this
climate, as the patients, says Dr. Robert Clarke, "are
made up from the liberated Africans from the condemned slavers, the colonial poor, and the British and
foreign destitute seamen."  The black colony here
is formed, too, of representatives of almost every
tribe of Western Africa. The same writer says that
the Negro is extremely liable to phthisis, though
he had met with but three cases among Europeans which had originated there.
Madeira, between 320 and 330 of north latitude,
with its balmy atmosphere, seldom disturbed by
violent winds, and its perpetual summer temperature,
the thermometer showing but a variation of 100




THROUGHOUT THE GLOBE.           43
the year round, and having a mean annual temperature of 65~, seems of all countries in the
world-unless we except the Hawaiian Islandsbest fitted for the mitigation and arrest of consumptive conditions.  Patients who come here affected with consumption live three or four years
longer than the ordinary duration of the disease
in England; and large numbers have resided on
the island in perfect health, while their brothers
and sisters have fallen victims to the disease at
home.  With regard to the climate of Madeira,
it may be observed that it is between that of the
Torrid and Temperate Zones; it is humid, though
not foggy. The island itself is rocky and mountainous, and well watered.
If we except the British troops stationed in the
Madras Presidency, the  forces in  New  Zealand
enjoy a greater immunity from consumption than
the troops in any other of the British possessions.
The number of deaths here per 1000 men, from
all diseases of the lungs, is only 2.4-considerably
less than the number of deaths from consumption
alone in the Mediterranean stations. These islands
are situated between 340 and 37~0 south latitude,
and longitude 1660 and 178~ east, have a mean annual temperature of 580, and a moderate amount of




44         STATISTICS OF ITS PREVALENCE
rain; the climate is not, however, equable, the temperature ranging throughout the year from 390 to 74o.
In singular contrast to this we find that, in Tahiti and the Marquesas, it is stated to be very common, and to destroy nearly a third of the population. "lItt occurs much more frequently," says
Boudin, "' among the women than the men, and,
above all, among children. Pulmonary disorganization advances in these countries with frightful rapidity: three or four months are sufficient to bring
the sufferer to the grave." —" In a few' weeks,"
says Ml. Erhel, "they pass from  the most flourishing health to the most complete emaciation." Tahiti is situated in 17~ south latitude, and longitude
149~ west.  Its climate, though warm, is not enervating; the most remarkable fact in its medical
geography is the complete absence of marsh fevers.
"During a sojourn there of three years," says a
writer, "I have sought in vain a well-marked case
of intermittent fever."  In  the absence of more
minute knowledge of the climate of the island, I
am aware of no circumstance to which this alarming prevalence of consumption can be attributed,
unless that of the absence of paludal or marsh
fevers; the theory, as is well known, having existed, and n umbering, among its warmest suppor



THROUGHOUT THE GLOBE.           45
ters, many eminent medical writers, that the two
cachexie, or conditions of the constitution, which are
produced by consumption and intermittent fevers are
inimical, and cannot exist together; and that the malaria which engenders the latter disease, or frequent
attacks of the disease itself, will stop the development
or progress of the former affection, and, mutatis
mutandis, that consumption is most prevalent in
countries where intermittent fever is unknown. The
correctness of this theory is yet, however, sub judice.
In the Hawaiian Islands, on the other hand, we
find that, although there are no intermittent fevers,
consumption is a very rare disease, almost, indeed,
entirely unknown among the foreign and native
inhabitants, except among those in whom  it has
been developed before reaching the islands, and,
in the cases of these, being followed by a decided
amelioration or a cure.
Chronic bronchitis and catarrhs are, on the contrary, very prevalent. Dr. Gulick, in his essay on
the climate and diseases of these islands, speaking
of the prayer-meetings held at daybreak, says
that, "1 For the first twenty minutes, it was generally
scarcely possible to proceed with the religious exercises, from the incessant coughing of the congregation.  It was as though each one was under the




46        STATISTICS OF ITS PREVALENCE
necessity of expectorating a certain amount of mucus
before respiration could be comfortably carried on."
As regards the amount of moisture, the various
parts of the islands present a great differencesome being arid, with hardly enough rain to
moisten the soil, and some being perpetually moist,
the annual amount of rain varying from 25 to 75
inches.
These islands are situated between latitude 180
and 22~ north, and between 154~ and 160~ of west
longitude. Their climate, both as regards daily and
annual variations, is -one of the most equable known
-the annual temperature being about 730; the daily
range of thermometer being at Nice 8.50, at Rome
110, and at Honolulu 12~; the mean difference of
successive months being at St. Augustine (Florida)
30 68', at Penzance 30 06'; at Madeira 2~ 41', and
at Honolulu and Waioli about 1~ 63'. At St. Augustine the annual range is 53~, at Madeira 23~,
and at Honolulu, Lahaina, and Waioli from 240 to
320. Dr. Judd, in speaking of the evenness of the
climate, says that so little is there unusual or noticeable in the weather that the natives seldom
speak of it-that there is no word in their language to express that general idea, and it is only
the occurrence of a storm or something unusual




THROUGHOUT THE GLOBE.            47
that attracts sufficient attention to make it a subject
of remark.
In London, the mean annual temperature of
which is the same as New-York, as we have already seen, consumption causes at present about
1 death in 8.6. In Stuttgart, according to Dr.
Caspar, in latitude 48~ north, and with a temperature of 49 —1 in 4.7. In Hamburg, with a
temperature of 48~, 1 in 4.6; in Amsterdam, with
a temperature of 490, 1 in 4. The mortality from
consumption in Paris is about the same as in
London.  In Berlin, with  a temperature of 48~,
1 death in 5.7 is occasioned by it; in Copenhagen, which has a temperature of 460, a seventh
part.
In Russia, in 1855, the deaths in all the civil
hospitals were 33,026, of which 3,912, or 1 in 7.8,
were by consumption. In the hospital population
of Montpelier it causes a third, and of Marseilles
and Rouen each, a fourth of the deaths. Havre,
situated near the sea, with a free circulation of air,
is nearly exempt from the disease.
At Rome 1 death in 40 occurs from consumption; at Naples 1 in 8; at Turin, with a mean
annual temperature of 530, 1 in 3; at Geneva, with
a temperature of 750, 1 in 6; at Nice, 1 in 7.




48        STATISTICS OF ITS PREVALENCE
In the hospitals of Florence the deaths from consumption have been variously estimated at from 1
in 6, to 1 in 11.5.
If we compare the mortality from consumption
in the hospitals of Naples and Paris, we find it
much more prevalent in the former place.  From
1835 to'39 the deaths by consumption in the civil
hospitals were:
In Naples......       1 in 23 of all diseases.
In Paris......       1 " 3f  " "
In the military hospitals, during the same period:
In Naples...........       1 death in 31
In Paris.....................  1   "   12
In 1850-51 the deaths by consumption in the
French Army of Occupationi in Italy were 1 in 6;
while in the French Army generally it causes
among the infantry but about 1 death in 13.
The Department of Ain is covered with ponds
and marshes, and is perhaps in all France the
district where intermittent fevers are most prevalent; yet, according to the testimony of several
physicians, consumption is almost wholly unknown
there. In Venice, with a mean temperature of 570,




TIHROUGHOSUT THE GLOBE.          49
and a moist atmosphere, while intermittent fevers
prevail extensively, consumption is very rare —among
1200 patients treated at the hospitals there being
but 2 cases. In the Tuscan Maremnmes, where internittent fever is abundant, of 81,731 cases of various
diseases there were only 100 of consumption, or 1
in 817.
Consumption might be supposed to be rare in
Brazil, with its fine climate and uniform  temperature; yet we find that, in the maritime cities, a fifth
part of the deaths occur from it. At Bahia so
great is the rapidity of its progress that it is regarded
as an acute disease.
In Constantinople, which has a mean temperature of 56~, and a climate characterized by great
variability, consumption is one of the most frequent of diseases, and seems to be as prevalent as
in most civilized countries. Something of its prevalence is undoubtedly due to the narrow ill-paved
streets, the crowded, dark, and filthy dwellings, and
the enervating life of the harem.
In the Canton of Geneva, with a temperature of
490, and rather a dry climate, the deaths by consumption in 1838 were one-ninth of the whole.




50          COMPARATIVE PREVALENCE
VII.-THE  COMPARATIVE PREVALENCE OF CONSUM}PTION AT SEA AND ON LAND.
THE theory has always prevailed, more or less extensively, that the sea may sometimes act, not only
as a palliative, but as a preventive of this disease.
There are undoubtedly certain cases and conditions of consumption which may be cured or
palliated by sea air, but we must bear in mind
the fact that the various stages of a single case of
consumption are often quite opposite to each other
in their character, so as to make consumption
appear as a congeries of distinct diseases, rather than
as a single disease, and that, consequently, it would
be as irrational to recommend sea air indiscriminately for consumption, as it would a particular
medicine.
Were we to form our ideas of the effect of sea
air in consumptive conditions from the comparative
prevalence of the disease in the army and navy,
without taking into consideration certain modifying circumstances which I shall mention, we




AT SEA AND ON LAND.             51
might, as many others have done, conclude that it
is both palliative and preventive. There are many
reasons why, aside from the influence of sea voyages,
the sailor in the navy should be less liable than
the soldier to consumption. Both in the British
and the American Navy every means are resorted
to, to prevent the admission of men affected with,
or in any degree predisposed to phthisis. Recruits
for the naval service are subljected to a rigid
physical examination before they are received, and
the examination is repeated, at the expiration of a
few days, when they are admitted to the receiving
ship where the recruit is entered, and, finally, when
the crew is transferred to a vessel destined for sea
service, every man of doubtful efficiency is returned
to the receiving ship.  Thus every vessel starts
upon her voyage with a crew as- little liable as possible to a disease of this kind.
Sailors, too, are engaged but for three or four
years, at the expiration of which time they are
obliged to undergo a physical examination before
they can be hired again, a system equivalent to
sending home every three or four years all the
sailors in the navy not in perfect health, an arrangement which evidently diminishes the ratio of mortality from  this disease.  In  the army, on the




52          COMPARATIVE PREVALENCE
contrary, the soldier is hired for a much longer
period.
I present, however, the following statistics of
the relative prevalence of the disease, without at
present considering how much the less frequency
of the disease which we generally find to exist
among naval than among military forces is owing
simply to sea air and to a residence on the sea;
though it seems evident that to these are due
much of the comparative immunity enjoyed in the
navy.
A comparison made in 1842 of the diseases of
the naval forces of the East India command of
the British Navy, whose operations were confined
principally to the Bay of Bengal, the Coromandel
or Eastern Coast, and the Island of Ceylon,
and the European.troops in the Island of Ceylon,
gives the following results-results particularly valuable, as the naval and land forces were employed
near each other in nearly the same latitude and
longitude, were collected during the same period,
between 1830 and'37, and from  forces whose
aggregate strength was nearly the same.




AT SEA AND ON LAND.                53.~.~ _.
Naval Forces... 12,942  39   3.0   16   1.2
Military Forces. 14,590  78   5.3   51   3.4
"The less frequency of phthisis in the navy, as
shown  by  this computation," says the authority
whence the above facts are derived, "may arise
from the frequent change of station in the navy,
from the shorter exposure to the debilitating influences of a tropical climate, and from the less
prevalence of fever, which is undoubtedly a frequent exciting cause in persons predisposed to
phthisis."  Another  reason  is doubtless that the
period of a sailor's stay in these regions rarely
exceeds four years, while the term  of service of a
regiment in Ceylon  is ten  years, and the longet
they  remain  the less  power of resistance have
their constitutions to disease.
Diseases of the lungs generally, and catarrhal
affections particularly, were, however, much more
prevalent in  the navy than  in the army; thus,




54            COMPARATIVE PREVALENCE
out of the forces above mentioned, the proportions
were as follows:
Land Forces.... 14590 1,158   79  83  5.6
Thus we see that these diseases are accompanied
by a much greater mortality in the army than in
the navy; in the former, inflammation of the lungs
and phthisis predominating, in the latter, catarrhal
affections, the sailor being much  more liable to
these complaints from the circumstances that he
is more exposed to the vicissitudes of the weather,
is obliged to turn out every night from  ]is close,
overheated berth to take his turn on deck, and
from his being allowed to wear whatever clothing
he pleases, while the soldier is obliged to wear his
g;reatcoat at night.
The navy; stahe former, inflammatics con opinion ve when
speaking of thredominating, in the latterof consutarrlption
spea~kinlg of thle relative amount of consumlption




AT SEA AND ON LAND.                 55
and catarrhal affections in the United States Army,
that there is no necessary connection between the
two diseases, and that they usually exist quite independently of each other.*
A comparison instituted between the naval and
land forces serving in the Mediterranean stations
from  1830 to 1843 gives the following results:
Number of men  Number of
Aggregate  per 1000 at- I deaths per 1000
tacked by con- men by constrength.   sumption.    sumption.
Naval Forces...  102,464       4.5        1.7
Land Forces....  102,214       6.1        4.0
In the naval forces there were 251 cases and 3.1
deaths, and in the land forces 144 cases and 5.9 deaths.
per 1000 men from diseases of the lungs, the proportion approximating that obtained from the comparison
presented of the amount of these diseases among the
soldiers and sailors of the East India command.
In 1856 there were attacked, in the whole of the
British Navy, 5.6 men per 1000, while the deaths
per 1000 were 2.7.
* These affections, however, frequently act as exciting causes
of consumption.




56          COMPARATIVE PREVALENCE
In the squadron stationed in the East Indies
and China coast from 1837 to 1843, in the Mediterranean Squadron, the Home Squadron, and the
irregular naval forces from 1830 to 1836, there
were attacked per 1000 men, by' consumption, 7.6.
This large proportion of consumptive cases can
hardly be considered a fair estimate of its prevalence in the navy generally, as there enter into the
data from which the estimate is drawn, the returns
of one of the squadrons in which the disease is
most prevalent of any in the navy —viz., the HIome
Squadron, many of the vessels of which remain in
one port a whole year, the sailors being permitted to pass a great deal of time on shore, while
no returns from the squadrons in which the disease exists in its minimum, are included.
Thus we find, accepting this last large estimate,
from the statistics given above, that there were attacked in the British Navy 5 men per 1000. In
the whole British Army the number attacked per
1000 is about 6.6.
In our own navy, from  1855 to 1860, out ot an
aggregate force of 29,258 men, there were attacked
per 1000 by consumption, 4.3. In our army about
4.2 men are attacked per 1000.
These last figures, however, are deduced  from




AT SEA AND ON LAND.             57
medical reports of the army and navy made at
different periods, those of the former extending
from 1840 to 1855, and those of the latter fro'm
1855 to 1860.  A  comparison made from  returns
derived from similar periods might give a different result.
The prevalence of the disease varies very much
in the different squadrons, there being attacked per
1000 men, in theBrazil Squadron................. 2.3
Home  "................. 2.9
African   ".................  4.4
Mediterranean Squadron............ 4.7
East India............ 5.0
Pacific         "............  6.1
The mortality from  consumption in the navy is
certainly  very  small.  Owing, however, to  the
facilities which exist in the navy for sending home
invalids, we must not conclude that its mortality
is proportionate to the ratio of its prevalence.
From 1830 *to 1836 the effective total of the
British Navy was 157,770 sailors. The total number of deaths by consumption during this period
was 166, or 1.7 per 1000 men, the mortality
among the various squadrons being as follows:
4




~58     PREVALENCE AT SEA AND ON LAND.
the Home Squadron, the Squadrons stationed on
the West Coast of Africa, the Cape of Good Hope,
and South America, each 1.7 per 1000 men; the
Squadrons of the WVest Indies and North America,
of the Mediterranean, Peninsular Spain, and Portugal, each 1.9; of the East Indies, 1.4.
The returns of the different squadrons from 1837
to 1843, show the mortality from consumption to
have been 1.5 per 1000.
Iln the British Army the number of deaths per
1000 men by consumption is about 4.09.
In our own navy, from 1855 to 1860, out of an
aggregate force of 29,258 men, only 7, or 0.2 per
1000 died of consumption.
In our army, from  1840 to 1855, there died by
consumption 2.4 per 1000 men.
There are no means of ascertaining the prevalence of the disease in our mercantile marine; it
is, however, of firequent occurrence among the
Nantucket whalers.




bIORTALITY FROM5 CONSUMPTION.       59
VIII.-THE MORTALITY FROM  CONSUIMPTION AT DIFFERENT MONTIS AND SEASONS OF THE YEAR.
IT would be of more practical use were we able to
tell the number of cases of consumption developed,
than the number that die from  the disease in the
different months of the year. The former, of course,
we cannot know.  In every month it is fearfully
fatal. Dr. Caspar, from tables of 11,472 cases, carefully kept at Berlin dluring a period of nine years,
shows that the mortality of various winters bears
no connection with the difference of temperature.
In the coldest of the nine winters, which had an
average temperature of 2~0, there were 393 deaths
from consumption; and in the warmest, with a temperature of 360, the number was nearly the same.
The temperature of three winters was almost the
same —320 and 330, yet there was a great variation
in the number of deaths-there being in one 345, in
another 284. The average temperature of the warmest spring was 503, and the mortality was as much
above the average as in the coldest, which had a




60         MORTALITY FRO'M CONSUMPTION
temperature of less than  44~.  Dr. Caspar also
shows by these tables that the difference in the
mortality was very slight in the winters in which
the variations in temperature were greatest, while
it was very strongly marked  in  the Mwinters in
which the variations were very slight.  So far as
any deductions could be drawn, the mortality was
least, those winters in which the barometer was
highest —the average height of the barometer during
this period being 29.79 inches.
Dr. Caspar is of the opinion that the changes in
dress, the difference in diet, in the amount of time
passed in and out of doors, and of habits generally,
in the various seasons, have a greater influence in
determining the mortality from  consumption than
the difference in the atmospherical conditions.
In a table which I have constructed, of 212,407
deaths from consumption, occurring in various years,
at New-York, Philadelphia, Paris, Providence, Baltimore, Boston, Chicago, London, and N!ew-Orleans,
I find that the mortality of the different months,
commencing with that in which it is highest, is as
follows:
March...............           21,950
April.........................  20,897
May.......    19,971




AT DIFFERENT MIONTIIS AND SEASONS.       61
February.....                  18,663
January.....                   18,600
December..... 18,046
June.....                       17,523
July.....                      16,523
November.......                16,360
August.....                    16,087
September.....                 15,387
October.....                   14,209
Arranged according to the seasons, the deaths
were, in theSpring.....                     61,945
Winter........................ 55,309
Summer.................        50,197
Autumn...                      45,956
A table of 12,668 deaths occurring from consumption, in Paris, Milan, and other cities of Europe, shows a corresponding rate of mortality in
the different seasons; there being, in theSpring...... 3,482 deaths.
Winter...                 3,109 "
Summer...               3,076 "
Autumn.... 3,001  "




62          COMPARATIVE PREVALENCE
IX. -COMPARATIVE: PREVALENCE OF CONSUMIPTION IN
TILE CITY AND COUNTRY.
So far as the statistics which we have at hand
enable us to judge, consumption does not seem necessarily more prevalent in large than in small cities.
It is, however, somewhat less prevalent in all the
rural districts of England, than in London. During
a period of six months, in 1837, in which the deaths
from consumption in the rural districts were 3.5
per 1000, they were 4 per 1000 in London, 4.8 in
Birmingham  and  Leeds, and  6.4 in  Liverpool;
though, while it caused in all England, except
London, 1 death in 5, in London it caused but 1
in 6.
There are, however, but few towns in the rural
districts of England so free from consumption as
London.  In Devonshire, during the same period,
one-fifth, and, in Norfolk and Suffolk, one-fourth
of the entire mortality was due to this disease.
During a later period, from 1847 to 1857, while in
all England it caused 1 death in 8, in London it
caused but 1 in 8.6.




IN THE CITY AND THE COUNTRY.        63
It was observed, in the HOpital Cochin, that in
cases in which the disease was hereditary, no imnmunity was enjoyed from the circum'stance of the
patients being born of parents who were natives
of the country, or who had themselves been
raised ifi the country.
A French writer, IM. Fourcault, assumes the
mortality to be much less in small towns and
villages which do not contain more than 2,000
inhabitants, and which have an elevated situation.
Under these  favorable circumstances, he asserts
that not more than one-fortieth of the entire mortality is owing to it, and, in villages still less
densely populated, not more than one-sixtieth or
one-hundredth part.  The small amount of consumption under these circumstances is, however,
undoubtedly due as much to the elevated situation as to the mere thinness of population; nor,
indeed, so much depends on the circumstances
of soil, climate, and situation, is any general
affirmation  that consumption is either more or
less prevalent in the country than in the city,
admissible.




61      INFLUENCE OF LIGHT AND DARKNESS
X.-INFLUENCE OF LIGIIT AND DARKNESS UPON ITS
EXISTENCE.
Htow much influence is exerted upon the prevalence
of consumption by light and darkness? two agents
which exercise such a controlling influence upon
health and upon animal and vegetable life. From
the deterioration in the activity of the animal
functions  which accompanies a long deprivation
of light, it might be supposed, d priori, that consumption  would  be much more likely to exist
under circumstances in which the darkness was
of longi continuance.  The elaborate work of MI.
Boudin on medical geography and statistics affords us much useful information on this point,
and I cannot do better than to present entire a
literal translation of his interesting, remarks:
"Past the Polar circle," he says, "a continued
day follows a long night, and the absence of an
alternation  of light  and  darkness  exercises  a
marked influence for the worse, upon the health.
Sleep, particularly, is neither complete nor restorative. In winter the inhabitants of the smaller cities




UPON ITS EXISTENCE.             65
try, by dancing and acting comedies, to lengthen
out the evening to the latest possible moment; for
every one, knowing that he will not obtain the
sleep which he desires, defers as long as possible
the hour of retiring.  Above all are the women
and children affected by this insomnia; even the
infants toss restlessly throughout the whole night in
their cradles; soon they become pale and rachitic,
and die if they are not sent to a better climate-to
the south of Norway. The same inconvenience, as
we know by personal experience, and the experience of the natives of the country has been the
same, exists in summer. The sun does not set,
the stimulating  action  of the light is unceasing,
and the need of sleep is not felt as with us.  At
eleven o'clock, at midnight,  and  even at one
o'clock, the inhabitants are to be found in
the streets, or standing idly before their doors;
and when, finally, overcome by a feeling of fatigue
and lassitude, repose is sought, it is to find only a
restless sleep which proves but slightly invigorating. It is of but little use to create artificial darkness, as the inhabitants seem to have discovered,
for their windows are supplied with neither shutters nor blinds.
"These influences leave their impress upon the
4*




66     INFLUENCE OF LIGHT AND DARKNESS.
physical constitution of the inhabitants of Finmlarck.
The males, and especially the females, are slender,
blanched, and often rachitic; spinal incurvations
are frequent, menstruation  difficult and  tardy,
embonpoint is rare, and the cheeks seldom  have
any color.  In the midst of all these physiological
and physical circumstances," says 3I. Martins, "one
would suppose that consumption would be very
common; notwithstanding, I believe it to be very
rare, and I do not remember ever to have seen a
single consumptive patient in Finmarek, and all
the physicians of Scandinavia are of the opinion
that the disease becomes less frequent as we advance farther towards the North." —Traite de Ge'ographie et de Statistique Jfedicales. Vol. II., page
630.




PREVALENCE AMONG DIFFERENT RACES.    67
XI.-ITS PrEVArLENCE AMONG DIFFERENT RACES.
THERE is no reason for supposing that, in his
native land, and surrounded by those climatic influences under which nature intended him to reside, the Negro is more liable than the white man
to consumption.  I have excellent authority for
stating that the disease is rare amongst the Negroes
in Africa, and in the interior is almost never
known. But it is found that, as the Negro is removed from his native clime, his predisposition to
the disease increases. Thus in all the stations (with
the single exception of the Madras Presidency) in
which Negro and European troops have been quartered together, the former have been the greater
sufferers, not only from consumption, but from diseases of the lungs generally. It may here be stated
that, of all the deaths from diseases of the lungs
in the British Army, about four-fifths are estimated
to be caused by consumption.
From 1817 to 1839 the annual losses per 1000




68                ITS PREVALENCE
men, fr om  these  diseases, among  the native or
black, and the European troops, were as follows:
EUROPEANS. NEGROES.
Windward and Leeward Islands 10.4      16.5
Jamaica...................   7.5     10.3
Mauritius.............   5.6           12.9
Sierra Leone................  4.9      6.3
Cape of Good Hope, Eastern
Frontier..........  2.4        3.9
Madras Presidency........... 2.3       0.7
This predisposition, under the above-mentioned
circumstances, of Negroes to diseases of the chest,
is rendered more apparent by a comparison of the
mortality  from  these  diseases  with  that among
other troops than of European origin.
In the Isle of Ceylon, where there were bodies
of soldiers from five different provinces, the mortality was as follows. Among theDEATHS
PER 1000 MEN.
Native Troops'......................   1.6
Troops recruited from India............ 1.9
Pioneers (same origin).................  2.5
Malays...............................  3.6
English Troops........................  4.1
Black Troops (Negro)..................  10.5




AMQNG DIFFERENT RACES.           69
As regards the comparative amount of consumption in particular, we find the deaths per 1000
men from  this affection, during a period of from
19 to 20 years, on theNEGROES. WHITES.
West Coast of Africa......... 4.0?
Honduras..............  6.6?
Bahamas.....................  7.0?
Jamaica....................  7.5    7.4
Mauritius...................  6.4   3.9
Antilles.............       9.8      6.4
Gibraltar.................... 33.5   6.1
At the Cape of Good Hope, the deaths from consumption among the HIottentots and British soldiers
are about the same: 2.4 per 1000.
In New-York city, during 1856 and'57, while
it caused, of the deaths among the white population, 1 in 8.6, among the black population, during
the same period, it caused 1 in 4.37.
In Charleston, from  1822 to 1S49, the proportion
of deaths from  this disease among the whites and
blacks was nearly the same: 15.20 per cent. of the
white population during that period, and 14.46 per
cent. of the black, falling victims to it; the excess
being a little among the whites.  The liability to




70     PREVALENCE AMONG DIFFERENT RACES
consumption in this climate is, however, stated by
the census report of Charleston, to be about the
same in the two races.
In Egypt, consumption is very rare among the
Turks, Armenians, Jews, Copts, and Europeans;
thlough, when once declared, it progresses rapidly.
The Negcroes and Abyssinians are, on the contrary,
decimated by it. "Egypt," says an English writer,
" seems to be the northern climate of the black
races; nor can the great prevalence of consumption
amongst them be attributed to the privations and
hardships of slavery, as they are much better cared
for and fed than most of the poor classes of the population."
In Algiers, during the years 1839,'40, and'41,
the total number of deaths was 6,678, of which 234
wvere by consumption.  We find a vast disproportion in the mortality it occasioned among the Europeans, Moors, and Jews: among the first'causing
1 death in 9.3, among the second 1 in 40.7, and
among the last 1 in 36.9.




AND AMONG VARIOUS TRADES.            71
XII.-ITS PREVALENCE AMONG THE VARIOUS TRADES
AND PROFESSIONS.
IF we except the relative amount of consumption in
different climates, we find the difference in its prevalence nowhere so strongly marked as among the
various trades and  professions.  In  a table constructed by M. de iNeufville, based on eight years'
observations at Frankfort on the Main, of 100
dea+hs, occurring among each of these callings,
there were, among —
Tailors........................  39.9 deaths.
Shoemakers.............. 38.4   "
Painters.....................   32.9   "
Locksmiths and Blacksmiths......  30.9   "
Professors............... 29.7   "
Gardeners...................   28.7   "
Brewers...............'26.3
Carpenters......              25 9
Bakers.......                  23.3 "
Merchants......                22.9 "
Physicians and Surgeons.........  18.2   "
Masons.............. 17.1 "
Butchers.............. 8.2 "
Lawyers and Magistrates........  6.8   "




72         PREVALENCE AMONG VARIOUS
The maximum of deaths from the disease being
among the tailors, and the mininuln among the
lawyers, and next among butchers. It is to be
regretted that no statement of the proportion of
deaths among farmers is given in the above table.
It has been computed that, in London, a fourth
part of the bakers have consumptive symptoms.
There seems to be, sometimes, a curious exemption among tobacco workers.  Several years ago it
was ascertained that, among the 5,000 workmen employed by the Government in the tobacco manufactories of France, though they were often ill with
catarrh, consumption was much less prevalent than
among the inhabitants of the distiricts in which they
dwelt. At Bordeaux it was not only rare among
the workmen, but its progress was slow; at Havre
no cases had been observed; nor had any cases
been known to exist among the workmen at Strasbourg, though their families were subject to it;
and at Marlaix and Lille it was much less common
than among other workmen. They were not subject to epidemics, typhoid fevers, nor influenza.
The only explanation that I am aware of, of this
immunity enjoyed by tobacco workers, is that of
Mi. Simon, who attributes it to the narcotic properties of the tobacco.




TRADES AND PROFESSIONS.          73
It is stated, in the Report of the Registrar-General
of England, that, in the year 1851, the deaths
between the ages of 35 and 45 were, among farmers,
9 per 1000; among carpenters, 10 per 1000; among
shoemakers, 11; among blacksmiths, 12; among
tailors, 14; among bakers, 15; and among butchers,
17. Between the ages of 45 and 55, the mortality
among butchers was 23, and between the ages of
55 and 65, 41 per 1000-a much higher rate of
mortality than prevailed among any of the other
classes above mentioned.
The fact that there is a smaller rate of mortality
amongst these classes past the age of 35 years than
among butchers, may perhaps find its explanation
in the circumstance that it is among these very
classes that consumption is most prevalent, and,
as the most frequent and fatal period of consumption is between the ages of 20 and 35 years, their
mortality must be greatest previous to their thiftyfifth year: and proportionately less after it. Butchers,
on the contrary, not being particularly subject to
any fatal disease, find their greatest period of mortality as they advance farther on in life.
Dr. Guy states that, in London, the proportion
of consumptive cases among gentry and professional
men is 16 per cent.; among tradesmen 28, and
among all kinds of laboring men, 30 per cent.




74         PREVALENCE AMONG VARIOUS
He assigns, as the cause of this great prevalence
among tradesmen, the fact that they are confined
so many hours within doors, occupying a middle
place between in and out-door laborers and men
following sedentary in-door pursuits. According to
the same writer the amount of consumption among
men working in-doors and those working out-doors
is as 1 to 3.81 in the former, and 1 to 4.13 in the
latter.  As regards the amount of consumption
among men working in-doors, and using different
degrees of exertion, the ratio among those following
sedentary pursuits is 1 to 3.08; among those using
more exertion, i to 4.44, and among those whose
occupations demand great exertion, 1 to 5.06.
Among single females, leading sedentary lives, there
were three times as many cases of consumption
as amongst those taking active exercise, as servants,
housekeepers, and shopwomen.  Among  females
generally, the smallest amount of consumption was
amongst those employed out of doors.
Dr. Guy also found that, in a large printing
establishment, the deaths from consumption among
compositors, who were obliged to occupy an unvarying and constrained position, amounted to 74
per cent.; among the pressmen, whose labors required the exercise of the whole body, only 31; and,




TRADES AND PROFESSIONS.           75
among those of the operatives who took regular
exercise in the open air, only 25 per cent.  IHe
does not, however, attribute this vast disproportion
solely to the difference in the amount of exercise;
but, in part, to the fact that the compositor often
selects his particular department from  the circumstance of not being sufficiently robust to perform
heavy presswork. He considers the exercise chiefly
of value in assisting to get rid of the effects of
impure air, which effects are increased by comparative inaction; instancing, in support of this opinion,
the good health and long lives enjoyed by literary
men, who lead sedentary lives, but enjoy an abundance of pure air.  Dr. Guy  seems disinclined
to give exercise, in this case, its due credit; many
literary men, including the most indefatigable
workers, passing but a small portion of their time
at their labors, and a good deal in the open
air.
His final conclusions are, that the ratio of cases
of consumption to those of all other diseases, is
highest, when the amount of exertion is least, and
lowest, when greatest; an intermediate amount of
exertion presenting an intermediate ratio.
Sir James Clarke divides the callings by which
the prevalence of consumption is influenced, into




76     PREVALENCE AMONG VARIOUS TRADES
two classes: those which act as local irritants of
the lungs, and those which exercise an injurious
effect upon the whole economy.  Among the former, he places the trade of the mason, the grinder,
and the flax-dresser.  To the second, those agencies
belong which affect the general health and induce
tuberculous cachexiae; such, for example, as do not
afford sufficient bodily exerise, and are attended
with a deficiency of pure air. To their passing so
much time inl the open air he ascribes the comparative immunity from this disease enjoyed by
butchers and tanners.




AND AMONG THE RICH AND POOR.       77
XIII.-CONSTUMiPTION AMONG THIE RICH AND POOR.
IT was estimated by NI. Lombard that consumption
is twice as prevalent among the bulk of the population as among that part of it situated in easy
circumstances.  According to a statistical account
published by M. Espine, the mortality from  consumption amounted to 68 per 1000 among those in,
rich and easy circumstances; 155 per 1000 among
the general population; while among the poor the
proportion was 233 per 1000. These statistics were,
however, drawn more particularly from the city of
Geneva.  The causes of this predominance of the
disease among the poor, are to be found in their
insufficient or improper food, their badly-ventilated
dwellings, and their want of personal cleanliness;
but perhaps, above all, in the mental depression and
listlessness so frequently attendant upon conditions
of life whose daily provisions are fraught with
anxiety and discontent —the influence of the mind
upon the status of the body being too well known to
need any comment. A French physician, M. Elie,




78              CONSUMPTION AMONG
once stated that four-fifths of mankind die of grief!
Nor, though it may seem at first even laughable,
is this assertion without some claim to respect.
ITe does not mnean to have us infer that men die
directly of broken hearts, or that a reverse in
)business will necessarily prostrate the vital forces
beyond that point whence there is no recalling
them; but he does mean that they may die of
diseases, whether they come in the shape of brain
or nervous fever or dyspepsia, springing from exbausted  and  irritated  conditions of the nervous
system, which, in turn, has become disordered by
prolonged and harassing conditions of the mind.
In no disease does the mind exercise a more direct
influence upon the physical condition, than in consumption.  In despondency and grief, the respirations are longer and less frequent; the lungs, the
favorite seat of tubercular disease, are in a semicongested state, the blood does not enter and leave
them  with  its usual readiness, and  a condition
exists calculated  to invite congestions, while that
prostration of the nervous strength which is often
the earliest and most frequent symptom in this
disease, is easily induced.  In  short, the nerve
force-which  regulates  the  whole economy, and
particularly that which  presides over the proper




THE tICII AND POOR.           79
nultrition of the system, and upon the derangement
of which, consumption may be regarded as dependent-is paralyzed.




80              ITS PREVALENCE
XIV.-ITs  PREVALENCE IN MANLTFACTURING Towxs.
So far as we can derive any information from the
statistics of Manchester and Belfast, consumption
does not seem more prevalent among the operatives
in cotton and  linen factories than among other
classes of operatives.
A number of years ago, 3Mr. Noble, an English
surgeon, presented a number of statistics by which
he showed that the proportion of deaths by consumption in Manchester did not exceed that of
other English  towns-that they did  not occur
more frequently, nor at an earlier age among the
operatives in the factories than among the other
inhabitants of the town; but, on the contrary, the
ratio of the mortality was less than in various other
cities and the surrounding agricultural districts.
During a period in which the deaths from consumption in this city amounted to 151 per cent.
of the whole, in Essex, one of the most purely agricultural districts- in England, while the general
mortality was much less than in Mhanchester, that




IN MANUFACTURING TOWNS.           81
from consumption amounted to 19 per cent. A similar result followed a comparison with other agricultural districts of England —-Cambridgeshire, Huntingtonshire, and Lincolnshire-in which, while the relative mortality was less, the per-centage of deaths from
consumption was greater than in Manchester, being
18 per cent. of the whole. Nor did a comparison
with several cities show that Manchester enjoyed
a relative immunity fron  consumption when contrasted simply with agricultural districts. In Liverpool and West Derby, the deaths from consumption
were 20 per cent., and in Birmingham, a city also
exempt from factory labor, 18 per cent. The proportion of consLnmptive cases in London, at about
the same time, was smaller in comparison with its
size than in any other English city, being only 15J
per cent.
Nor was an undue proportion of the consumptive cases of Manchester furnished from the factory
population. The total number of deaths from consumption, during the period referred to, was 1141,
of which 174, or about one-sixth, occurred among
the operatives. As this class formed about a sixth
part of the entire population, the ratio of deaths
from the disease, among the operatives and the other
5




82               ITS PREVALENCE
inhabitants of the town, was, therefore, about the
same.
That factory labor does not induce consumption
at an earlier age than do other occupations, is
demonstrated  by  varieus facts-such  as the following:
The 174 deaths above referred to as occurring
among the operatives, were mostly between the
ages of 15 and 40-the period of life at which
consumption is most liable to occur under ordinary  circumstances.   The  whole  1141  deaths
from consumption were divided among the different periods of life as follows:
AGES.                  NUMBER OF DEATHS.
15 to 20 years.......... 195
20 " 25  ".........              243
25 " 30 "......... 260
30 " 35  "....................  223
35"   40  "....................  220
Total........................ 1141
A table which does not show a greater mortality during the earlier periods of life than we
should ordinarily expect.




IN MANUFACTURING TOWNS.            83
Sir James Clarke constructed a table of 1000
deaths from consumption, deduced from observations made promiscuously in Edinburgh, Berlin,
Nottingham, Philadelphia, Chester, Carlisle, and
Paris. By including certain tables referring only
to Carlisle and Paris and to Manchester, we find
a total of 1155 deaths for the two former places,
and of 1141 for the latter —the numbers at various
ages, of the respective series being as follows:
CARLISLE
AGES.              AND PARIS. MANCHESTER.
Between 15 and 20 years...... 196     195
"    20  "  30   "...... 515      503
"    30  " 40   "...... 444       443
Total.................... 1155   1141
"A most remarkable accordance," says the author,
"in the ages of persons dying of consumption under
very different external circumstances."
We are, however, by no means to regard these
data, taken as they are from  one town alone, and
collected in a brief period of time, as sufficiently
conclusive evidence in determining whether, or how
much, factory labor is calculated to develop consumption. Were we to accept a favorite theory




84              ITS PREVALENCE
of medical men, that moisture and sudden atmospherical transitions are the most prolific causes of
this disease, we should be almost justified in concluding, without any array of facts, that factory
labor would induce it: as the operatives, in many
departments, are occupied in rooms whose atmosphere is not only warm, but saturated with vapor;
and, constantly perspiring, they emerge from this
moist atmosphere, three or four times a day,
into the cool air outside, and this, too generally,
without the precaution of changing the dress, or
adapting it to the transitions of temperature.
This theory must be received, however, with
some allowance. Circumstances of this kind have
a tendency to produce catarrhal and bronchial, rather
than tubercular affections.  Statistics of the extensive linen factories-,of Belfast, among the operatives
in which the former class of diseases are found to
predominate, show this to be the case; this
fact was demonstrated also when comparing the
amount of catarrhal and tubercular affections in
our army and in the naval and land forces in
the East Indies.
Whatever predominance of consumption more
extended statistics might show to exist among operatives in cotton and woolen mills, should, perhaps,




IN MANUFACTURING TOWNS.           85
be attributed in a great part to the constrained
and stooping positions which many of them  are
obliged to occupy, frequently to a want of proper
exercise, and often owing to low rates of wages
and failure of work, to poor food, and to badly
ventilated and cared for houses.
In treating of the prevalence of consumption
among the various callings, it may be remarked
that I have omitted the statistics of the disease
among a very numerous class of workmen, engaged
particularly in the large manufactories of Birmingham and Sheffield, known as "dry grinders," who
are employed in grinding upon dry stones, needles,
forks, knives, &c. These workmen, as are also filecutters, are subject to a species of consumption, so
called, so malignant in its form, and so fearful in
its extent, that almost all who adopt and pursue
for a long time these occupations, fall victims to
them.  This disease has been treated of at full
length by medical writers, and abundant statistics
have been  collected  relative  to  its prevalence.
None of these are, however, presented here, as
the disease, while it is looked upon generally as
genuine tubercular consumption, is, in reality, a
species of bronchitis, induced by the irritation
caused by the floating particles of steel which find




86    PREVALENCE IN MANUFACTURING TOWNS
admission into the lungs, and is characterized, not
by the formation of tubercle, but by ulcerations
extending from the large bronchial tubes to their
terminations.




AND AMONG THE TWO SEXES.          87
XV. - COMPARATIVE PREVALENCE OF CONSUMPTION
AMONG THE TWO SEXES.
WHETHER consumption is most prevalent among
males or females is a question on which a difference of opinion has always existed among medical
writers. An abundant supply of facts shows conclusively that it causes a larger proportion of deaths
among the latter sex. Of the numerous facts confirmative of this conclusion, the following may be cited:
Of 1554 patients who died of consumption in
four of the French hospitals, 745 were men, and
809 women.  We are told by Louis that, of a
certain number of consumptive patients under his
care, 57 were males and 70 females; and he confirms the deduction from this fact by the circumstance that, of forty individuals who died of various other chronic diseases, and whose lungs were
found in a tuberculous condition, 15 were males
and 25 females.
Still stronger confirmation of his opinion is
found in a statement of [M. de Chateauneuf, to the




88          COMPARATIVE PREVALENCE
effect that, of the entire number of patients admitted into the  Parisian Hospitals between the
years 1821 and 1836, 26,055 were males, of whom
754 died of consumption, and 16,955 were females, of
whom  809 died of the same disease-the excess
being greatly on the side of the latter sex.
There died of consumption in England, in 1838,
27,935 males and 31,090 females; as the number
of males in England that year was 7,668,245, and
of females 7,885,615, the proportion of deaths from
consumption among the two sexes was 36 males
and 39 females, to every 10,000 inhabitants; while,
according to the Irish census for 1841, there died
from  consumption in ten years 63,635 males and
71,955 females: the ratio, calculated in a manner
similar to the one given above, being 15.8 males
and 17.3 females to every 10,000 inhabitants-the
relative proportion being about the same.
Of 247,419 deaths occurring from  consumption
in New-York, Philadelphia, Providence, England,
Boston, Itamburg, Rouen, Naples, Geneva, Berlin,
Sweden, and Paris, 116,527 were among the male,
and 130,992 among the female sex.
Though consumption is, on the whole, more
prevalent among females than males, certain writers
maintain that, in large cities, it occurs more fre



AMONG THE TWO SEXES.             89
quently in the former sex.  This certainly is the
case in some of the principal cities of England,
though even in these, as we shall perceive, the
statement does not admit of universal application.
Dr. Duncan states that while, of the general
population of England and Wales, consumption
would cause 378 deaths among every 100,000 males,
it would cause 408 deaths among every 100,000
females; but, in the city of London, it would cause
among the same number of males 451 deaths, and
among the same number of females 377; and, in
the city of Birmingham, 526 deaths among males
and 410 among females.
The predominance of consumption among males
in several of the English cities, is shown by the
following table of the number of deaths by consumption occurring in every 100,000.
MALES.  FEMALES.
Leeds....................    440  477
Birmingham.............. 526     410
Lohdon.................. 451     377
Liverpool and West Derby.. 595    571
Manchester and Salford..... 549   548
England and Wales........ 378     408




90          COMPARATIVE PREVALENCE
In the city of Leeds, as may be perceived, the
excess is on the side of the females.
By the latest mortality reports of the city of
London, the excess of consumption is still seen to
be among the male sex, as I find that, of 308,318
deaths occurring in London among males, from
1847 to 1858, 1 death in every 8.2, or 12.17 per
cent. of the whole, were caused by consumption;
while of 300,357 deaths, during the same period,
among females, it caused only 1 death in 9.2, or
10.18 per cent. of the whole.
An explanation of this excess of consumption
among males in cities, over that which exists in
the same sex in the country, has been offered in
the fact that, in the city, men's passions are
more excited and depressed —the failure of work,
disappointed and over-wrought ambition, all have
their due effect; while that mental tranquility
so necessary to a sound body, is rarer than in
the country-an explanation rational enough, so
far as it goes, but by no means sufficient, inasmuch
as, in the majority of cities generally, the excess
of consumption is on the side of the female
sex.   A  more reasonable supposition, I think,
would be that, in the cities mentioned abovewhich are devoted almost exclusively to manufacturing or trading —the men are more subjected




AMONG THE TWO SEXES.             91
than in most cities to the deteriorating influences
of bad air, confinement, and constrained and injurious
positions attendant upon occupations in large factories, while, in  Birmingham  particularly, large
numbers of workmen are exposed to danger from
the effects of fine particles of iron and steel which
are liable to enter the lungs-the deaths from diseases thus caused being generally classified in the
reports as cases of consumption; and in London,
aside from these influences, shopkeepers, particularly, do not enjoy the benefits of a free and pure
atmosphere to so great an extent as they would in
smaller cities.  It has already been stated above,
in speaking of the prevalence of consumption among
various occupations, that a very large proportion
of the tradesmen of London-not less than 28 per
cent.-die of consumption. There are various other
reasons, upon which I cannot at present touch,
why the excess of consumption in London might
be among males; certain it is that this excess,
which has invariably existed for a large number
of years, is not a mere accident, but has its origin
in settled causes, to some.of which is to be attributed a similar excess when it exists in other cities.
As may be seen, however, from the following
table, constructed by Sir James Clarke, and derived from a large number of cases, the excess of




92            COM3PARATIVE PREVALENCE
consumption in cities generally is by no means
constant on the side of either sex.
CASES OF CONSUMPTION  PROPORTION
AMONGG            AMONG
MALES.  FEMALES.  MALES. FEMALES.
Hamburg......  555         445       10 to  8.7
Rouen (hospital
population).   55       44       10 "  8.6
Naples........  382        315       10 "  8.2
New-York...... 1,584      1,370       10 "  8.6
Geneva........   71         62       10 "  8.7
Berlin.. 3......  328       292       10 "  8.8
Sweden....... 2,088      1,860      10 "  8.9
cc....... 3,054      3,103       10" 10.4
Berlin.........  560       655       10 " 11.6
Paris.......... 2,219    2,970       10 " 13.3
1......... 3,965      5,579       10 " 14.3
Berlin (includ'g
children)....  363      567       10 " 15.6
By this table, which was constructed a number
of years ago, the excess of consumption among
the two sexes is seen to vary at different periods
and in different cities.  In New-York the preponderance is shown to be on the side of the males,
while at present it is on that of the females. The
table, however, giving,  as  it  does, merely  the




AMONG THE TWO SEXES.            93
number of deaths from consumption among the two
sexes, is of comparatively little value, as we are
left in ignorance how much the excess of deaths
among either sex might be due to the greater
number of that sex among the general population.
In the city of Philadelphia, during a period of
three years, among the males, 1 death in 9.81, or
10.18 per cent. of the deaths, was caused by consumption; among the females, 1 death in 8.28, or
12.07 per cent.
In the city of New-York, during the years 1848,'49,'50,'51,'53,'55,'56, and'58, the deaths from
consumption were 21,567 —the proportion among
the males being 1 in 9.28, or 11 per cent., and,
among the females, 1 in 8.23, or 12.4 per cent.
There are various circumstances which would
lead us to suppose, a priori, that women would
be more liable-in civilized countries particularlyto consumption than men; prominent among which
are certain peculiarities of physical organization,
and various habits of dress and life, which modern
society has imposed upon its votaries.
Among the former may be mentioned the following, which are enumerated by the able Hufeland in treating of the physical peculiarities of the
female:




94            COMPARATIVE PREVALENCE
"Great laxity of fibre: hence a disposition more to
diseases of atony and relaxation.
"Quicker and richer chylification and sanguification;
sanguification calculated to the nutrition of a second being;
hence a plethoric state, a disposition to congestions.
" Greater productivity  and  plasticity: hence  more
inclination to abnormal productions, especially when the
sexual production is interrupted or ceases."
We find, in these peculiarities, some of the principal conditions calculated to induce a fibrinous
exudation into the lungs, which may afterwards
become tubercle-corpuscles.    According  to  Dr.
James  Hughes  Bennett, of Edinburgh,  in  his
"Monograph  upon  Pulmonary  Tuberculosis" —tlhe
most reasonable and satisfactory explanation, to my
own mind, that has yet been offered of the phenomena of consumption-tubercle is originally a
simple exudation into the lungs of the liquor
sanguinis, which, instead of progressing and  becoming developed into perfect cells, forming normal
or abnormal tissue, from its imperfect power of
organization  undergoes a retrograde  metamorphosis, forming what are known as tubercle-corpuscles.
Obviously, therefore, for tubercular deposits to
be formed, a certain condition of the blood and
blood-vessels must exist, favoring exudation, and
exudation must take place.




AMONG THE TWO SEXES.             95
Without inquiring, at present, what the original
cause is which induces these changes in the blodd
-which cause is at the foundation of the disease —
it may simply be stated that the peculiarities of
the female, noted by IIufeland, are such as favor
these exudations. There is greater laxity of fibre,
and a disposition more to diseases of atony and
relaxation-hence to exudations.  There is a plethoric state, a disposition to congestions, of which
exudations are the usual sequence; greater plasticity, and, therefore, greater inclination to abnormal productions.
That all these circumstances have their weight
in the development of diseases which are characterized by exudations, is shown by the fact that
cancer-a formation in which the exudation goes
on to a high degree of developlnent —is much more
frequent in females than in males, and that this
disease, as well as consumption, is almost certain,
if there is a tendency to either disease, to develop
itself when the period of menstruation and childbearing is over, after which period, a disposition to
plethora of the blood-vessels is generated, from the
circumstance that the system is no longer regularly
relieved of a portion of its blood.  Pregnancy,
also, as is well known, will frequently prevent or




96          COMPARATIVE PREVALENCE
arrest the development of consumption, and this,
perhaps, from  so great a portion of the blood
being required for the nourishment of the fcetus.
I do not mean to be understood to assert that
this rich condition of the blood and disposition to
plethora are the most favorable that can exist for
the production of tuberculous, though it may be
of cancerous exudations; but it is more so than
that condition of the blood and blood-vessels that
ordinarily exists in men. On the contrary, a watery, impoverished condition of the blood-vessels is
by far the most favorable to tubercular exudation: as
it is exudation from  blood in this condition that
is most liable to sink into the low organization of
tubercle-the rich plastic blood being most favorable to the development of the higher organization which exists in cancerous formations. Modern
chemistry has, however, shown that woman's blood
contains a smaller amount of globules and more
water than that of man, and is, therefore, more
easily deteriorated-an additional reason why consumption should be more prevalent among the
female than the male sex.
Aside from these peculiarities of the female organization, there are numerous artificial causes
which exercise a still more decided influence in
the production of consumption among females.




AMONG THE TWO SEXES.            97
Nor are we to place in the front rank of these
causes, the domestic and in-door life which in most
civilized countries is the habitual lot of women.
Valuable as is vigorous bodily exercise to the
maintenance of health, the ordinary household avocations of woman, regularly pursued, are quite as
satisfactory to the requirements of her health as
the more violent labor of man to his; unless,
indeed, we coincide with those energetic ladies
who maintain that masculine occupations are better
adapted to woman than her own. Nature has so
constructed her and ordered her life that she is
not fitted for violent bodily labor: she is weaker,
her bones and limbs are smaller and more delicately
formed, her temperament is more lymphatic, she
has more fat and less muscle, is less energetic and
capable of enduring fatigue than man, and, during a
great part of her existence, she is incapacitated,
by peculiar physical conditions and the duties of
maternity, from  severe bodily labor.  It is stated
that, in certain parts of France and Belgium —
where a great part of the out-door labor is performed by women-they are no more subject to
consumption  than  men.   Nevertheless, while a
greater immunity from consumption may be gained
by women (as by men) by additional exercise, it




98          COMPARATIVE PREVALENCE
is still true that, so far as the disease in question
is concerned, women will enjoy, in the regular exercise of their ordinary avocations, ceteris parib'ts,
their normal degree of health. Per contra, the gain
in health which women on the Continent acquire,
by their masculine labors, is counter-balanced by
the roughening and distortion of their womanly
physique.
Prominent among the artificial causes above referred to as calculated to favor the development
of consumption among women, may be mentioned
the habit of constricting thb lower part of the
chest by tight lacing, by which the action of the
lower part of the lungs is impaired and confined,
and the burden of respiration, and more than a
normal proportion of blood, is thrown upon the
upper lobes, the favorite seat of tuberculous deposits
-a tendency to stagnation, congestion, and exudation being thereby induced in those parts; and
the habit of leaving the upper part of the chest,
the vital part in phthisis pulmonalis, exposed, too
often without regard to the condition of the atmosphere, under the impression that these parts are
strengthened by exposure to the weather.
Some common habits of life, and Fashion-a
queen pitiless to her too devoted subjects, in her




AMONG THE TWO SEXES.             99
rule, and, like Moloch, oft "besmeared with sacrifice
of human blood"- furnish no small number of victims to this disease. Days passed in idleness, in
perusing books not promoting tranquil or healthy
thought, but ministering to the less noble qualities
of the imagination, in languid employment or
unrefreshing exercise, and eccentricities of diet
abhorrent to all reason,-betray themselves too
often, in our American ladies particularly, in
the narrow and contracted chest, the inelastic
step, and disorders of deranged nutrition, the
latter, generally, the fons et origo of tubercular
diseases; while thin shoes and damp walks, balls
and parties following close upon each other, with
their accompaniments of heated rooms alternating
with chilling draughts, indigestible suppers at unnatural hours, unrefreshing sleep by day-light and
wakefulness at night, a complete revolution in
short, of nature's laws, present an array of external circumstances than which more favorable to
the development of consumption can scarcely be
imagined.
Ritchie, in his descriptions appended to Turner's
"Riveris of France," states that, in the Arrondissement of Nantes alone, three hundred and seventeen unmarried girls, from the age of sixteen to




100          COMPARATIVE PREVALENCE
twenty-two, die every year, and two hundred and
forty young married women, from the age of
twenty to thirty-two!  These, with few exceptions,
are the victims of the " al."  He says, describing
the French bal: "'It often takes place under a
thin canopy, and the tired danrseuse sits down to
look at the others, unconscious of her danger.  If
the scene has been a room, she lingers in the cold
air on coming out to bid good night. We have
often ourselves seen a company of young girls crouching under a canvass roof, loth to be driven away by
a shower, receiving the rain-drops as they fell upon
their glowing bosoms with a playful scream, and
inhaling, with the unconsciousness of lambs ill the
steaming den of the butcher, that damp, chill,
heavy atmosphere in which  the germs of consumption were as thick as moths in the sunbeam."
Unlike as our festivities are to these, the effects
are often the same; and, too often, alas! perishing
in the unrelenting grasp of consumption, do we
meet their victims, whose unhappy fate Victor
Hugo describes in lines so pathetic and beautiful, that I hope to be pardoned for giving them,
even in a statistical paper:
"Quels tristes lendemains laisse le bal folAtre!
Ad:eie -oarure, et danse, et rires enfantins!




AMONG THE TWO SEXES.                   101
Aux chansons succedait la toux opiniatre;
Aux plaisir, rose et frais, la fievre au teint bleuatre,
Aux yeux brillans, les yeux eteints.
Elle est morte.  A quinze ans, belle, heureuse, adoree!
" Joyeuse, et d'une main ravie,
Elle allait, moissonnant les roses de la vie,
Beaute, plaisir, jeunesse, amour!
La pauvre enfant, de fete en fete promenee,
De ce bouquet charmant arrangeait les couleurs!
Mais qu'elle est passe vite; helas! l'infortunee,
Ainsi qu' Orphelia, par le fleuve entrainee,
Elle est morte en cueillant des fleurs!"




102              ITS PREVALENCE
XVI.-ITs PREVALENCE  AT  DIFFERENT  AGES  OF
LIFE.
IT it stated by Hippocrates, that the period of life
at which the greatest mortality from consumption
occurs is between the ages of 20 and 35 years.
All modern statistics are confirmatory of this statement, as all show the greatest number of deaths to
occur between the twentieth and thirtieth year.
The proportion of deaths at the various periods
of life is shown by the following table, taken
from  the "G6ographie et Statistiques Medicales"
of M. Boudin.
Total number of deaths from consumption in
England and Wales, in 1847: 53,317; divided as
follows:
AGES.               DEATHS. PER CENT.
Under 5 years............ 5,195    9.7
5 to 10    "............   1,656  3.1
10' 15    "............  2,342    4.4
15 "c 20   "c........... 5,526    10.4
20 " 25   i"........... 7,420    13.9




AT DIFFERENT AGES OF LIFE.         103
AGES.                DEATHS. PER CENT.
25 to 30 years......    6,666    12.5
30 " 35 "........... 5,467 10.2
35" 40    "......... 4,757         9.0
40 " 45    "........ 3,750    7.3
45 " 50............ 2,938    5.5
50 " 55    "............ 2,372     4.4
55" 60    "............ 1,899      3.5
60 " 65    "............ 1,464     2.7
65" 70    "............ 1,020      2.0
70 " 75    "............  449      0.9
75 " 80    "...........  237      0.4
80" 85    "..........   67         0.1
85" 90    "............   19       0.04
90 " 95    "...........    5        0.005
95 and over..............   18     0.03
Of a table constructed by myself, of 88,427 deaths
from consumption, occurring in both sexes, in
various cities and countries, there occurred between
the ages of 20 and 30, the ten years in which the
number of deaths was greatest, 22,554; between
the ages of 30 and 40, the next most fatal period,
18,152.
Between 10 and 20.                 11,093
9" 40 " 50......10,932
From birth to 10 years of age.    9,605




104             ITS PREVALENCE
Between 50 and 60.                6,886
"  60 " 7o..5,745
" 70  "  80..,178
C"  80  "  90.                  194
"1 90 "100.                      33
Thus we see that the liability to the disease is
greatest between the ages of 20 and 30, after which
period it becomes less and less as we advance in
life; though, as we have seen by this table, it is
somewhat greater between the tenth and twentieth
than between the fortieth and fiftieth year.
It has been variously stated by writers, that consumption is developed at an earlier age among
females than among males. The following table,
which I have constructed, shows that this is not
true before the tenth year; yet, between that time
and the forty-fifth year, the various decades furnish a greater per-centage of deaths among the
females than the males; but that, after the fortyfifth year, the per-centage is greater among the
males.




O3  -Deaths occurring from  Consumption  in England, from  1848 to 1852, in 1856,
and in  London in  1857.
MALES.                                              FEMALES.
TOTAL DEATHS FRIOM CONSUMPTLON:                      TOTAL DEATHS FROM CONSU-MPTION:
193,729.                                            216,133.
MALES.                       FEMALES.
Under 5 years of age......... 15,857 or 8 4 per cent.          15,111 or 6.9 per cent.
Between 5 and 10 years......    5,440.. 2.8..            6,116.. 2.8
10..15.6,670.3.4..                             10,852.. 5.0
(5.. 15).12,110..                    6.2..           16,968.. 7.8
15.. 25........ 44,423. 22.92..                56,515..26.1..  25..35........ 43,791..22.6..                   53,965..24.9.. 35..45........ 32,890..16.9..                    36,795..17.0
45..55........ 23,244.. 11.9..                 20,534.9.5....55..  65.....    13,903.. 7.0..            11,448.. 5.2. 65..75........  5,862.  3.0..                 4,773.2.2
75..85........    867.  0.45..                      901.. 0.41
85..95........            59..0.02..                 84..  0.03 




106  PREVALENCE AT DIFFERENT AGES OF LIFE.
Various explanations have been given, of the
greater tendency of consumption to develop itself
among females than among males, during the period
above mentioned, all of which are far from being
satisfactory. Perhaps as rational an explanation as
can be adduced, may be found in the fact that the
physical peculiarities, which I have mentioned as
being characteristic of the female sex, are most
strongly marked at this period-the period of womanhood, and in the circumstance that it is at
this time that the habits of social life above enumerated exercise their greatest influence.
There are many other points connected with the
existence and course of consumption, relative to
which statistics might be given, but upon which I
have at present neither time nor space to enter.
Among these may be mentioned the statistics of
the duration of the disease; of the results of treatment; of the cases in which hoemorrhages occur;
of the different lungs and different parts of the
lungs affected; statistics of its hereditariness; and
more extended statistics of its prevalence in regions
in which intermittent fevers prevail. These points
I hope to make the subject of consideration in a
future paper.




CONCLUSIONS.              107
XVII.- CONCLUSIONS.
FROM the various facts I have presented, the following conclusions may be deduced:
I. —That, if climate be incapable, per se, of generating consumption, it is one of the most powerful
agents in modifying and controlling its prevalence.
II. —That there are certain varieties of climate
inimical to the development of consumption, and
of these the most unfavorable, are:
1. Those characterized by extreme and unvarying cold.
2. Those climates characterized by a cool, dry
atmosphere.
3. Those which have a very high temperature,
with but a moderate amount of moisture.
III.-That the climates most favorable to the
development and  existence of consumption, are:
1. Those which have a high temperature and
a moist atmosphere.
2. Moist climates with a moderate temperature.
3. Climates characterized by great variations
in the daily temperature.




108                CONCLUSIONS.
Finally, with regard to climate, humidity seems
most favorable, and dryness most unfavorable to
consumption, though a moist salt air is not calculated to develop it.
IV.-That the liability to consumption is increased by  insufficient exercise, by  occupations
which require such positions as constrict the chest,
by impure and confined air, by improper or insufficient food, and by influences which have a depressing effect upon the mind.
V.-That a long continuance either of light or
darkness will not produce it.
VI. —That it is more prevalent on land than on
the sea.
VII. —That it is more prevalent among females
than among males, and, finally,
VIII.-That the period of its greatest mortality
is between the ages of twenty and thirty years.




TO PHYSICIANS!
Recently Published by Win. RADDE, 303 Broadway.
A
MONOGRAPH ON ACONITE.
ITS USES:
TOGETHER WITH ACCURATE STATEMENTS DERIVED FROM
TIE VARIOUS SOURCES OF MEDICAL LITERATURE.
TRANSLATED FROM THE GERMAN OF DR. REIL,
B3v HENRY B. MILLARD, M.D., A.M.
Price.................. $0.75.-With Colored Plate.... $1.00.
The above production has received, since its translation, the highest expressions of commendation from physicians and medical journals of both systems of medicine,
and may be regarded as the classic work upon the subject
of which it treats.
7




2                     REIL S MONOGRAPH
Of the seventeen Monographs upon Aconite-published
in Latin, German, English, and Italian (including the
valuable treatise of Fleming), between  1761 and  1861this is by far the fullest and most complete, and presents
all that has yet been ascertained of the physiological and
therapeutic action of this valuable remedy.  The author,
well known as one of the ablest physiological writers of
Germany, has treated his subject with equal ability and
impartiality, and  has included  the  most important and
valuable uses and experience, as furnished by physicians
of both schools.
An idea of the thoroughness and impartiality of the
work may be conveyed by the followingPREFACE. —INTRODUCTION.
PART I.
HISTORICAL.
PART II.
PHYSIOLOGICAL.
CHAPTER 1. —Accidental Poisonings of Men: a. Cases of Poisoning; b. Observations of its Action upon the Sick.
CIAPTER 2.-Experiments and Provings with Aconite: A. Upon Men-a. By
Physicians not of the Homceopathic School; b. By Homceopathic Physicians.
B. Aconitine-a. Experiments on Animals; b. Experiments on Plants.
CHAPTER 3.-Pathological Changes: a. In Men; b. In Animals.
PART III.
PHARMACODYNAMIC VIEWS AND GENERAL THERAPEUTIC INDICATIONS.
CHAPTER 1.-Opinions of Physicians not of the Homceopathic School.
CHI4PTER 2.-Views of Homceopathic Physicians.




UPON ACONITE.                     3
PART IV.
THE THERAPEUTIC EMPLOYMENT OF ACONITE.
CHAPTER 1.-Its Employment by other than THomceopathic Physicians.
CHAPTER 2.-Its Employment by Homceopathic Physicians.
PART V.
CONCLUsIONS.-LITERATURE.
From  numerous favorable notices of medical journals we present only the following:
This Monograph-probably the best which has ever
been published upon the subject-has been translated and
given to the public by Dr. Millard, of New-York.  Apart
from the intrinsic value of the work, which is well known
to all German medical scholars, the translation of it has
been completed in the most thorough and pains-taking
way; and all the Latin and Greek quotations have been
carefully rendered into English.
The book itself is a work of great merit-thoroughly
exhausting the whole range of the subject. To obtain a
thorough view of the spirit of the action of the drug, we
can recommend no better work.-North American Journal
of Homaeopathy.
After a careful examination of this treatise, we find it
full and complete on the subject of which it treats. The
bibliography of the subject, the medical history of the
plant, the results of original investigations and experiments made with a view of testing its properties, the
several accidental experiences obtained from various wri



4           A MONOGRAPH UPON ACONITE.
ters respecting its poisonous action, are all fully detailed.
The author collates the testimony from any and every
source, examines critically its relative weight, sifts out
whatever seems erroneous or unconclusive, and concludes
with a resume of the real value of Aconite as a remedy.
We consider this "prize essay" as presenting, in a
high degree, the great advantages flowing from special
treatises devoted exclusively to one theme. The search
for information bearing upon it is almost exhaustive; it is,
consequently, rich in facts for those desiring to be fully
informed. Text-books and general treatises do very well
for beginners, or for those who take only a general interest
in the multifarious questions of which they are expected
to treat; but to those who wish a thorough knowledge
upon any one article, treatises exclusively devoted to
their consideration must, of course, always prove more
satisfactory. — Charleston Medical Journal and Review.