A Report on the Origin and 
Geographical Distribution of 
Phthisis Pulmonalis for 
the State of Michigan. 
Br V 
E. L. SI1URLY, M. D., 
-'fwmyf'TT. 
REPRINTED FROM 
2Tbe Xeto York fHctucal .Journal 
for November 14, 1885. Reprinted from the New TorTc Medical Journal 
for November If 1885. 
A REPORT ON 
THE ORIGIN AND GEOGRAPHICAL DIS- 
TRIBUTION OF PHTHISIS PULMONALIS 
FOR THE STATE OF MICHIGAN * 
By E. L. SHURLYj M. D., 
DETROIT. 
Mr. President and Gentlemen : The object of the in- 
vestigation upon which this imperfect report is based is to 
ascertain, if possible, what, if any, influence is exerted by 
strictly telluric environment upon the causation of phthisis 
pulmonalis. The aerial and social factors of its aetiology 
have been for a long time freely and widely discussed, but 
the telluric aspect and geographical distribution, according 
to my observation, have received much less consideration, 
and perhaps deservedly, although it seems to me that we 
have too little knowledge on this point to warrant such a 
decision. 
Circulars were sent out to the profession of the State of 
Michigan asking for data relating to the number of cases of 
phthisis pulmonalis which had originated only in the town- 
ship or county where the practitioner resided, together 
with a statement of the number of such patients who were 
* Read before the American Climatological Association, May 28, 
1885. 2 
ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
known to have hereditary predisposition, and whether pri- 
mary or secondary. Although a large number of replies 
were received, I regret to say the number was somewhat 
less than I had hoped for. 
As the number of physicians who keep notes of cases is 
small in the aggregate, I endeavored to shape the queries 
as concisely as possible, and to ask for so little that almost 
any practitioner could till out the answer from memory and 
with the consumption of very little time. To those who 
were good enough to reply I feel greatly indebted, and I 
believe all who are interested in this subject will also share 
in this feeling. 
I thought it advisable, even at the risk of wearying you, 
to precede the tables with a few extracts from the reports 
of Professor Winchell and Dr. liominger, showing the topog- 
raphy of the State. 
I am greatly indebted to Dr. A. W. Nicholson, lately of 
our State Board of Health, for the general and census 
tables, and to Dr. Erwin Wright for the preparation of the 
other data in the form presented. 
Topography, Hydrography, and Geology. 
“The two natural divisions of the State are distinguished 
by marked physical characteristies. They are completely 
cut off from one another by the Straits of Mackinac. The 
northern is rugged, with numerous rocky exposures; the 
southern consists of plains, plateaus, gentle undulations, 
and moderate hills, with very few outcrops of rocky strata. 
The northern peninsula is a mineral region; the southern, 
agricultural. The climates of the two peninsulas are as 
distinct as their location and topography.” 
“The climate of Michigan, both in summer and winter, 
is well adapted to the interests of agriculture and horticul- OF PHTHISIS PULMONALIS IN MICHIGAN. 
3 
ture. Its marked peculiarity is attributable to the influence 
of the great lakes by which the State is nearly surrounded. 
It has long been known that considerable bodies of water 
exert a local influence in modifying climate, and especially 
in averting frosts; but it has never before been suspected 
that Lake Michigan, for instance, impressed on the climatic 
character of a broad region an influence comparable with 
that exerted by the great oceans.” 
“ The influence of the sea in equalizing temperatures 
has long been understood. The immunity from unseason- 
able frosts secured by bodies of fresh water to localities in 
their immediate neighborhood has also been universally 
observed; but the fact that inland lakes of the size of Lake 
Michigan exert an ameliorating agency quite comparable 
with that of the Atlantic Ocean is something which has 
only been brought to light by recent thorough discussion of 
a wide range of meteorological data.” 
Distribution of Precipitation through the Seasons in Percentages of 
Total Precipitation. 
Spring. 
Summer. 
Autumn. 
Winter. 
Upper Peninsula 
190 
2'7’0 
28-8 
22 
Lower Peninsula 
25-8 
28-7 
27-3 
19 
Whole State 
23-8 
28'3 
<2,7-7 
20 
It appears that the northern localities experience a some- 
what greater liability to dryness in all seasons. It must be 
borne in mind, however, that the percentages given are per- 
centages of the seasonable means. 
“ A general glance at the superficial configuration of the 
lower peninsula reveals a surface swelling gently from the 
shore toward the interior regions.” 
“ Generally the lake shores are depressed.” 
“ The rise of the peninsula from the level of the lakes is 4 
ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
generally gradual, and in a few places only is it abrupt. 
The surface is of an undulating, hilly character; the hills 
are rounded, and never attain a very great height above the 
surrounding country. The southern peninsula is lower than 
the northern. The swell of the land forming the water-shed 
of this southern division coincides with a line drawn in a 
southwest direction from Port Austin, at the entrance of 
Saginaw Bay, to the southwest corner of Hillsdale County, 
where it enters the boundaries of the State of Ohio. With- 
in the limits of Tuscola and Sanilac Counties the known 
surface elevation of this water-shed is about four hundred 
feet, while in Hillsdale, not far from the southern State 
line, some points with an elevation of six hundred feet are 
recorded; but the water-shed is probably not over five hun- 
dred feet high.” 
“ This, which may be called the southeastern water-shed, 
is not broken through by any of the streams, though deeply 
excavated by the Huron River in Washtenaw County.” 
“The descent from the height of the water-shed to the 
lake shore is so gradual that a traveler in crossing the pen- 
insula from either lake to the other, if he follows the river 
valleys, can scarcely perceive it. The northern division of 
the peninsula rises to nearly double the height of the south- 
ern part; its surface is more broken and diversified by 
steeper ascents from lake to terrace. Its highest points in 
the vicinity of Otsego Lake are, according to the records 
of the railroad surveys, eleven hundred feet from the lake 
level. Otsego Lake lies directly west of Thunder Bay, and 
not far from the northern terminus of an extensive high 
plateau with undulating surface, and an average elevation 
of from seven hundred to eight hundred feet.” 
“All the rivers of the northern part of the peninsula 
have their source within this plateau, which is dotted with 
a number of inland lakes, some of which, like Lakes IIig- OF PHTHISIS PULMONALIS IN MICHIGAN. 
5 
gins, Houghton, and St. Helen’s, are of large size. The ter- 
races by which the descent from the plateau is made form a 
succession of broad belts; their sides are moderately steep 
and finely timbered; the lowest are wider, gradually slant- 
ing toward the shore, or overlooking it in bluffs of from 
forty to sixty feet.” 
In some places on the west side the bluffs are from one 
hundred to two hundred feet high, and Sleeping Bear 
Point, a promontory facing Lake Michigan west of Big 
Traverse Bay, is said to have an elevation of five hundred 
feet. Opposite this point, twelve miles out in the lake, 
the Manitou Islands rise abruptly to a height of two hun- 
dred feet above the water. South of the second correction- 
line the plateau rapidly declines toward Saginaw Bay. Be- 
tween the north and south parts of the peninsula a de- 
pressed strip of land extends from Saginaw Bay to the 
mouth of the Grand River on Lake Michigan, having rarely 
more than one hundred feet elevation. 
An astonishing number of smaller and larger inland 
lakes are found in every part of the peninsula; all have 
crystal-clear water, and the principal supply of the head 
branches of our rivers comes from them. The more im- 
portant rivers collecting the waters of the western slope of 
the peninsula are the St. Joseph’s, Kalamazoo, Grand, Mus- 
kegon, and Manistee. The three first named have their 
sources in close proximity to the elevated lands of Hills- 
dale and Jackson Counties. 
From the same swell of land the River Raisin emanates, 
flowing outward into Lake Erie. The Raisin River enters 
the lake near Monroe; it drains the southern part of Wash- 
tenaw County, and draws its branches from a number of 
small lakes in the southeast corner of Jackson County 
through its main north branch. The south branches have 
the drainage of Lenawee County. 6 
ORIGIN AND GEOGRAPHICAL DISTRIRUTION 
The St. Joseph’s, Kalamazoo, and Grand Rivers almost 
touch each other within the small area of a few square 
miles in the County of Hillsdale. The St. Joseph’s River 
originates in a number of small lakes and marshes in Hills- 
dale County, and enters Lake Michigan at the village of St. 
Joseph. 
The streams which form the head-waters of the Kalama- 
zoo River rise in Hillsdale County. The river runs north, 
west, and northwest, and falls into Lake Michigan near Sau- 
gatuck. 
Grand River springs from a few lakes in Jackson Coun- 
ty ; it runs north and opens into Lake Michigan near Grand 
Haven. 
Huron River collects its waters from innumerable lakes 
and marshes in Livingston and Oakland Counties, flows 
southwest, and at Dexter turns southeast and retains this 
direction until it enters the Detroit River in the northeast- 
ern corner of Monroe County. 
Clinton River drains the eastern part of Oakland Coun- 
ty and all of Macomb County, entering Lake St. Clair near 
Mount Clemens. 
Black River is remarkable for its southern course for 
nearly fifty miles parallel with Lake Huron, at a distance of 
only five or six miles from it. It begins in the northern 
part of Sanilac County, and enters St. Clair River near Port 
Huron. 
Saginaw River is the receptacle of a whole system of 
rivers. By the Tittibawassee River the waters of the north 
and west are led into it. The Shiawassee collects from the 
south, the Flint River from the south and southeast, and 
finally the Cass River brings its waters from the northeast 
and east. 
The river system of the northern part of the peninsula 
consists of the following rivers : Commencing at the south- OF PHTHISIS PULMONALIS IN MICHIGAN. 
7 
east side, we first find the Rifle and Aux Gres Rivers, 
which drain the southeastern shore-belt surrounding the be- 
fore-mentioned high plateau. Au Sable River is the next 
largest river north of them. It draws its branches right 
from the high plateau, and drains Otsego in the north end 
of it. 
Thunder Bay River, opening into Thunder Bay, spreads 
its arms north, west, and south, reaching the foot of the 
high plateau. The Cheboygan River on the north of the 
peninsula forms the outlet of three large lakes—Black, 
Mullet, and Burt. These lakes are fed by rivers of good 
size. On the west side of the peninsula two large rivers 
deserve to be mentioned. 
Manistee River originates very near the head-waters of 
the Au Sable River on the east side. Its mouth is at Man- 
istee. 
Muskegon River is larger than Manistee; its branches 
extend to the top of the central high plateau, and are fed 
by Higgins and Houghton Lakes. Of all the rivers men- 
tioned, none are navigable. The water-power afforded by 
these rivers is ample, and those the branches of which flow 
through timbered lands are of vital importance to the lum- 
ber business as mediums for the transportation of felled 
timber from otherwise almost inaccessible parts of the in- 
terior to ports or railroad stations. 
Relief Features in the Lower Peninsula. 
SOUTHERN LOBE. 
Livingston Summit 350 feet. 
Ingham Summit 391 “ 
Grand Ledge Summit.... 250 “ 
Barry Summit 250 “ 
Kent Summit 213 “ 
Northwestern 
slope. 
Cass Summit. 
Oshtemo culmination 349 “ 
Cassopolis culmination 384 “ 8 
ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
Oakland Summit 639 feet. 
Washtenaw Summit 394 “ 
Francis County Summit 411 “ 
Southeastern 
water-shed. 
Hillsdale 
Summit. 
Somerset culmination 600 “ 
Cambria culmination 618 “ 
California culmination 546 “ 
NORTHERN LOBE. 
Roscommon Summit 820 feet. 
Clare Summit (central water-shed) 750 “ 
Ogemaw Summit 860 “ 
Southern Division. 
Crawford Summit 700 “ 
Wexford Summit 700 “ 
Osceola Summit 700 “ 
Northern Division. 
Oscoda Summit 800 “ 
Otsego Summit 1,200 “ 
The rivers have all eroded their valleys into the loose 
drift masses which almost universally cover the surface of 
the peninsula in great thickness. Only in rare instances 
have they been deep enough to touch the solid rock ledges 
below the drift, or, if such deep cuts did exist, they have 
tilled them up with debris, and the beds of the present 
streams lie high above those of former times. The penin- 
sula was, in its original condition, heavily timbered, with 
the exception of a few marshy flats. Climate and quality 
of the soil determine the character of the vegetation. In 
the southern part of the peninsula deciduous trees, particu- 
larly hard-wood timber, prevail. Pine is only sporadically 
intermingled. The mildness of the climate favors the 
growth of the oak, hickory, walnut, poplar, etc., which 
abound here, but become rarer farther north, where beech, 
maple, and birch take their place. The sandy soil of the 
central high plateau is most congenial for the growth of 
pine forests, which have taken possession of nearly the en- OF PHTHISIS PULMONALIS IN MICHIGAN. 
9 
tire district. The marshy condition of some other places 
adapts them for the tamarack, elm, asp, and willow trees, or 
for the growth of the cedar, while a few parts of the high 
plateau, proving too sterile even for the pine, afford suste- 
nance to nothing more than a stunted scrubby growth of 
Finns banksiana, and a few creeping herbs which attempt 
to hide the barrenness of the scene. Such barrenness has, 
in some instances, been caused by fires which annihilated 
forests of large area, totally denuding the surface, and leav- 
ing it exposed to the burning rays of the sun and to the 
exsiccating winds, and unable for a long time, if not for 
ever, to recover its former well-timbered condition. 
“ The entire surface of the peninsula is covered by heavy 
drift deposits, with the exception of a few limited localities 
in which the drift, subsequent to its deposit, has been washed 
off by the floods, or by rivers curving their course deep 
enough to touch the rock-beds of older formation. These 
drift masses are almost the same as those of the upper pen- 
insula. The material has been changed somewhat, by the 
admixture of rock-debris, from the formations encountered 
by the moving glaciers in their southern course. The gla- 
cier-drift spreads itself in a compact body over the entire 
surface of the lower peninsula, in evidence of which fact 
the rock-beds, wherever they are found denuded and the 
nature of the rock has been capable of preserving the 
marks, bear the traces of its motion on their scratched sur- 
face. Not all the drift material found on the lower penin- 
sula has been transported there by glaciers; a large por- 
tion of it must have been carried southward by water, 
partly in suspension—as mud and sand—partly frozen with 
floating ice—as the coarser material, the gravel and the 
bowlder. 
“ The glaciers deposited moraines—heaps of rubbish 
composed of all kinds of rock-debris in every degree of com- 10 
ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
minution, from the large bowlder down to the impalpably 
line clay. 
“ Much of the drift is not found in this orderless form 
of moraines, but is disposed in well-stratified layers, assorted, 
according to the weight of its particles, by water-currents.” 
A long time of submergence of the land must have fol- 
lowed the glaciers. The surface of the highest points of 
the peninsula, 1,100 feet above the level of the lakes, is 
formed by stratified drift-sand, mixed with pebbles. 
“ The older glacier-drift and the later deposit of floods 
and icebergs are materially of the same composition; both 
are made up of clay, sand, gravel, and bowlders of detritus 
from crystalline and metamorphic rocks, mixed with debris 
of younger sedimentary strata.” 
The coarse bowlder-drift all through the southern part 
of the peninsula appears not to occupy the lowest position, 
in which most frequently a hard, dark blue, sandy clay, 
with pebbles and some bowlders intermingled, is found; in 
layers of considerable thickness. It is known among-Ja- 
borers by the popular name of hard-pan. 
“ Bog-iron occurs very frequently in small patche's of 
marsh lands in all parts of the State.” 
“ As another surface deposit, peat has been mennfuied. 
Innumerable larger and smaller patches cover the swampy 
surface depressions throughout the whole State.” 
The soil of the lower peninsula, being a drift-soil, is gen- 
erally very deep, and contains all the chemical constituents 
of a good soil. 
The assortment of the drift-soil into clay, sand, and 
gravel determines its character as the layers happen to oc- 
cupy the surface positions, while by intermixture a great 
variety of intermediate shadings in the quality of the soils 
is locally produced under atmospheric influences. The dis- 
tribution of soils over the State is sometimes very unequal OF PHTHISIS PULMONALIS IN MICHIGAN. 
11 
and changeable, so that within limited areas, and often 
within single farms, a number of variations in the character 
of the soil are represented. But with the differences seen 
in the surface configuration of certain districts is also usual- 
ly found a corresponding contrast in the quality of their 
soil. The high plateau in the northern part of the penin- 
sula has its peculiar soil, a thick, uniform mass of fine sand, 
containing few pebbles and a small proportion of argilla- 
ceous constituents. In accordance with it is its vegetation ; 
the pine-tree finds a congenial home in these sandy hill- 
lands, and their surface is overgrown with splendid forests 
of this tree, to the exclusion of almost every other kind. 
“Other districts—represented by lowlands adjoining the 
lakes, and, to all appearances, within comparatively recent 
times parts of the lakes’ bottoms—are covered by a stiff clay 
soil overgrown with elm, ash, and kindred trees, as, for 
instance, the lower part of Saginaw Valley and a strip of 
land bordering Detroit River, from Monroe up to Lake St. 
Clair. 
“The climate of the peninsula, which is the other prin- 
cipal factor in its productiveness, is over the whole extent 
temperate, extremes of heat or cold being prevented by 
the surrounding lakes. From the northern to the southern 
end all the cereals can be planted with little risk of failure. 
The northern part is somewhat cold, its vegetation coming 
out two weeks later than in the south, and tbe winter set- 
ting in that much earlier, which affects somewhat the rais- 
ing of the more tender fruit crops, as grapes, peaches, etc. 
“ The grape and the peach do well in the southern part 
of the State, and particularly near the shores of the great 
lakes, where the foggy, humid air prevents late frosts, the 
greatest enemy of these fruits. The west shore up as far as 
Muskegon has become famous for its peaches and other 
mail fruits.” 12 
ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
“ Beneath the drift the peninsula is underlaid by regu- 
larly stratified rock-beds, in undisturbed horizontal position, 
which represent the upper part of the paheozoic strata.” 
Deaths by Phthisis Pplmonalis in the State of Michigan. 
Record by Counties. ■ 
COUNTY. 
Population in 
1870 and 1880. 
No. of 
deaths from 
phthisis 
from 1839 
to 1882. 
No. 
origina- 
ting in 
county. 
Pri- 
mary 
Secondary. 
Alcona 
766 
& 
3,107 
155 
11 
2 
Allegan 
32,093 
it 
37,815 
506 
5 
3 
2, 
’83-’84 
Alpena 
2,756 
U 
8,780 
58 
Antrim 
1,985 
U 
5,237 
87 
Baraga 
1 
,804 
17 
Barry 
22,204 
& 
25,317 
332 
Bay 
16,820 
U 
38,081 
415 
Benzie 
2,148 
a 
3,433 
45 
4 
. . 
’81-’84 
Berrien 
35,119 
a 
36,785 
602 
4 
3 
1, 
82’-’84 
Branch 
26,229 
“ 
27,941 
467 
15 
13 
’80-’84 
Calhoun 
36,571 
a 
38,452 
653 
23 
12 
4, 
’80-’85 
Cass 
21,097 
a 
22,009 
808 
9 
’78-’84 
Charlevoix 
1,724 
a 
5,115 
63 
3 
2 
’82-’84 
Cheboygan 
2,197 
a 
6,524 
30 
Chippewa 
1,690 
a 
5,248 
63 
Clare 
266 
a 
4,187 
22 
3 
1 
’82-’84 
Clinton 
22,852 
a 
28,100 
348 
Crawford 
1 
,159 
2 
Delta 
2,441 
& 
6,812 
43 
6 
6 
’60-’70 
Eaton 
25,164 
(4 
31,225 
450 
29 
18 
6, 
’70-’85 
Emmet 
1,211 
a 
6,639 
84 
Genesee 
33,965 
a 
39,222 
515 
32 
2 
oc 
t 
00 
tffc. 
Gladwin 
1 
,127 
3 
Grand Traverse. 
4,443 
& 
8,422 
65 
3 
’80-’84 
Gratiot 
11,809 
“ 
21,936 
180 
13 
63 
’70-84 
Hillsdale 
31,691 
(4 
32,723 
577 
19 
10 
9, 
’79-’85 
Huron 
9,049 
44 
20,489 
135 
Ingham 
25,270 
44 
33,6 6 
424 
2 
1 
’82-84 
Ionia 
27,676 
44 
33,872 
469 
100 
16 
1, 
’57-’84 
Iosco 
3,175 
44 
6,873 
56 
5 
2 
3, 
’75-’84 
Isabella 
4,113 
44 
12,159 
172 
Isle Royal 
65 
Jackson 
36,042 
& 
42,031 
550 
Kalamazoo 
32,063 
44 
34,342 
618 
15 
12 
3, 
’70-’84 
Kalkaska 
424 
44 
2,937 
12 
Kent 
50,410 
44 
73,263 
1,114 
28 
16 
2, 
’69-’84 OF PHTHISIS PULMONALIS IN MICHIGAN. 
13 
Deaths by Phthisis Pulmonalis in Michigan.—(Continued.) 
COUNTY. 
Population in 
1870 and 1880. 
No. of 
deaths from 
phthisis 
from 1869 
to 1882. 
No. 
origina- 
ting in 
county. 
Pri- 
mary 
Secondary. 
Keweenaw 
4,209 “ 
4,270 
27 
Lake 
548 “ 
3,232 
22 
Lapeer 
21,345 “ 
30,138 
314 
Leelenau 
4,577 “ 
6,253 
81 
Livingston 
19,417 “ 
22,251 
324 
98 
68 
15,’56-’84 
Lenawee 
45,503 “ 
48,343 
693 
35 
9 
17,’70-’85 
Michilimackinac. 
1,716 “ 
2,992 
44 
Macomb 
28,050 “ 
31,627 
544 
8 
4 
3, ’68-’85 
Manistee 
6,074 “ 
12,532 
109 
30 
13 
17,’72-’84 
Manitou 
891 “ 
1,334 
11 
Marquette 
15,077 “ 
25,394 
258 
10 
10 
’81—’85 
Mason 
3,266 “ 
10,065 
87 
Mecosta 
5,645 “ 
13,973 
122 
21 
9 
5, ’82-’84 
Menominee 
1,894 “ 
11,987 
25 
1 
1 
’80-’84 
Midland 
3,383 “ 
6,893 
80 
13 
4 
1, ’80-’84 
Missaukee 
1,553 
5 
4 
2 
’64-80 
Monroe 
27,534 & 
33,624 
470 
30 
19 
11,’82—’84 
Montcalm 
13,642 “ 
33,148 
295 
36 
14 
20,’71-’84 
Montmorency... 
Muskegon 
14,895 “ 
26,586 
251 
49 
39 
10,’74—’84 
Newago 
7,292 “ 
14,688 
107 
10 
4 
6, ’80-’84 
Oakland 
40,906 “ 
41,537 
618 
65 
35 
13,’74-’84 
Oceana 
7,222 “ 
11,699 
160 
5 
2 
OD 
OO 
O 
1^ 
OO 
Ogemaw 
1,914 
6 
Ontonagon.... 
2,846 & 
2,565 
34 
2 
2, ’77-’84 
Osceola 
2,104 “ 
10,777 
62 
15 
14 
1, ’7 2-’84 
Oscoda 
467 
1 
Otsego 
1,974 
2 
Ottawa 
26,665 & 
33,126 
455 
6 
JO 
OO 
CO 
1^ 
OO 
Presque Isle.... 
3,113 
14 
Roscommon.... 
355 & 
1,459 
Saginaw 
39,078 “ 
59,095 
915 
62 
25 
30,’78-’84 
Sanilac 
14,565 “ 
26,341 
250 
14 
9 
2, ’72-’84 
Schoolcraft 
1,575 
9 
Shiawrassee 
20,864 & 
27,159 
307 
15 
5 
10,’81-’84 
St. Clair 
36,687 “ 
46,197 
672 
29 
18 
ll,’66-’84 
St. Joseph 
26,274 “ 
26,626 
430 
Tuscola 
13,721 “ 
25,738 
247 
Van Buren 
28,735 “ 
30,807 
478 
9 
6 
3, ’79-’84 
Washtenaw .... 
41,442 “ 
41,848 
683 
13 
7 
6, ’78-’84 
W ayne 
119,054 “ 
166,444 
4,237 
396 
237 
85,’75-’84 
Wexford 
650 “ 
6,815 
45 ORIGIN AND GEOGRAPHICAL DISTRIBUTION 
14 
In the foregoing report it will be seen that under the 
heading of County is given the name of each county ; under 
the heading of Population is given the population by coun- 
ties in 1870 and 1880, and under the heading of Number of 
Deaths by Phthisis is given the total number of deaths from 
phthisis from 1869 to 1882, inclusive. The column marked 
Number of Cases originating in County gives the cases re- 
ported to me from various physicians as having originated in 
their county, with the year of their appearance. Of these, 
the remaining columns, marked Primary and Secondary, 
will show the number of cases as far as known which were 
primary, and those which arose secondarily to some other 
malady. 
It will be seen by these tables that the whole number of 
deaths from phthisis pulmonalis, as reported to the State 
Board of Health, from 1869 to 1882 (thirteen years) is 
22,103, or an average of 1,700 a year. Of these, 1,241 
were reported in 1869 and 1,979 in 1882. 
During 1882 rain fell 179 out of the 365 days, with a 
total fall of 30‘31 inches, which was about the average fall 
for the preceding ten years. The mean temperature for 
1882 was 51*2, which was slightly higher than the average 
for the preceding ten years. 
The whole number of cases reported to me as having 
originated in the State between the years .857 and 1885 is 
1,370, and of these, 673, or nearly one half, were reported as 
primary, while 205 were reported as having been secondary 
to some other disease. 
Of the total number of original cases (1,370) from 1857 
to 1885, 602, or a little less than one half, occurred between 
the years 1879 and 1885, or during a period of six years. 
The total population of the State, according to the cen- 
sus, in 1870 w’as 1,184,059, and in 1880 was 1,856,100, 
showing an increase of 672,041; so that proximately, so far OF PHTHISIS PULMONALIS IN MICHIGAN. 
15 
as learned, tlie percentage of deaths from original cases to 
population would be about per cent., which no doubt 
is somewhat below the truth; but, as before remarked, these 
statistics are necessarily inaccurate (as are all United States 
vital statistics). However, if enough has been elicited to 
awaken an interest in the further investigation in this line, 
the work may not prove entirely valueless. 
Note.—A very full and able account of the climate and topography 
of Michigan, illustrated by numerous maps, by Dr. H. F. Lyster, of 
Detroit, may be found in the “ Report of the Michigan State Board of 
Health ” for 1878. The lew York Medical Journal, 
A WEEKLY REVIEW OF MEDICINE. 
Published by 
0. Appleton & Co 
Edited bt 
Frank P. Foster, 
M.D. 
The New York Medical Journal, now in the twenty-first year of its 
publication, is published every Saturday, each number containing twenty- 
eight large, double-columned pages of reading-matter. By reason of the 
condensed form in which the matter is arranged, it contains more reading- 
matter than any other journal of its class in the United States. It is also 
more freely illustrated, and its illustrations are generally better executed, 
than is the case with other weekly journals. 
It has a large circulation in all parts of the country, and it is largely on 
this account that it is enabled to obtain a high class of contributed articles, 
for authors know that through its columns they address the better part or 
the profession; a consideration which has not esca{>ed the notice of adver- 
tisers, as shown by its increasing advertising patronage. 
The special departments of the Journal are as follows: 
LECTURES.—The frequent publication of material of this sort is a prominent fea- 
ture, and pains are taken to choose such as will prove valuable to the reader. 
ORIGINAL COMMUNICATIONS.—In accepting articles of that class, regard is 
had more particularly to the wants of the general practitioner, and all the 
special branches of medicine are duly represented. 
BOOK NOTICES.—Current publications are noticed in a spirit of fairness, and with 
the sole view of giving information to the reader. 
CLINICAL REPORTS are also a regular feature of the Journal, embracing clinical 
records from the various hospitals and clinics, not only of New York, but of 
various other cities, together with clinical contributions from private practice. 
EDITORIAL ARTICLES are numerous and carefully written, and we are able to 
give timely consideration to passing events. 
MINOR PARAGRAPHS.—Under this heading are given short comments and 
notes on passing events. 
NEWS ITEMS contain the latest news ef interest to the profession. 
OBITUARY NOTES announce the deaths which occur in the ranks of the profes- 
sion, with a brief history of each individual when practicable. 
SOCIETY PROCEEDINGS are given promptly, and those of a great number of 
societies figure. At the same time we select for publication only such as we 
think profitable to our readers. 
REPORTS ON THE PROGRESS OF MEDICINE constitute a feature of the 
Journal which we have reason to think is highly valued by our readers. 
MISCELLANY includes matter of general interest, and space is also given for 
NEW INVENTIONS and LETTERS TO THE EDITOR. 
As a whole, we are warranted in saying that the New York Medical 
Journal 13 regarded with the highest favor by its readers and by its con- 
temporaries. 
Subscription price, §5.00 per annum.