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The Problem of Excess Female Mortality: Tuberculosis in Western Massachusetts, 1850-1910

Under the modern mortality pattern females die at all ages at a lower rate than males. However, this was not always the case. For much of the nineteenth century in the United States and parts of Europe it appears that females died at a higher rate with respect to at least one disease, pulmonary tuberculosis. The purpose of this research is to investigate this question in four towns of the Connecticut River Valley, Massachusetts. First, it is necessary to establish age- and sex-specific mortality rates in the four rural towns in the Connecticut River Valley during the latter half of the 19th century and beginning of the 20th. Secondly, it is necessary to identify those cases in which tuberculosis was the main disease and cause of death. This research seeks to discuss and contribute to the topic of excess female mortality. The four Massachusetts towns of Greenfield, Deerfield, Shelburne, and Montague constitute my research sites. These towns are appropriate for the anthropological pursuit of historical epidemiology due first to the towns’ rural nature at a time when the majority of Americans lived in rural towns, not large urban cities where studies are often focused. Secondly, these towns are of interest because of the extensive data collection that has been conducted previously. Tuberculosis (TB) is an interesting and instructive disease to focus research on. TB has re-emerged in recent decades, and research on the disease may have applied implications and value. TB was the number one killer during the study period, and the nature of the disease is such that it is very sensitive to the social environment. The combination of a rural setting and tuberculosis may give insight into the etiology of a disease that shares a long yet uneven history with humans, and has both biological and cultural significance. Under the traditional mortality pattern females of particular age ranges have greater mortality rates than males. This research discovered that females exceeded males in mortality rates at ages ten to 19 and 30 to 39 and that TB was the root cause of greater female mortality. Interestingly, the sex-specific gap in TB mortality rates was much wider than the gap in overall mortality rates. Thus, while females were dying of one cause, evidence shows that males were dying of another, which may have offset male TB mortality rates.