PRESIDENTS ADDRESS—SECTION I. 149 
then no sewerage connections, it cannot be yet said that the 
improvement is due to the drainage connections. Though 
we must wait for the fuller evidence which time alone can supply, 
experience in other cities and other parts of the world justifies 
us in cherishing the confident hope that before many more years 
have elapsed, typhoid as a cause of death will stand constantly at 
or below the lowest level which it has hitherto occasionally 
reached. 
Tuberculosis is the great scourge of civilised life. With the 
doubtful exception of malaria, it causes a larger mortality the 
world over than any other disease. In this colony it is true, as 
it is in Great Britain, that tuberculosis causes about twice as 
many deaths, yerr by year, as all the well-known epidemic 
diseases taken together. Within the last few years we have 
almost got rid of the depressing belief that consumption is a 
hereditary disease, and so, in a manner, the inevitable fate of 
very many persons in whose family the tuberculous taint seemed 
to exist. We cannot say that heredity counts for nothing in 
calculating the liability to consumption. But we are now clear, 
from the results of observation and experiment, that unhealthy 
surroundings and contagion are the real causes of its occurrence 
in most cases. We have attained the firm assurance that tuber- 
culosis, in all its forms, is a preventable disease, and also that in 
a large proportion of cases it is curable if proper treatment is 
instituted at an early enough stage. The knowledge that a 
fatal disease is preventable is in itself a call to the adoption of 
vigorous steps for its prevention. That all kinds of improve- 
ments, in the conditions under which people live, tend to 
make tuberculosis less common and less fatal, is true, as it is 
true of many other diseases. And it is to the progress of 
sanitary improvement, both in town and country, that we must 
ascribe the reduction in the mortality from consumption, which 
has steadily been going on in Great Britain and other countries 
for the last fifty years. Now that we can trace the occurrence 
of tuberculosis to some infection by means of food, or by the 
inhalation of dried particles of the sputum of consumptive per- 
sons, we have at our disposal modes of prevention more specific 
than ordinary sanitary measures. If all the matter expectorated 
by consumptive persons could be carefully collected and quickly 
destroyed, there can be no doubt that within a few years the 
disease would be comparatively rare, and, further, if pure milk 
and perfectly sound meat, and no other, were allowed to pass 
into consumption, a further reduction in tuberculosis prevalence 
would be effected. Common as the disease still is, the hope is 
not an unreasonable one, that tuberculosis will, at no very 
remote period, be as rare in England as leprosy is, that it will 
be practically extirpated, as that disease has long been. For 
the hastening of that most desirable end there has been estab- 
