lute, December, January.
Minimum. — May, June, July, August; absolute, June to
August. .
Premature Birth.
London. — Maximum. — January, February, May, July, August, De-
cember.
Minimum. — During remaining months.
Curve shows little variation from the average through the
year.
Privation.
London. — Maximum.— December to middle of April.
Minimum. — Middle of April to end of November.
Curve allied to that of diseases of respiratory organs.
Want of Breast Milk.
London. — Maximum. — July, August, and September; absolute, July;
August.
Minimum. — October to end of June; absolute, May.
This curve is allied to that from diseases of abdominal organs.
Alcohol Diseases and Delirium Tremens.
London. — Maximum. — Beginning of May to end of September; absolute,
July. *
Minimum. — Beginning of October to beginning of May, with
rise to the average in October, and slightly above the aver-
age in first week of new year; absolute, January, February,
March, December.
The curve for delirium tremens stands alone, resembles no
other curve, and is steady.
Suicide.
London. — Maximum. — Latter part of March to latter part of August,
absolute, end of June.
Minimum. — End of August to March; absolute, beginning of
February.
Neiv York. — Maximum. — Beginning of April to end of September; ab-
solute, May.
Minimum. — Beginning of October to beginning of April;
absolute, February.
Both curves have the maximum period in spring and early
summer.
24
CHAPTER XXL.
THE RELATIONS OF CLIMATOLOGY TO LIFE IN-
SURANCE.
About a dozen years ago, under the auspices of the " Chamber of Life
Insurance," representing thirty American Life Offices, a " Collection of
the Statistics of Mortality Experience, classifying, arranging, and
tabulating them for practical use," was begun and after eight years com-
pleted in the form now before us. 1
The diseases or causes of death are returned by twenty-seven of the
thirty companies, including the general collection, and aggregate 37,624;
of which 35,442 were of males, and 2,182 of females. There were also
§,919 deaths additional, not specifying diseases. 160 diseases are
enumerated, and divided into seven classes:
Diseases and Deaths in Twenty-seven Life Insurance Companies from
their organization to the year 1874.
diseases. Males. Females. Totals. % of Total.
All Causes 35,442 2,182 37,664 100.00
Zymotic Diseases,
Constitutional Diseases,
Nervous Diseases,
Circulatory Diseases,
Respiratory Diseases,
Digestive Diseases, • . . . 3,344 273 3,617 9.61
Miscellaneous Diseases, . . . 5,704 468 6,172 16.42
The principal or leading diseases in order are typhoid fever — which,
appears to have been quite uniformly distributed — 5.99 per cent; other
fevers, 4.35; consumption, 18.31; apoplexy, 4.70; paralysis and disease
of brain, 4.34; heart disease, 3.61; pneumonia, 7.68; accidents and in-
juries, 7.21 per cent of all. Consumption, it is remarked, occurred at
nearly uniform rates in all the companies, 18.31 per cent; and when in-
creased, as it probably should be, by one-thirteenth of the deaths by
1 "System and Tables of Life Insurances. A Treatise developed from the
Experience and Records of Thirty American Life Offices, under the direction of
a Committee of Actuaries." By Levi W. Meech, Actuary in Charge. 4to,
pp. 553. Published by subscription. 1881.
6,356
303
6,659
17.70
8,175
548
8,723
23.19
5,106
193
5,299
14.08
1.986
106
2,092
5.56
4,771
291
5,062
- 13.45
Tin: RELATIONS OP CLIMATOLOGY TO LIFE iv-i i:\vi. :I71
pneumonia (ohronic cases), and by deaths registered from «- 1 1 » . - . — of
lungs, hemorrhage of lungs, and disease of lungs, becomes 20. 67 per
cent, or more than one-fifth of the whole mortality.
Another table shows that the effect of medical selection is exhausted,
and the average mortality of consumptive cases reached in the third year
of duration of the insurance. The largest mortality by consumption
occurs between the ages of 20 and 30 years. But after this period, the
proportion of consumptive deaths of males bears a twofold aspect. That
is, when compared with the number of living exposed, it slowly decreases
to a minimum rate between 50 and 60 years, and then gradually rises
again, with a heavy mortality all the while in every period of age.
Ratio of Consumptive Deaths to 10,000 Living at each Age.
Age, . . . Under 20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, all ages
Ratio, . . 12.0 22.7 19.6. 17.4 15.8 17.6 19.1 18.6
But when compared with the total contemporary deaths, the propor-
tion from consumption continually decreases, as the complementary pro-
portion from other causes increases above the age of 30 years.
Passing now to the climatic distribution, we observe that north of
latitude 36.30° the deaths from consumption are 18.7 per cent of the total
deaths for male life, and 19.3 for females, while south of 36.30, the per-
centages are 12.3 and 9.0 respectively. The apparent deficiency from
consumption in the latter proceeds only from comparison with a larger
total, including an excess from malarial and other diseases.
Compared with the United States Census for 1870, the percentage of
consumptive deaths, 18.3 in a total of 100 deaths insured, is less than the
result of the Census, which is represented by 26.2 for males, and 29.7
for females. Thus the rejection of lives uninsurable from incipient con-
sumption is manifest.
In proceeding towards the tropical regions, the ratio of deaths by con-
sumption to those from other diseases gradually diminishes. The de-
crease, however, is not from absolute decrease of consumptive deaths,
but entirely from increased mortality from other causes.
The practical question, What part of the United States is most favor-
able to consumptive invalids, can now be satisfactorily answered, so far
as average yearly results are concerned, from the following interesting
table:
372
THE RELATIONS OF CLIMATOLOGY TO LIFE INSURANCE.
Proportional Deaths and Diseases to 10,000 Males living in each
Group of States.
Group o£ States.
*I.
II.
HI.
IV.
v.
VI.
VII.
Mean
Group.
Groups.
105.3
97.7
107.1
104.5
130.5
170.5
112.2
*I.
Summary.
New England.
17.6
18.5
16.6
18.7
27.5
48.5
15.9
23.3
New York.
Constitutional . . .
26.4
21.4
27.9
23.0
27.3
26.3
22.1
24.9
Nervous
15.4
11.5
15.4
14.4
20.1
22.3
18.4
16.8
II.
Circulatory
6.6
4.4
7.3
4.6
6.7
6.8
9.2
6.5
Northwest.
13.3
14.6
12.1
16.6
18.1
21.5
14.6
15.8
Michigan.
Digestive
8.6
10.0
11.2
11.2
11.9
22.0
9.1
12.0
Wisconsin.
Miscellaneous
17.4
17.3
16.6
16.0
18.9
23.2
22.9
18.9
Minnesota.
Nebraska.
Zymotic.
Typhoid, typhus .
7.6
8.5
6.8
6.7
6.9
4.8
5.2
6.6
III.
Malarial fever. . .
1.7
2.3
1.8
3.3
3.8
11.8
1.9
3.8
1.0
1.3
1.0
1.3
1.3
1.5
2.2
1.4
New Jersey.
1.7
1.4
.9
1.4
3.6
5.8
1.5
2.3
Pennsylvania.
.9
.7
1.0
.8
1.6
3.6
.2
1.3
Cholera
.9
.3
.8
.3
1.1
.3
2.0
.4
3.5
.5
2.4
.3
.9
.6
1.7
.4
IV.
Alcoholism
Other zymotic. . .
3.6
3.2
3.7
2.8
6.3
18.2
3.4
5.9
Ohio.
Indiana.
Constitutional.
Illinois.
1.8
1.6
2.6
1.9
2.2
2.2
1.9
2.0
Iowa.
2.1
1.5
2.1
1.6
2.2
1.1
1.9
1.8
Kansas.
Consumption
20.8
16.9
22.2
18.5
21.5
21.0
16.9
19.7
Other constitut'al
1.7
1.4
1.0
1.0
1.4
2.0
1.4
1.4
V.
Nervous.
Delaware.
Apoplexy
5.2
3.8
5.0
4.2
7.2
8.2
6.8
5.8
Maryland.
Congestion o f
1.5
1.5
2.1
2.5
2.9
4.9
1.7
2.4
Dist. Columbia
brain.
Virginia.
Paralysis, soften-
7.2
5.2
6.5
6.2
7.8
7.5
7.3
6.8
Kentucky.
ing of brain.
Missouri.
Epilepsy and con-
.3
.3
.6
.4
.5
.7
1.5
.6
vulsion.
VI.
Other nervous . . .
1.2
.7
1.2
1.1
1.7
1.0
1.1
1.1
South of 32.30°
Circulatory.
North Carolina.
Diseases of heart.
6.1
4.1
7.1
4.4
6.3
6.6
7.4
6.0
South Carolina.
Other circulatory
.5
.3
.2
.2
.4
.2
1.8
.5
Tennessee.
Georgia.
Respiratory.
Florida.
Pneumonia
7.3
8.5
6.6
9.8
10.8
12.6
9.0
9.2
Alabama.
Congesti on of
1.8
1.7
1.2
1.7
2.2
2.2
.9
1.7
Mississippi.
lungs.
Arkansas.
Bronchitis and
1.8
2.0
1.5
2.0
1.8
3.4
2.2
2.1
Louisiana.
pleurisy.
•
Texas.
Abscess, hemor-
1.9
2.0
2.0
2.4
2.4
1.9
1.8
2.1
rhage of lungs.
VII.
Other respiratory
.4
.4
.8
.7
.9
1.4
.7
.8
Pacific, Etc.
Digestive.
Washington.
Diseases of stom-
1.6
2.3
2.0
1.9
2.1
5.1
1.3
2.3
Dregon.
ach.
California.
Diseases of bowels
1.9
2.2
2.5
2.5
2.5
5.8
1.6
2.7
Utah.
Peritonitis
.7
.8
1.0
.8
â– 7
.5
.3
.7
Dakota.
Diseases of liver..
2.7
3.4
3.7
3.7
3.9l
4.8
4.2
3.6
New Mexico.
Till' KKI.ATIONS ill' - CLIMATOLOGY TO LIFE INSURANCE.
373
( IrOtipof States.
I.
II.
in
IV.
V.
VI
VII.
1.7
.0
2.6
.7
M'-ati
Group.
Group!.
Other digestive.
Miscellaneous.
1 lialii'tcs
1.7
.5
2.3
5
2.0
.5
3.1
1.1
2.3
.4
l.'.t
.5
2.7
.8
2.1
.9
5.8
.3
2.4
1.2
2.6
.5
2.4
.9
Disease of kidne's
Other urinary.. . .
3.5 1.4
.9 .8
peral diseases.
and uterus.
Abscess, hemor-
rhage of old age
Debility, exhaus-
tion, etc.
Accidental inju-
ries.
Unknown causes.
1.2
1.0
7.2
1.3
1.8
15.273
.8
1.0
9.7
2.1
1.0
2.716
1.1
2.4
6.0
1.3
1.1
3.976
1.1
.7
9.0
1.3
1.1
6.239
1.3
1.3
9.3
1.8
2.5
3.306
1.0
1.1
13.3
1.4
1.4
2.153
.3
1.2
12.8
3.3
1.3
863
1.0
1.2
9.6
1.8
1.5
Briefly summarized, with special reference to consumption:
Ratio of Consumptive Deaths to 10,000 Living.
Groups of States,
Ratio,
III. V. VI. I. IV. II. VII.
22.2 21.5 21.0 20.8 18.5 16.9 16.9
Group III. comprises New Jersey and Pennsylvania; V., Delaware,
Maryland, District of Columbia, Virginia, Kentucky, and Missouri;
VI., States south of latitude 36° 30; I., New England and New York;
IV., Ohio, Indiana, Illinois, Iowa, and Kansas; II., Michigan, Wiscon-
sin, Minnesota, and Nebraska; VII., Washington, Oregon, California,
Utah, Dakota, and New Mexico.
By an obvious generalization, the first four groups, comprising the
Atlantic and Gulf States, from Maine to Florida and from Florida to
the borders of Mexico, have very nearly the same rate of consumptive
deaths, or 21 annual deaths to 10,000 living. The Western States show
a decrease of the consumptive rate to 18-j in Group IV., while the Groups
II. and VII., or Northwestern and Pacific States, agree in the more
favorable rate of 17 consumptive deaths to 10,000 living. In establish-
ing these important conclusions, the statistics entirely concur without
discordance.
But the reader should not fail to observe that these conclusions are
based upon the statistics of mortality of the insured — that they do not
include deaths under fifteen years of age.
Grouped on the basis of the Census returns for 1880, when (as will
be seen by reference to a previous chapter), the ratio of deaths from
374
THE RELATIONS OF CLIMATOLOGY TO LIFE INSURANCE.
consumption to all causes was 12.09, the ratios would stand under the
same groups as follows:
Groups of States,
Ratios,
III. V. VI. I. IV. II. VII.
13.4 13.4 8.4 16.7 10.7 10.2 9.1
But this grouping, it hardly seems necessary to observe, after refer-
ence, as already made to table of the respective ratios of all the States,
is manifestly unfair. For example, Missouri, with a ratio of 9.8, is
placed in the same group with Delaware (16.1) and District of Colum-
bia, 18.9. Again, New Mexico, with a ratio of 2.1; Utah, 3; and
Dakota, 8, are grouped with Washington, Oregon, and California, with
ratios respectively of 12.1, 13.2, and 15.5. A simpler grouping would be:
I., of those States with ratios below 8 percent; II., of those from 8 to 11
per cent; III., of those from 11 to 13 per cent; and IV., of those above
13 per cent. It would be as follows:
I. The District of Columbia, New England States, Delaware, Cali-
fornia, New York, Tennessee, New Jersey, Ohio, Michigan, and Wash-
ington, 15.7 per cent.
II. West Virginia, Pennsylvania, Virginia, Indiana, Oregon, Mary-
land, Kentucky, and Wisconsin, 12.1 per cent.
III. Louisiana, Illinois, Iowa, North Carolina, South Carolina, Min-
nesota, Alabama, Dakota, Georgia, Nevada, Colorado, Florida, and Iowa,
9 per cent; and
IV. Kansas, Nebraska, Arizona, Idaho, Texas, Arkansas, Montana,
Utah, Wyoming, and New Mexico, 5.4 per cent.
Moreover, the results, or rather the measure of the prevalence of
consumption as summed up by the insurance companies — that the de-
crease from consumption in the warmer portion of the United States is
not absolute, but entirely from increased mortality from other causes — is
not in accord with the most recent census reports, either in respect to
consumption or the general mortality.
THE RATIOS OF MORTALITY FROM ALL CAUSES, PER 1,000 OF POPULA-
TION, IN THE SEVERAL STATES AND TERRITORIES OF THE UNITED
STATES, ACCORDING TO THE CENSUS OF 1880, ARE AS FOLLOWS:
State.
Population.
Ratio.
State.
Population .
Ratio.
Alabama,
1,262,505
14.20
Kansas,
996.096
15.21
Arkansas,
802,525
18.45
Kentucky,
1,648,690
14.38
California,
864,694
13.32
Louisiana,
939,946
15.44
Colorado,
194,327
13.10
Maine,
648,936
14.87
Connecticut,
622,100
14.74
Maryland,
934,943
18.09
Delaware,
146,608
15.08
Massachusetts
1,783,085
18.59
Florida,
269,493
11.72
Michigan,
1,636,937
12.06
Georgia,
1,542,180
13.97
Minnesota,
780,773
11.57
Illinois,
3,077,871
14.62
Mississippi,
1,131,597
12.88
Indiana,
1,978,301
15.77
Missouri,
2,168,380
16.88
Iowa.
1.624,615
11.92
Nebraska,
452,402
13.10
THE RELATIONS OF ci.lMA 1'oLOGY To LIFE ENSUE
State.
Nevada!
N.-w Samphire,
New Jersey,
New York,
North * arolina,
Ohio,
< Oregon,
Pennsylvania,
Rhode Island,
.Sou tli Carolina,
Tennessee,
Texas,
Vermont,
Virginia,
Population.
63,368
846,001
1,181,116
5,083,871
1,880,760
8,188,062
174,768
4,382,801
376,581
005,577
1,543,850
1,591.749
332,286
1,512,565
Ratio.
11.69
16.00
16.88
17.37
15.36
13.32
10.66
11. !H
17.00
15.79
16.80
15.53
15.11
16.13
State.
West Virginia,
Wisconsin,
Population,
618,457
1,815,407
11.00
12.17
Arizona,
40,440
7.1!)
Dakota,
1 85, 177
0.64
District of Columbia,
177.624
38.60
Idaho,
32,610
0.80
Montana,
39,159
8.58
New Mexico,
119,505
30.87
Utah,
143,963
16.76
Washington,
75, in;
10.05
Wyoming,
20,788
9.09
United States (Total), 50,155,783 15.90
Divided into three groups, say of 12 and under, 12 to 15, and over
15 per 1,000 of population, the relative healthfulness of the different
States and Territories of the Union, as measured by the ratio of deaths
to population, stands in the following order:
I. II. III.
Arizona. Michigan. Delaware.
Montana. Wisconsin. Vermont.
Washington. Mississippi. Kansas.
Wyoming. Nebraska. North Carolina.
Dakota. Colorado. Louisiana.
Idaho. Ohio. Texas.
Oregon. California. Indiana.
Minnesota. Georgia. Rhode Island.
Nevada. Alabama. New Hampshire.
Florida. Kentucky. Virginia.
Iowa. Illinois. New Jersey.
West Virginia. Connecticut. Utah.
Maine. Tennessee.
Pennsylvania. Missouri.
New York.
Maryland.
Arkansas.
Massachusetts.
New Mexico.
District of Columbia.
In weighing the value of this summary, allowance should be made
for density of population. With a few exceptions, for example, New
Mexico and Utah in Group III., the highest ratios of mortality occur in
those States where the population is most congregated in cities. And
the close reader will not fail to observe that the preponderance of con-
sumption holds the same relation.
OHAPTEE XXII.
PKACTICAL CONCLUSIONS.
Some of the conclusions deducible from the evidence which has now
been submitted in regard to the climatology of the United States are:
1. No country in the world possesses a greater variety of climate or
climates with a higher degree of salubrity; but in this country, as
elsewhere, the effects are measurably due to the various conditions
which obtain among different populations and communities independent-
of the influences of climate per se.
General absence of cities and towns and their surroundings, recent-
ness and sparseness of population, open-air pursuits and frugal diet, are
important considerations promotive of the health of the people every-
where, above all to consumptives. And after all that has now been stated
of the effects of the atmosphere in high altitudes or at the level of the sea,
the influences of forests and ocean, of sea-coasts and interior places, humid-
ity and dryness, cold and heat, the winds, electricity, and ozone, and no
matter what of other conditions, the paramount considerations for the
promotion of health are an abundance of pure air and sunshine and out-
door exercise. Without these no climate is promotive of health or pro-
pitious for the cure of disease; and with them it is safe to say the
human powers of accommodation are such that it is difficult to distin-
guish the peculiarites of any climate by their joint results on the health
and longevity of its subjects.
While evidence is stijl insufficient to show that any community of
considerable magnitude, in any climate, is entirely free from pulmonary
consumption, or that any climate confers immunity from that disease,
it is doubtless to the greater freedom from impurities of every kind,
constant freshness and concomitancy of sunshine more than to density,
and notwithstanding an excess of moisture, that an ocean atmosphere is.
found to possess the highest degree of salubrity; and, moreover, not
because it possesses a maximum amount of oxygen, contains small quan-
tities of bromine and iodine, and is subject to more regular variations of
barometrical measurement and greater equability of temperature than
any other, though these may contribute somewhat to the good results.
2. Mountain air of an altitude of 2,500 feet and upwards, with rare
exceptions, possesses the one chief attribute of salubrity common to sea-
n;\< ii, \f. conclusions. :;77
air — freedom from organic imparities. Pasteur, Tyndall. and other-'
have shown that the air of greal altitudes is entirely free from organic
impurities.
Miguel, as recently quoted by Weber, 1 gives the following interesting
table of the number of bacteria found in ten cubic metres of air taken
as nearly as possible at the same time in July, 1883:
1. At an elevation of from 2,000 to 4,000 metres, none.
2. On the lake of Thun (5G0 metres), . . 8.0
3. Near the Hotel Bellevue, Thun (560 metres), 25.0
4. In a room of the Hotel Bellevue, . 600.0
5. In the Park of Montsouris, near Paris, . 7,600.0
6. In Paris itself (Rue de Rivoli) . . 55,000.0
This table is doubtless equally indicative of the difference in the
amount of floating organic matter in the air at different altitudes,
between town and country, and also between in-door and out-door air
elsewhere, as in the places mentioned, and is particularly significant with
relation to the commonly observed results on the health of persons sub-
ject to corresponding conditions. And, as remarked by "Weber, it is
likewise significant in the difference between the air on the lake of Thun
(8.0) and on the shore, i. e., the grounds of the Hotel Bellevue (25.0).
With this diminished amount of organic impurities coincident with
increasing altitude, mountain air possess an increasing diathermancy, an
excess of ozone, and a minimum of aqueous vapor. How far these gen-
erally accepted advantages of altitude compensate for the rarefaction of
the atmosphere, the diminished amount of oxygen, the maximum diur-
nal variations of temperature, its lowest point, and the greatest and most
irregular variations of barometrical pressure — qualities accepted as bene-
ficial by some, and regarded as positively detrimental by many — is an
important question for the therapeutist, rather than for the climatolo-
gist. That the results are frequently in the highest degree beneficial will
scarcely be doubted by any one who carefully weighs the evidence sub-
mitted from wdiich this conclusion is drawn.
It may here be remarked, however, that the basis of this conclusion
is by no means confined to the region of the Western Highlands. The
careful reader will not have failed to observe the disadvantage which ob-
tains in some portions thereof — extreme aridity and inorganic dust —
which should be avoided by invalids; nor should he lose sight of the
eastern highlands of warmer latitudes— the Alleghany region of Geor-
gia, the Carolinas, Tennessee, Virginia, West Virginia and Pennsyl-
vania: and the White Mountains — which are devoid of such objection-
able features.
3. The atmosphere of islands and sea coasts, places that are favorably
1 " Hygienic and Climatic Treatment of Chronic Pulmonary Phthisis." Lan-
cet, September, 1885. .
378 PRACTICAL CONCLUSIONS.
situated with regard to an abundance of sunshine and devoid of contam-
inating local conditions, is also proportionally free from floating mat-
ter; and it is generally sedative and tonic to consumptives, and fortifying
to the human system in a state of health. These results are most manifest
in islands situated far from the main land, and in peninsular places, of
which Florida is a prominent example, and the more if in conjunction
with pine forests, though the air in all such situations holds a propor-
tionally large amount of moisture. But a sharp distinction is observable
between the results of these conditions and those which obtain along the
cold, damp, and misty sea coasts of New England, and some extensive
marshy districts and river bottoms of several interior regions, which are
of all others most predisposing to pulmonary diseases, both on account
of their intrinsic qualities and the in-door confinements which the
weather enforces.
4. The pine-forest regions, particularly of the Atlantic States, from
Tirginia southerly, at an altitude of from 500 to 1,500 feet above sea level,
are notable for their salubrity at all seasons, and especially for the small
ratio of deaths from pulmonary diseases. Moreover, similar results ob-
tain on the Pacific coast: pulmonary diseases are more prevalent in the
northern and colder regions than in the southern and warmer.
5. Temperature, per se, as will be found on reference to tables for all
latitudes and altitudes, appears to have but little influence. But when-
ever the extremes are such as to deprive persons of the benefit of open-air
exercise they are proportionally detrimental. By a careful study of the
isothermal lines on the Charts, however, and comparing their course with
the results of the statistical tables for the several States, as the annual
mean temperature rises there is a marked decrease in the consumption
death-rate. This is most marked in Florida. Southern Louisiana is
exceptional by reason of its greater density of population — comprehend-
ing New Orleans in relation with the moisture from a filthy soil.
6. The relative humidity of the atmosphere is, perhaps, of all conditions,
the one to which most importance is attached, and with special reference to
pulmonary diseases. But careful study of the hygrometric tables and