CAUSES OF DEATH.

In the remarks hitherto made in relation to the total number of deaths in the State, or in any specified locations, as also in what has been said of the births and marriages, we have endeavored to compare the registered facts with the numbers of the population. Aided by a knowledge of the United States census of 1860, we have been able to form a closer approximation in estimating the population in the middle of the years of the registered facts than in some of the former Reports. Where the records are complete, a comparison of the numbers of births, marriages, and deaths, with the numbers living, especially when we know the distribution of the population over the different periods of life by knowing the numbers at the different ages, and also the numbers of those who have died at different ages, a correct estimate of the relative health and prosperity of the community can be deduced; and it is only with a correct knowledge of such facts that a proper and just estimate can be made. Other States have not given sufficient attention to these cardinal points. to enable us to compare Massachusetts with them, even if our and their records were, of themselves trustworthy. It will be noticed, therefore, that in the preceding pages of this Report, we have more generally instituted comparisons with the results of registration in some other countries whose reports are within our reach.

In turning our attention from that wider range of inquiry presented in vital statistics, to the more specific details of the absolute or the proportional numbers recorded as having died of stated diseases, our investigations must take a somewhat different direction, though in many respects equally important and interesting.

The abstracts in the tabular portion of the Reports compare the numbers who have died from different fatal causes, not with the living, but with the total deaths from all specified causes; those who have died in the several months, with the total deaths registered in the entire year; and such as have deceased at divers ages, with the aggregate numbers at all ages and it is to such ratios that we more particularly find it necessary to confine our

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subsequent remarks in alluding to particular diseases, or to groups of the causes of death.

Nomenclature and STATISTICAL CLASSIFICATION of the Causes of Death. In the XVIth Report (1857) we instituted some discussion of the Nomenclature and Statistical Classification of fatal Diseases. We there gave the action which this matter had received at the highest tribunal-the International Statistical Congress-in connection with some reasons why the present policy was pursued in the later Massachusetts Registration Re. ports. That Congress had adopted the Nomenclature, but at that time still held the Classification under consideration. Hence we remarked (page 235, XVIth Report, 1857) that "the adoption of the new form in the Massachusetts Reports, appears to have anticipated its adoption in the English Reports. There is but little doubt, we think, that with some slight modifications, it is to be the Classification which will eventually be used in Europe." It had already been adopted in Australia and also in the Weekly Reports of London. It was not, however, until the XXIst Report (1858) came from the English Registrar-General's office, that we found it fully and exclusively used in that Department. An examination of that Report, which has but recently been received,* shows an identity between the Classification now used by them and the one which we had in anticipation adopted from Dr. Farr. The only apparent modification consists in the necessity for us to introduce one or two very indefinite and unsatisfactory terms which are in vogue with our people, but which are not used in England, to express the cause of death from inanition, &c., among infants.

This classification resulted from a comprehensive view of the whole subject by one of the ablest of living statisticians. It is entitled to great authoritive weight morever, from the fact that it originates where a more profound attention has been bestowed upon the causes of death, than this topic has received from any other civilized nation.

In our last Report (p. 76) we gave a tabulated comparison of between thirty and forty of the more fatal diseases in Massachu

* It is with much pleasure that we here acknowledge the favor of a prompt reception from the English Registrar-General's office, of their exceedingly valuable Annual Reports, as they appear.

setts and England. That statement does not directly define the relative liability of the living to fall by specific causes, but it shows the proportional distribution of the aggregate deaths among the separate causes there stated, and is worthy of careful study. The following tables correspond with analogous statements given in our late Reports, and compare the numbers of deaths from some of the more prevalent diseases in Massachusetts, which occurred in 1859, with the collective numbers in several previous years. They also exhibit the proportional distribution of each. of the specified diseases in regard to sex, to months and to different periods of life. As this series of tables (commencing on the following page) embraces some of the most fatal maladies, its value is apparent. That portion which includes the aggregate of the past nine years, exhibits the fact that each one of the diseases named, except consumption, proves more fatal to males than to females. The same is also true with slight exceptions, in each of the years. Again, it will be noticed that many of the diseases, such as dysentery, typhus, measles, cholera infantum and teething, prevail and prove excessively fatal in the summer and early autumnal months. Pneumonia and croup, on the other hand, produce most deaths in the cold weather. But while these latter, together with consumption, are more uniformly distributed through the year, they prove more severe at certain periods of life than at other ages. Croup of course is confined to children, but consumption and pneumonia, especially the former, draw largely from adults who are in those ages which cover what is often denominated the prime of life. The tables should receive a very careful study.