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Bills of mortality, newspaper and gazette articles, journals, and other records with specific references to 'consumption,' 'phthisis,' and other terms for tuberculosis were reviewed to determine the occurrence and importance of tuberculosis in the American colonies before 1820. Review of these sources indicates a marked increase in the proportional mortality from tuberculosis in the United States in the 18th century. 'Consumption' may have been the leading cause of death in adult American colonists