Rhode Island

Massachusetts

New York

New Jersey

Connecticut

Illinois

Maryland

Pennsylvania

TABLE IIIa.

ANALYSIS BY AGE GROUPS AND GROUPS OF TEN STATES.

Tables compiled by Westergaarde suggest that probably the city, with its physicians and hospital service and its freedom from severe muscular work, saves female life during this the child-bearing period rather than destroys male life at such a wholesale rate. The succeeding table, however, which shows that from these very causes connected with child-bearing the American city is more fatal to women than is the country, refute the suggestion squarely, so far as the United States is concerned.

It is plainly set forth now that, with the increase of cities in number and size, the death-rate of men grows higher and higher in comparison with the death-rate of women. In some groups of states during certain age periods this general statement does not hold good, but in the main it seems to be true. The natural inquiry is, What is the reason? To answer, in general terms, that city life is nerve-racking, artificial, and unsanitary, is to answer nothing that will point out any remedy. We must know at what points we are attacked before we can concentrate our forces to repel the assault. So an inquiry was made into the causes of death, to ascertain, if possible, what diseases are particularly fatal to men in cities.

The high excess of male mortality in cities in the registration area has been found to be typical of the whole United States hence the registration data for causes of death may be considered fairly indicative of conditions throughout the country.

On page 566, Vol. I, Vital Statistics, Census of 1900, a list of classified causes of death is given for the registration area, with the death-rates per 100,000 of population for each sex, from each cause, for both the urban and the rural districts. (See Table IV). It will be noted that the city gives an excess from all causes of 234 (Ibid., col. 5), while the country gives an excess of 85.2 (col. 6). Thus the city excess is 148.8 higher than the country excess (col. 7). We shall call this difference between the excesses of the respective districts "preponderance.' By looking at the causes, it will be seen that only one class, Diseases of the Circulatory System, gives a large rural preponderance (in other words, a city female preponderance) of 24.3;

and two classes, General Diseases and Diseases of the Respiratory System, give a city preponderance of 139.8 and 40.2, respectively; while the other classes about balance up each other.

In the difference, therefore, between the city preponderance of 180 from General Diseases and those of the Respiratory System, and the rural preponderance of 24.3 from Diseases of the Circulatory System, we have somewhat more than accounted for the general city preponderance of 148.8, having 155.7.

General Diseases include ordinary fevers, contagions, bodily disorders, alcoholism, old age, venereal troubles, cancers, tumors, consumption, etc. It is the most numerous class of diseases, being divided by the census into four sub-classes, containing in all 41 specific diseases, and being responsible for nearly a half of all deaths. No one of these specific diseases has a very large city preponderance except consumption. Consumption gives the alarming city preponderance of 76.8, nearly a half of the total city preponderance.

Diseases of the Respiratory System are seven in number, and the preponderances balance one another in such a manner as to leave a total rural preponderance, if it were not for pneumonia, which with a city preponderance of 45.7 brings the city preponderance for this class up to 40.2. From this table (Table IV), then, it would seem that two specific diseases, pneumonia and consumption, are responsible for nearly six-sevenths of the city preponderance, the exact figures being 122.5 to 148.8. All of the other 108 specifically mentioned diseases so balance each other as to yield a city preponderance of only 26.3,—barely one-third as large as consumption alone.

The "hustle and dash" and "nervous strain" of city life do not seem to be so fatal to men as might have been expected, for Diseases of the Nervous System give a city preponderance of only 5.8, and suicides one of only 3.5. Manufacturing and congested traffic is hazardous to men, but the country has dangers as well, so the city preponderance in Accidents and Injuries rises no further than 2.9. The immoral allurements of city life do not assume high importance, as far as death-rates or preponderances are concerned, due largely, no doubt, to the fact that dissipation in most cases first weakens the vitality, after which other complications set in, to which the death is