A SANITARY OUTLOOK 351 



that tuberculosis is not handed down as gout and insanity are known 

 to be, it is right that the public should be taught that the old notion 

 of its heredity is erroneous, and that the main thing to be held in view 

 is the avoidance of the pestiferous bacillus. But it is right also that 

 they should be taught — and they have been so taught from all plat- 

 forms of which I know anything — that the marriage of a person actu- 

 ally laboring under consumption or of two persons belonging to 

 families in which a marked liability to take on consumption has been 

 decisively manifested are imprudent and to be condemned. 



The belief for which Dr. Maudsley makes our intemperate platform 

 orators responsible, that phthisis is curable because the tubercle bacillus 

 has been discovered must have been promulgated, if it exists, by per- 

 sons in a state of complete obfuscation; for every medical tyro knows 

 that phthisis was curable and was cured in many cases long before 

 Koch's enlightening revelation, and that the espial of the bane, did not 

 at once guide us to an efficacious antidote. But surely Dr. Maudsley 

 will not deny that the discovery of the one true cause of the disease 

 puts us in an infinitely better position for circumscribing its ravages, 

 for preventing it, ay, and for curing it than we w T ere before. We know 

 now that it is the outgrowth not of any subtle tendency passed on from 

 generation to generation, but of a fungus which invades the body from 

 without, by certain channels and has a definite life history; which nut- 

 side the body has certain favorite haunts and may be destroyed by cer- 

 tain agents and inside the body may have its growth encouraged or 

 retarded by certain conditions, which it is in our power to create or 

 modify. Phthisis is still killing upwards of 40,000 persons in England 

 and Wales annually. Tuberculosis in all its forms is killing upwards 

 of 57,000, but the mortality from phthisis and tuberculosis has fallen 

 enormously and is still falling. Twenty years ago— and during that 

 time there can be no question as to improved diagnosis or change in 

 nomenclature vitiating statistical returns — phthisis caused upwards 

 of 49,000 deaths; to-day it is causing only about 40,000 per annum; 

 tuberculosis caused upwards of 20,000 drat lis; to-day it is causing not 

 more than 17,000. Twenty years ago the annual death rate from 

 phthisis was 1,827 per million, against 1,203 in 1903; the death rate 

 from other forms of tuberculosis was 567 per million, living against 

 l-V.i in 1903. In as short a period as twenty years the death rate from 

 phthisis was reduced as much as 25 per cent. Surely these figures 

 justify platform speakers in some degree of exultation if not of inso- 

 briety, and warrant them in exhorting the people to persevere in the 

 use of the means which have secured such splendid results, and to 

 supplement these by other means suggested by our new knowledge of 

 the cause of the disease. The reduction in the mortality from phthisis 

 and tuberculosis has been due, we know, to subsoil drainage, and the 



