NATURAL DEATH, PUBLIC HEALTH 231 



directed, with, as we are accustomed to say, most grati- 

 fying results. The diseases are: 



1. Tuberculosis of the lungs. 



2. Typhoid fever. 



3. Diphtheria and croup. 



4. Dysentery. 



We note at once that the death-rates from these 

 diseases have all steadily declined in the 19 years under 

 review. But the rate of drop has been slightly unequal. 

 Remembering that the slopes are comparable, where- 

 ever the lines may lie, and that an equal slope means a 

 relatively equally effective diminution of the mortality 

 of the disease, we note that the death-rate from tuber- 

 culosis of the lungs has decreased slightly less than any 

 of the other three. Yet it may fairly be said that so 

 strenuous a warfare, or one engaging in its ranks so many 

 earnest and active workers, has probably never in the 

 history of the world been waged against any disease as 

 that which has been fought in the United States against 

 tuberculosis in the period covered. The rates of decline 

 of the other three diseases are all practically identical. 



Figure 53 shows entirely similar trends for four 

 other causes of death namely: 



1. Bronchitis (acute and chronic). 



2. Paralysis without specified cause. 



3. Purulent infection and septicaemia. 



4. Softening of the brain. 



Now it will be granted at once, I think, that public 

 health and sanitation can have had, at the utmost, ex- 

 tremely little, if anything, to do with the trend of mor- 

 tality from these four causes of death. For the most 

 part they certainly represent pathological entities far 

 beyond the present reach of the health officer. Yet the 



