Page:EB1911 - Volume 27.djvu/373

 In English counties containing populations of 100,000 or over the highest rates were—in 1908—London, 1806; Lancashire, 1848; Northumberland, 1947; Carnarvonshire, 2025; and Carmarthenshire, 2328 per million living. Of the fifteen counties in England and Wales with the highest tuberculosis moralities, no fewer than seven are Welsh. Cardiganshire, with 2270 for both sexes, has a rate nearly double that of England.

According to the United States census of 1900, the death-rate from tuberculosis in the area chosen for registration which embraced ten registration states, namely, Connecticut, Maine, District of Columbia, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Rhode Island and Vermont, and 153 registration cities outside these states, was:—

The returns of the mortality statistics of the United States for the year 1908 cover an area of 17 states, the district of Columbia and 74 registration cities, representing an aggregate population of 45,028,767, or 51·8% of the total estimated population of the United States.

In the United States tuberculosis of the lungs forms from 86 to 87% of all cases. The death-rate, as we see, is steadily decreasing. It is, however, difficult to estimate the ravages of the disease in that country owing to the fact that rather less than half the United States is still unprovided with an adequate system of registration. The following was the death-rate from tuberculosis (all forms) per 100,000 of the population of the chief cities of the United States during 1908:—

The returns in the United States show a high rate of mortality from tuberculosis amongst the coloured population, the negro being particularly susceptible to pulmonary phthisis; the death-rate from this cause is nearly double that amongst whites.

Age and Sex.—The most complete information under this heading is derived from the English records. “In both sexes,” says Dr. Tatham, “the real liability to phthisis begins somewhere between the fifteenth and the twentieth year. Among males it attains its maximum at age 45–55, when it reaches 3173 per million living. Among females it attains its maximum (2096) at age 35–45. In both sexes the rate rapidly declined after the attainment of its maximum. Practically the incidence of pulmonary phthisis is upon the ages of 15 to 75 years, very old people and young children being comparatively exempt. According to recent experience, females seem to be rather less liable than males to death

by phthisis at ages under 5 years, more liable at the age of 5–20, and again less liable at subsequent ages.” These observations, it must be noted, refer only to consumption. The comparative immunity of the very young does not extend to all forms of tuberculous disease. On the contrary, tuberculosis of the bowels and mesenteric glands (tabes mesenterica), tuberculous peritonitis and tuberculous meningitis are pre-eminently diseases of childhood. The tables at foot of page show in detail the relative incidence of pulmonary phthisis at different ages, and the steady diminution of the disease in England and Wales since 1850.

Occupation has a marked influence on the prevalence of pulmonary tuberculosis. The comparative mortality figures for various occupations are taken from the supplement to the registrar-general's 65th annual Report, and show the incidence of pulmonary phthisis, agriculturists being taken at 100 for purposes of comparison.

The high incidence in the first group will be seen chiefly to affect those occupations where there is dust (scissors and file makers and furriers). The high mortality amongst general shopkeepers can only be ascribed to continuous indoor occupation. Coal miners enjoy an unexplained immunity.

Dr Von Körösy has tabulated the result of seventeen years’ observation in Budapest, which is an excessively tuberculous town. His figures include both males and females above fifteen years of age, and extend to 106,944 deaths. The field of observation is evidently very different from those which furnished the statistics already given. His results are: (1) Males—printers 606, butlers 520, shoemakers 494, dyers 493, millers 492, joiners 485, tinkers and locksmiths 484, masons 467, labourers 433, tailors 418, bakers 398, drivers 370, servants 360, carpenters 339, officials 336, butchers 333, innkeepers 272, merchants 253, lawyers 205, physicians 118, capitalists 106; (2) Females—servants 353, day labourers (? char-women) 333, washerwomen 314, gardeners 269, capitalists 42. The inmates of lunatic asylums, who are classed among the