THE COMBATING OF TUBERCULOSIS. 473 



patients as possible in order to reduce the number of those that reach 

 the infectious stage of consumption and thus to reduce the number 

 of fresh cases was therefore a very natural one. The only question 

 is whether the number of persons cured in this way will be great 

 enough to exercise an appreciable influence on the retrogression of 

 tuberculosis. I will try to answer this question in the light of the 

 figures at my disposal. According to the business report of the Ger- 

 man Central Committee for the Establishment of Sanatoria for the 

 Cure of Consumptives, about 5,500 beds will be at the disposal of 

 these institutions by the end of 1901, and then, if we assume that the 

 average stay of each patient will be three months, it will be possible 

 to treat at least 20,000 patients every year. From the reports hitherto 

 issued as to the results that have been achieved in the establishments 

 we learn further that about 20 per cent, of the patients who have 

 tubercle bacilli in their sputum lose them by the treatment there. 

 This is the only sure test of success, especially as regards prophylaxis. 

 If we make this the basis of our estimates, we find that 4,000 con- 

 sumptives will leave these establishments annually as cured. But, 

 according to the statistics ascertained by the German Imperial Office 

 of Health, there are 226,000 persons in Germany over fifteen years 

 of age who are so far gone in consumption that hospital treatment is 

 necessary for them. Compared with this great number of consump- 

 tives the success of the establishments in question seems so small that 

 a material influence on the retrogression of tuberculosis in general is 

 not yet to be expected of them. But pray do not imagine that I wish 

 by this calculation of mine to oppose the movement for the estab- 

 lishment of such sanatoria in any way. I only wish to warn against 

 the overestimating of their importance which has recently been 

 observable in various quarters, based apparently on the opinion that 

 the war against tuberculosis can be waged by means of sanatoria 

 alone and that other measures are of subordinate value. In reality 

 the contrary is the case. What is to be achieved by the general 

 prophylaxis resulting from recognition of the danger of infection 

 and the consequent greater caution in intercourse with consumptives is 

 shown by a calculation of Cornet's regarding the decrease of mortality 

 from tuberculosis in Prussia in the years 1889 to 1897. Before 1889 

 the average was 31.4 per 10,000, whereas in the period named it sank 

 to 21.8, which means that in that short space of time the number 

 of deaths from tuberculosis was 184,000 less than was to be expected 

 from the average of the preceding years. In New York, under the 

 influence of the general sanitary measures directed in a simply ex- 

 emplary manner by Biggs, the mortality from tuberculosis has 

 diminished by more than 35 per cent, since 1886. And it must be 

 remembered that both in Prussia and in New York the progress indi- 



VOL. LIX. — 33 



