Cottinffos ) STATISTICS CONSUMPTION IN ROXBURY; By B. E. COTTING, M.D. ' J STATISTICS OF CONSUMPTION IN ROXBURY; SEAP BEFORE THE NORFOLK DISTRICT MEDICAL SOCIETY OF MASSACHUSETTS, AT THE ANNUAL MEETING, MAY 17th, 1854, (Printed by Vote of the Society.) By B. E. COTTING, M.D. WITH AN APPENDIX. BOSTON: PRINTED BY DAVID 1854. 00 Lii;:r rt> t-^XXvIXS CLAPP. [CIRCULAR.] The Norfolk District Medical Society will hold its annual meeting at Dedham, on the Third Wednesday, the 17th, of May next, at the Phoenix House in Dcdham, at 11 o'clock, A. M. There will he no address on the occasion. There will be a general discussion upon Consumption, The attention of the fellows is especially requested to the following questions, in respeot to this disease. I.—Is it increasing in a more rapid ratio than the population ? H.—Is there any tendency to its production in some years more than in others ? HI.—Is it more prevalent along water courses, or near to mill-ponds that are alternately raised and drained off? IV.—Has any effect been observed of any other kind of locality ? V.—Is it hereditary, and to what extent ? VI.—Are the children of intemperate parents more liable to it than others ? VH.—Are children who were nursed by consumptive females more predisposed to it? VHL—What effect has the free use of alcoholic liquors upon the production of this disease ? IX.—What influence has sex in producing it ? X.—What influence have factory labors or any other employments or trades in producing, or accelerating, or retarding it ? XI.—How far is it influenced by the seasons ? XII.—How far influenced by change of climate ? XHI.—What climate is the most favorable ? XIV.—When is a change of climate most favorable ? XV.—.Does sleeping with a tuberculous patient tend to produoe it ? XVI.—Is the disease communicable from one to another in any way ? XVII.—What is the best treatment ? XYIH.—What is the effect of cod-liver oil ? By order of the President, EDWARD JARYIS, Sec'y. Dorchester, April 29, 1854. N. B.—It is proper to state that the following paper was prepared without a knowledge of the extensive investigations, still progressing, of a respected colleague, and therefore has the value of independent testimony, if nothing more. j$# jj_ q_ STATISTICS OF CONSUMPTION. Mr. President^, and Gentlemen of the Society; The circular of the Secretary, containing the questions for discussion at this meeting, was received on the 5th of this month. Acknowledging the right of the Society to the services of its members, and thinking that I could most satisfactorily perform my part by collecting such statis- tical information as the place of my residence afforded, I offer for your consideration the results of my effort, though they are not so perfect as could be desired. The bills of mortality in the city of Roxbury have been kept with much accuracy for the last four years. For the previous three years and eight months the records, though respectable, were not so full or so reliable. Before that time they were very imperfect. The tables, there* fore, which follow, have been constructed chiefly, and almost necessa- rily, from the records of the last four years; and the remarks accom- panying the tables relate also to this period. No attempt is made to go beyond the record for the sake of giving more general or more extended answers to the several questions than its cases warrant. To have done this would have been a work of supererogation, and defeated the object in view. Were an apology necessary for the imperfections of this essay, it might with truth be stated that it was compiled literally inter tcedia et labores —most of it having been written in the later midnight hours, and a large portion at the bedside and during the intervals of ease of expectant patients. To any who may complain that too long a story has been made of so small a matter, it can only be answered that there was not time to make it shorter. 4 ■ STATISTICS. The city of Roxbury originally extended from Boston-Neck to Ded- ham, a distance of seven miles or more by the Dedham Turnpike which nearly bisected the town; and had an irregular parallelogramic form. It was bounded on the north-eastern side by the tide waters of Back Bay, and South Cove, and by Boston-Neck which is dovetailed into its terri- tory nearly a mile's length and three quarters of a mile's width. On the north-west lay Brookline and Newton ; to the south-west, Dedham ; and Dorchester extended along its south-eastern line. Its greatest length was about eight miles ; its narrowest width not far from two miles. Its area was about ten thousand and six hundred acres. In the spring of 1851, the city was divided, and about three quarters of its territory set off to constitute the new town of West Roxbury. It is to the present city of Roxbury that our investigations will chiefly relate ; though from the impossibility of making a separation in all cases we must sometimes take the statistics of the two places together. This, however, will not materially alter the numbers, nor have any very sensible effect on the results deduced from them. The city of Roxbury now contains about thirty-five hundred acres, of which eight hundred are marsh lands, unoccupied except on their bor- ders. On the twelve hundred acres adjoining the marshes and running from the marshes inland, it has been calculated that there are from twelve to thirteen hundred houses. It should be slated, however, that many of these houses are huddled together, and contain an excessively- crowded population. Nearly the whole city, exclusive of the eight hun- dred acres of salt marshes, may be generally considered as high ground. The church of the first Parish stands about seventy feet, and the highest point of the Highlands is about one hundred and twenty-five feet, above high-water mark. The surface is very uneven ; the soil rock}', but un- der a hifh state of cultivation. Two brooks girt its northern and south- ern boundaries ; and two pass through its central portion—one of which turns a grist mill, and is bordered by many manufacturing establishments. By the United States' census of 1850, the population of the city was 18,373 ; of which West Roxbury contained about 3000. That of the whole county was 79,000. At the present time the city of Roxbury is estimated to contain more than twice a-3 many inhabitants as the largest of the other twenty-two towns in the county, and nearly a quarter of its whole population. 5 I.—" Is consumption increasing in a more rapid ratio than the popu- lation ?" The average annual increase in the population of Roxbury from 1S45 to 1850, as shown by the census taken in those years, was 875 a year, or 62i for every thousand inhabitants. From the best estimates that can be formed, from rolls and other docu- ments kept since 1850, it is inferred by those most conversant with these matters, that the average annual increase from 1850 to 1854 was from 1000 to 1100 a year. If we assume the larger number, the increase was at the rate of 60 ; but if We accept the former, which is probably more correct, the rate was only 54^ for every thousand inhabitants. The births averaged 572 a year from 1845 to IS50, or about 41 for every thousand inhabitants ; and from 1850 to 1854 they averaged 687 a year, or about 37J for every thousand inhabitants. The deaths from all causes, for the three years and eight months from May 1st, 1846, to Jan. 1st, 1850, averaged 403 a year, or 23J for every thousand inhabitants ; and for the four years from 1850 to 1854, they averaged 333 a year, or 18} for every thousand inhabitants. The deaths from consumption from May, 1846, to Jan. 1850, averaged 64 a year, or Ah for every thousand inhabitants, and 1 in 6.289 of all deaths. During the last four years, from 1850 to 1854, the deaths from consumption have again averaged 64 a year, or 3* for every thousand in- habitants ; and 1 in 5.264 of the deaths from all causes. These statements may be condensed into the following tables. Years. Whole increase Increase for every in a year. 1000 Inhabitants. Births. Yearly Average. Births for every 1000 inhabitants. 1845—1850 1850—1854 875 1000 624 54i 572 687 41 37A Years. Deaths. Deaths Yearly average for every from all causes. 11000 Inhabitants. Consumption. Average yearly deaths. Ratio to the deaths from all causes. Consumption. Deaths for every 1000 inhabitants. 1845—1850 1850—1854 403 338 284 184 64 64 1 in 6.289 1 in 5.264 4.590 3.493 During the ten years from 1840 to 1850, the population of Roxbury doubled, having been 9089 by the census of the former, and 18,373 by that of the latter year. Such a rate of increase could not be expected to continue, and the following tables show that it has not. In the last four years it has fallen from 62} to 54£ for every thousand inhabitants. Now the deaths from consumption, to have followed the same rate of decrease, should have fallen from 4.590 to 3.920, but they actually fell to 3.493, in every thousand inhabitants. This is a gain of .427. 6 But if we compare the proportion of deaths from consumption to that of births for every thousand inhabitants, we find that instead of being 4.116 it is 3.493, or a loss of .623 ; or if to that of the deaths from all causes, we find that instead of being 2.421 it is 3.493, or a loss of 1.072. Moreover, the deaths from consumption from 1845 to 1850 were 1 in every 6.289 ; and, from 1850 to 1854, have increased to 1 in every 5.264 of the deaths from all causes. So that we may conclude that in Roxbury consumption, during the periods passed in review, has not increased in quite so rapid a ratio as the population ; but that it has much increased in proportion to the num- ber of deaths from all causes. II.—" Is there any tendency to its production in some years more than in others ?" The following table exhibits the whole number of deaths yearly from all causes, and from consumption alone, from May 1st, 1846, to Jan. 1st, 1854. Years. Whole number. Average. Prom Consumption. Average. May 1st, 1846, to May 1st, 1847 1847, to "" 1848 " 1848,to " 1849 1849, to Jan. 1st, 1850 Jan. 1st, 1850, to « 1851! " 1851,to " 1852 « 1852, to " 1853 " 1853, to " 1854] 236 376 564 302 333 375 297 348 1 1 t-H o CO 1 J 43 60 87 45 59 73 74 51 1 1 o 1 J The smallest number from all causes was 236 in 1846-7 The smallest number from consumption, 43 " " The largest number from all causes was 564 " 1848^9 ' The largest number from consumption, 87 " " According to the above table, consumption seems to have followed the laws which influenced disease and death in this community ; since in the year of fewest deaths from all causes we find the fewest from con- sumption, and in the year of greatest mortality from all causes we find the largest number from consumption also. In the year 184S-9, when dysentery alone caused seventy-five deaths, and when many were left enfeebled from ship fever and dysentery, which together had carried off one hundred in the year previous, we find the number of deaths from consumption to be 87, or 23 over the yearly average from this cause. And in other subsequent years, when deaths from consumption seem to have exceeded their usual proportion to those from all causes, it may hereafter appear that those who thus fell victims 7 were such as might have been expected to succumb to this, or to any disease. Hence we may infer that those causes which ordinarily reduce the general health of a community, and epidemics, though usually supposed to swallow up other diseases, have had, for the place and time we are considering, a direct tendency to the production of consumption. III.—" Is it more prevalent along water courses or near to mill-ponds I that are alternately raised and drained off!" We have been at some considerable pains-taking to mark, on a plan of the city, the localities of the deaths from consumption for the last four years ; and have thus with tolerable accuracy indicated as many as could be ascertained, or 208 out of 257 the whole number. By reference to this plan, it appears that along the only fresh water mill-pond (that near Lowell st.) which is alternately raised and drained off, and where is often left exposed a large muddy surface, and on whose margins, with those of its inlet, are the principal low grounds bordering on fresh water, there have been but three deaths from consumption dur- » ing the past four years ; and these, so far as can be ascertained, origi- nating clearly from causes not connected with the locality. Along the ridge of land between the full and empty basins of salt water of the " Boston Mill Company," in that part within the limits of Roxbury, but two deaths from consumption have been recorded during, the same time. IV.—(C Has any effect been observed of any other hind of locality ?" On the borders of the marsh land, and the ridges immediately ad- joining, there have been many deaths ; but in these localities the popu- lation is most dense and of the most destitute classes. And even here the native population and the best and most comfortably housed of the < foreigners seem to be as exempt from consumption as in other localities. In such neighborhoods, from the comparative cheapness of land, the new emigrants erect their miserable tenements, and fill them to over- flowing with such as either desire or are able to procure no better abodes. Crowded apartments (sometimes ten or a dozen persons, frequently half that number occupying for all purposes a room, say, fifteen feet square) ; filthiness to an incredible degree in person and raiment; coarse and ill- cooked food, eaten in ravenous haste ; intolerably oppressive and offen- sive atmospheres ; excessive use of tobacco, and perhaps other bad habits; all these are prevalent among the denizens of such places, and are in a 8 common-sense view of the matter as likely to be productive of disease, even the disease in question, as the resting of their habitations on low and damp foundations.* This view seems to be sustained in the following tables, constructed for the purpose of throwing some light on these points. Descent of those Dead from all Diseases. Year. Roxbury Born. Other Americans. Foreign Immigrants. Total. 1850—51 1851—52 1852—53 1853—54 145 139 118 161 93 115 96 96 95 121 83 91 333 375 297 348 Descent of those Dead from Consumption. Year. Roxbury Other Foreign Tot; Born. Americans. Immigrants. 1850—51 11 21 27 59 1851—52 10 29 34 73 1852—53 12 25 37 74 1853—54 6 21 24 51 According to the State Census, taken in 1850, the proportion of Ame- ricans to foreigners and children of foreign parents, in the five lower wards, now constituting the city of Roxbury, was as follows ; | Americans. Children of Foreign Barents. Foreigners. Total. 8347 1921 4882 15150 Thus it is evident that while the proportion of immigrant foreigners to Americans and the children born here of foreign parents, is as 48 to 102, * Since the above went to press, through the kindness of Drs. Harris and Weld, of Jamaica Plain, I have been furnished with a transcript from the Church Records of sixty-seven cases of death from consumption, which occurred in that Parish (embracing the middle third part of the area of the original city of Roxbury), from Feb. 7, 1793, to Jan. 7, 1847—a period of fifty-four years. These cases I have carefully examined and classed as follows. Deaths from, Consumption at Jamaica Plain, from 1793 to 1847. High and Dry Ground. High near Low Ground. Low Ground. Salt Marsh. Came in Last Stages. Location not known. Total. 26 12 4 1 10 14 1 1 67 Of these cases, twenty-six occurred on high and dry ground; twelve on high land, within an eighth or a quarter of a mile of a meadow, brook or pond ; four on low grounds ; one near a nar- row strip of salt marsh which touches the Parish at one of its corners ; ten came into the place in the last stages of the disease; and the locations of fourteen are not stated, and are not now known. Ten of the dead are spoken of in the records as having been of consumptive families ; of which four were on high ground, two near low, two on low, and two on locations not stated. 9 or less than one third, and while the deaths from all causes to the immi- grants amount to only one in three or four of the whole number; nearly, and in some instances quite, half of all the deaths from consumption occur amongst the immigrants. Furthermore, it may be seen by the following table that the number of those who died from consumption, and who were known to have dwelt on low, wet, or made lands where many of the immigrant popula- tion reside, amount to 78 out of 257, or a little less than one third— while those who died of consumption on high and dry lands, amount to 170, or two thirds of the whole number. Localities of the Deaths from Consumption. Year. High. Low. Not known. Total. 1850—51 33 11 15 59 1851—52 31 25 17 1 73 1852—53 42 23 9 I 74 1853—54 24 19 8 51 1850—1854 170 78 49 257 V.—" Is it hereditary, and to what extent ?" There is great difficulty in ascertaining satisfactorily the health and habits of the parents of those who are recorded to have died of con- sumption. The following table exhibits the results of an effort for this end. It is necessarily imperfect, although all the cases recorded were examined in this regard. Year. Father Consumptive. Mother Consumptive. Both Consumptive. Total. 1850—51 1851—52 1852—53 1853—54 2 2 2 1 1 1 1 1 3 4 4 3 1850—1854 6 6 2 14 The Irish immigrants, amongst whom the largest proportion of the deaths from consumption have occurred, generally represent their parent- age to have been healthy, and many point to the presence of their « old folks " in proof of these assertions. The general impressions of those conversant with this class also confirm this statement. The record of one American family is rather remarkable. In May, 1851, the father died of consumption, aged 40 years. The next Sep- tember an infant son, aged six months, died of the same disease. In 2 10 January following (1852), the mother, aged 38 years, died of consump- tion also. And on the 25th of the same month another son, 3 1-2 years of age, died, of what is recorded " scrofula," but which the relatives say resembled, so far as they could judge, the disease of the parents. Of this family there remained three girls and one boy ; the oldest 18 years, in appearance a remarkably healthy and robust young woman ; and the youngest, 5 years, in poor health, but improving. The remain- ing girl and boy are apparently healthy. One grandfather died of colic, suddenly—a grandmother and an aunt, of consumption. VI.—" Are the children of intemperate parents more liable to it than others ?" Although all the cases were subjected to inquiry on this point, the fol- lowing table exhibits all that could be ascertained respecting the habits of the subjects themselves or of their parents, so far as regards in- temperance :— Year. Grandfather, Father