28^ Dr. H. T. BuUtrode [May 15, 1908] 



As illustrative of the diagram, it may be mentioned that, as re- 

 gards London, the death-rate fell from 25 per 10,000 in 1871-80 

 to 18 per 10,000 in 1891-1900 ; in Cornwall the rate fell during 

 the same interval from 22 to 13 per 10,000 ; in Lancashire from 

 25 to 15 per 10,000, and so on throughout the several counties. 

 The fall in some counties has been less than in others, but in all it 

 has been a very material one. The excessive incidence of the disease 

 in North and South Wales will be remarked, as also will the fact that 

 this fall has been great in both divisions of the Principality. 



The chart suggests the continued operation over all parts of 

 England and Wales of some force which is not improbably making 

 for the extinction of tuberculosis. 



The Sex-Incidence of the Disease. 



As is well known, there is in the case of many diseases what may, 

 for the want of a better term, be called a sex-proclivity. In some 

 cases, as in cancer, the explanation of this sex-proclivity is easier of 

 explanation than in other diseases ; in the case of pulmonary tuber- 

 culosis the problem is a difficult one, more especially when regard be 

 had to the fact that in the earlier years of the period dealt with in 

 Chart I. the greatest incidence of the disease was upon females, 

 whereas for many years i)ast, as will be seen by following the re- 

 spective curves for males and females, by far the heaviest death-rate 

 has been upon the males — the fall in the female curve having been 

 much greater than that in the male ; so much so, indeed, that at the 

 present time the death-rate amongst males is about loOO per million, 

 that amongst females about 900 per million. This sex-incidence is 

 of int,erest in connection with the subject of communicability, seeing 

 that, on the current ideas as to the spread of the disease, the women, 

 who are so frequently nurses of the tuberculous sick, are likely to be 

 exposed for prolonged periods to a concentrated infection. But 

 reference will be made to this subject later on. 



The Main Factors which are regarded as having Promoted 

 THE Steady Fall which has apparently taken place in 

 the Death-Rate from Pulmonary Tuberculosis during 

 THE last Fifty Years. 



It is quite impracticable in an address such as this to enter fully 

 into this question, and a few words only can be said upon it. In 

 some measure the fall may be apparent only : that is to say, greater 

 opportunities for more accurate diagnosis may have had the effect of 

 relegating deaths Avhich formerly would have been attributed to 

 "consumption" or "phthisis" to the real causes, and if this increasing 

 knowledge transferred more deaths from pulmonary tuberculosis to 

 other diseases than it brought to pulmonary tuberculosis, a fall in the 

 phthisis death-rate would, aetens ijarihus, ensue. It must suffice to 



