88 



TllK CHARTS LOCALITY. 



dent of the American Medical Association, will materially aid the reader in studying 

 the relation between disease and locality ; that is, the effect upon the human organism, 

 of its physical " environment." 



Table showing mean altitude of the different States from which the statistical matter of the charts of 



Class III was drawn. 



States. 



Mitiiiesota 



West Virginia .. 



Iowa 



Wiscousiu 



New York 



Missouri 



Mifbigan 



Peiiiisvlvania .. 



Oliio ." 



Iiuliaua. 



New Hanipsbire 



5 S > 



100 



o.-o 



ilOU 

 850 

 800 

 800 

 800 

 7,')0 

 700 

 075 

 025 



States. 



Illinois 



Vcnuont 



Keutiicky 



Massacliusetts 



Maine 



Maryland 



Connecticut 



New Jersey 



Rliodc Island 



District of Columbia 

 Delaware 



*0 c3 © 



f525 



(iOO 

 000 

 400 

 :575 



a75 



300 

 200 

 125 

 115 

 100 



In explanation of the divisions adopted in the chart on phthisis puhnoualis, it is 

 proper to state that West Virginia is inchided in the Western States, and that the other 

 divisions were determined by considering the several States that belonged, a part in 

 one and a part in another division, (as for example Pennsylvania,) merely as groups 

 of congressional or enrollment districts, which could, with considerable exactness, be 

 assigned each its proper place, as East of Range, On Range, West of Range, Seashore, 

 Inland, etc. 



The greater prevalence of pulmonary consumption in the Eastern States, whether 

 it be referable to climate, geological formation, occupation, emigration, immigration, 

 altitude, nutrition, or miasmatic influences, is clearly indicated, and the indication is 

 sustained by concurrent testimony. 



The subject of hernia, which is particularly of interest to the surgeon, is shown in 

 its relation to locality in Chart XL. As in the other charts of this class, the 501,002 

 men, on the examination of whom these locality-statistics are based, were all drafted 

 men ; that is, were taken by lot from among all whose names appeared upon the 

 enrollment-lists, and therefore they may be supposed to fairly represent the masses. 

 The ratio of rejection on account of hernia, in the several States, as will be seen, varied 

 to a remarkable extent ; and hei-e again, as in phthisis pulmonalis, a most exhaustive 

 treatment of the various circumstances of surroundings, as also of inheritance, would 

 be necessary in order to deduce a satisfactory theory of the causes, immediate and 

 remote, of hernia. As coming within the province of this repoiit, one disturbing element 

 may be pointed out: When, during the progress of the late civil war, a "call" was 

 made l)y the President for more men to recruit the armies in the field, the proportion, 

 or ((uota, that was erpiitably due from each district was dependent upon, and deter- 

 mined by, the number of men enrolled ii"i such district relatively to the total number 

 (enrolled in all tlic districts. It was, liowever, allowable for l)oards of enrollment to 

 strike from the lists the names of men who were manifestly incapacitated for military 



