THE GREAT WHITE PLAQUE. 3°3 



increasing amounts to stimulate the flagging energies, thus making a 

 bad matter worse. Some who contract the disease in this way have 

 occupations directly conducive to alcoholism, such as workers in the 

 liquor trade, barmen, waiters and hotel servants, people who are thus 

 employed because they are, from their physical and moral make-up, 

 ' unfit ' (as the evolutionist might say) for another and a better sort 

 of work. 



Poverty, with all that the word implies — underfeeding, deficiency 

 of sunlight, defective ventilation, overcrowding, uncleanliness, bad 

 drainage, rank-smelling and damp-walled houses — stands enormously 

 in a causative relation. There are plenty of data to demonstrate that 

 tuberculosis is preeminently a disease of humanity's submerged strata. 



It was estimated in Hamburg, for instance, among the several in- 

 come tax classes (inclusive of the dependents of the tax-payers) that 

 for incomes of from nine to twelve hundred Marks the death rate from 

 consumption is 55.4; for incomes of from twenty-five to fifty thousand 

 Marks the death rate is 7.5 — a proportion against the poorer classes of 

 nearly eight to one. 



One may grasp the idea in a glance upon the maps of New York 

 City districts which its Health Board has prepared under the medical 

 directorship of Dr. Herman M. Biggs. By far the greatest num- 

 ber of our consumptives are in the poorer districts; eleven of them, 

 for instance, dying in one year in a house in the ' lung block.' In- 

 structive, too, are the thousand odd photographs which the New York 

 City Tenement House Department has taken during the two years just 

 passed, showing air shafts twelve inches wide and six stories deep; 

 more than 360,000 ' dark rooms' whose only means of ventilation, if 

 they have any ventilation at all, is through such air shafts. En- 

 lightening, too, is Mr. Ernest Poole's brochure on ' The Plague in its 

 Stronghold.' Such grim humor as the following may also have 

 illuminative value : Three families occupied an apartment of three 

 rooms, one living in the front room, another in the rear room, the 

 third in the middle room; and they all got along very well together 

 until the family in the middle room wanted to take in boarders. 



Besides these predispositions to tuberculosis there are many others. 

 There are the family relations. If one member is consumptive, his 

 sputum may in various ways be infective. It may be spat upon the 

 floor, and if there is an infant, it will, in playing about, pick up 

 bacillus-laden objects and, after the habit of infants, put them in its 

 mouth. Then after weeks or months the child becomes tuberculous. 

 So that on such accounts as these it was formerly considered that the 

 disease itself was of hereditary origin. Then 'neglected colds,' fevers 

 and exhausting diseases, such as typhoid or malaria, enervate the body 

 and make it a fruitful soil for microbic germination. Direct injury, 



