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45
Report of the County Medical Officer—General,
movement the figures giving the difference between the growth of population in the intercensal period
and the excess of births over deaths in the same period may in the first instance be referred to.

This statement clearly indicates that the very large volume of emigration from Europe to America
has been drawn in quite differing degrees from various sources during the period under review. Thus,
the percentages for Germany, England and Ireland overwhelmingly preponderate over those for the
other three countries in the decade 1861-70, and migration from Germany was maintained at a high
level in the two succeeding decades ; but in recent decades the countries in the above table formerly
showing low percentages now present high percentages and vice versa.
It is important to bear in mind in connection with phthisis rates, that it is not merely the numbers
giving the balance of emigration and immigration, and not merely the total figures giving emigration
and immigration (so far as these can be obtained), to which attention should be directed. One country
may give largely of its best and retain generally speaking, its feebler and more diseased units, while
another may send away its poorer population and its phthisics in large numbers and only very exceptionally
part with those who are more resistant to disease. Generally speaking, countries which are passing
through a period of prosperity tend to shed the less vigorous and successful units of population, while
countries suffering from privation and disturbed conditions are likely, on the other hand, to lose their
more energetic and capable citizens or country folk.
Another point of importance is the fact that in different countries not only the nature of the
stimulus to emigration, but the opportunities open to the emigrant may vary considerably. Thus, in
the case of Germany some 90 per cent, of the emigrant population, during the three decades when there
was a considerable exodus from the country, went to the United States of America and they consisted
largely of capable and energetic country people; the same comment has been made regarding the population
emigrating from Ireland during those decades. On the other hand the existence of rapidly growing
British colonies furnished an open field for emigrants from this country, but while many of the emigrants
were of vigorous type, numbers of sickly persons were included among them ; for until comparatively
recent years no restrictions as regards physical fitness were placed upon those entering the Colonies
and, as a matter of fact, in the last half-century large numbers of persons with early phthisis have proceeded
from this country to Australia, New Zealand, South Africa, Canada and other British possessions.
The remarkable development of facilities of travel and the closely waged competition between emigration
agencies has led to notable extension in the particular field of enterprise concerned with the "lifting"
of masses of population. The extent of operation of the disturbing influence of emigration upon the
phthisis death-rate has been dealt with in some detail elsewhere (Trans. Roy. Soc. Med. 1912-13), and
it has been shown how markedly the phthisis death-rates of English registration districts are affected
by movement of population. An especially curious point is the effect produced on the rates at certain
ages by the return of consumptives to their homes in the country to die; this phenomenon is much more
marked in females than in males; the rate at higher ages in males in the towns, on the other hand,
may be in part explained by the tendency manifested by men, who are incapable of earning a living
in the country, to tramp up to the town. The same facts are illustrated on a larger scale when the male
and female death rates in the urban and rural areas of the country as a whole are examined. On turning
from the statistics of registration areas to those of entire European countries, the teaching of the figures
is more difficult to understand, but there are clear indications of differences between prosperous countries