466 ANNUAL REPORT OF THE 0£f. DoC. 



sanatoria alone, aod 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 in- 

 fection and the consequent greater caution in intercourse with con- 

 sumptives is shown by a calculation of Cornet's regarding the de- 

 crease 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 exemplary manner by Biggs, the mor- 

 tality from tuberculosis has diminished by more than 35 per cent, 

 since 1886. And it must be remembered that both in Prussia and 

 New York the progress indicated by these figures is due to the first 

 beginnings of these measures. Considerably greater success is to 

 be expected of their further development. Biggs hopes to have got 

 so far in five years that in the city of New York alone the annual 

 number of deaths from ti:berculosis will be 3,000 less than formerly. 

 I take this opportunity of most urgently recommending Dr. Biggs' 

 organization to the study and imitation of all municipal sanitary au- 

 thorities. 



Now, I do indeed believe that it will be possible to render the san- 

 atoria considerably more efficient. If strict care be taken that only 

 jiatients be admitted for whom the treatment of those establish- 

 ments is well adapted, and if the duration of the treatment be pro- 

 longed, it will certainly be possible to cure fifty per cent., and per- 

 haps still more. But even then, and even if the number of the sana- 

 toria be greatly increased, the total effect will always remain but 

 moderate. The sanatoria will never render the other measures I 

 have mentioned superfious. If their number become great, however, 

 and if they perform their functions properly, they may materially 

 aid the strictly sanitary measures in the conflict with tuberculosis. 



If now, in conclusion, we glance back once more to what has been 

 done hitherto for the combating of tuberculosis, and forward to what 

 has still to be done, we are ai: liberty to declare svith a certain sat- 

 isfaction that very promising beginnings haA'e already been made. 

 Among these I reckon the consumption hospitals of England, the 

 legal regulations regarding notification in Norway and Saxony, the 

 organization created by Biggs in New York, the sanatoria, and the 

 instruction of the people. All that is necessary is to go on develop- 

 ing these beginnings, to test, and if possible to increase their in- 

 fluence on the diminution of tuberculosis, and wherever nothing has 

 yet been done, to do likewise. 



If we are continually guided in this enterprise by the spirit of 

 genuine preventive medical science, if we utilize the experience 



