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As a case in point mention may 1m; made of the County of Cornwall, which, as Dr. Brownlee says,
furnishes "an example of conditions observed in no other county in England. Cornwall differs from
all other counties (except Huntingdon) in that its population began to decline as far back as the sixties.
At the census of 1861 the population was 369,390, and this by 1901 had fallen to 322,334. Since then
there has been an increase to 328,098 in 1911, not unconnected perhaps with a partial revival in this
period of the tin mining industry. The ages mainly affected by the migration which the decline in
population implies will be seen from the following figures quoted from the census of 1911 (Vol. VIL,
p. xxiv.), showing the number of persons in various age-groups in Cornwall compared with England
and Wales taken as 100 .—

The 1911 census thus shows a marked deplet ion in the Cornish population of males at ages between
20 and 40 years and also, though in much less degree, a deficiency at those ages among females. Cornish
miners have a world-wide reputation, and hence young adults after an apprenticeship in Cornish tin
mines emigrate to other mining districts of the world. The reduction in the number of tin-miners aged
20-25 upon those aged 15-20 is shown in the Registrar-General's occupational statistics for 1900-02
and is far in excess of the corresponding reduction in the number of coal-miners of these ages. On the
other hand, in the age-group 65 and over, while among tin-miners about 45 per cent, of the total were
" retired or unoccupied miners," the corresponding figure for coal-miners was about 30 per cent.
Obviously, with so clear an indication of migration of tin-miners in the occupational statistics, the
mortality rates must be regarded with reserve, especially in contrast with other mining occupations.
It is thus clear that young miners, probably the ablest and fittest of them, when sufficiently trained
emigrate to other mining centres of the world, returning later in life to live upon their earnings ; but
they do not necessarily in all instances return to the tin-mining registration districts ; and, elsewhere, the
more prosperous of them are not described at death as retired tin-miners. Thus the phthisis mortality
of Cornwall for the age-period 20-25 appears to be based upon a residual population ; while, on the other
hand, deaths among the returned tin-miners of high age are added to a mortality already loaded with
an excess of phthisis. The absence of any second "hump" in the mortality curve for females in Cornwall
seems finally to dispose of the possibility of the Cornish "old age " phthisis being, as Dr. Brownlee
contends, peculiar to the district, and not due to the tin-mining industry.
With regard to the curves for Ireland and the Shetland Isles, the volume of emigration from
Ireland to America and from the Shetland Islands to the shipbuilding areas of the mainland, and of young
seamen into the Navy, cannot be disregarded, the effect being to exaggerate the phthisis mortality among
the residual young adults.
The effects of migration upon the contour of the phthisis mortality curves were clearly shown
in the Annual Report for 1913 in the diagram facing page 42, where Urban and Rural Counties are
contrasted. Between the ages 15 and 30 the rural mortality slightly exceeds the urban, and this is at
any rate in part accounted for by the addition to the urban districts of those "selected" from rural
areas by the attractions of urban life, and, in part also, by the return of those dying from phthisis to their
country homes. On the other hand from age 30 onwards the urban phthisis mortality is greatly in excess
especially among males.
To account for this urban excess it must be premised that from the earliest times the beneficial
effect of an outdoor life upon those suffering from or pre-disposed to phthisis has been recognised and has
been the foundation of treatment. Tn rural counties the predominant male occupation is outdoor work,
mainly farming ; in urban counties, on the other hand, it is mainly indoor work. The divergence
between urban and rural mortality or between fanners and industrial workers is much more likely to
have affected the curves than the assumed influence of three or more " types " of phthisis. If, indeed, any
proof were wanted of the soundness of the former explanation it is afforded in the similarity in the
mortality curves for females in the rural and urban areas since, in the case of females, the working
conditions do not offer anything like the same contrast, the bulk of female occupation in both areas
being of an indoor nature.
The effects of movement of population are broadly exemplified in the mortality contours for males
in England and Wales since 1841 which Dr. Brownlee gives (Diagram II.). The volume of total emigration
was large up to the end of the sixties and in this period the phthisis mortality is maintained, especially
at the age-period chiefly affected, i.e., 20-25 years. Thereafter, the total quantity of emigration declined
and with it the mortality rate, the decline being proportionately far greater at the age period mentioned
than in later years of life. It must be borne in mind, moreover, that with increase in the total number
of emigrants there has undoubtedly been up to five or ten years ago a steadily increasing exodus of
phthisical persons, owing to cheapened means of transit and the opening up of countries having the
reputation of being suited for consumptives.