482 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1944 
fering from moderately advanced or even far advanced tuberculosis. 
Ironically, many of them are not even aware of the seriousness of their 
condition. The tubercle bacillus is not a vicious pathogen despite the 
fact that it causes the most important single disease from which man 
has ever suffered. It is therefore all the more important that the 
facts about tuberculosis be known, so that medical practice and science 
can continue adequately in the effort to solve the tuberculosis problem. 
What is the present status of tuberculosis as a medical problem ? 
First of all, it is worthy of note that there has been a very marked 
decrease in this country in the number of deaths from tuberculosis. 
In 1900 the rate was 194.4 per 100,000; in 1940 it was 45.9; in 1942 it 
was 48.1. There was only 1 death in 1940 where there were 4.2 deaths 
in 1900. Not only has the number of deaths decreased but the distri- 
bution of those deaths has changed both within the total mortality 
picture and within the mosaic of tuberculosis itself. Table 1 will make 
some of these changes clear. 
Taste 1—Change in death rates (per 100,000) from 1900 to 1940 for tuberculosis 
and some other diseases 
Ratio 
Disease cain 1900 1905 1910 1915 1920 1925 1930 1935 1940 
194 
ANU Geaths-seccrscere oe 1. 59/1, 719.1 |1, 588.9 |1, 468.0 {1,317.6 |1, 298.9 |1, 168.1 |1, 132.1 |1, 094. 5 |1, 076. 4 
Tuberculosis_--------- 4.2 194. 4 179.9 153.8 140.1 113.1 84.8 (algal 55.1 45.9 
Percent of all__.__- 2.6 11.3 11.3 10. 4 10. 6 8.7 7.2 6.2 5.0 4.2 
Typhoid.-2-2se2= 42-52 31.3 31.3 ; 22. 4 22. 5 11.8 7.6 7.8 4.7 PONT 1.0 
Malaria: == gees 5.6 6.2 2.5 ee 1.6 3.4 2.0 2.9 3.5 La 
Miessios2 = ae 26.6 13.3 7.4 12.4 5:2 8.8 2.3 3.2 3.1 0.5 
Scarlet fever__.-------- 19.2 9.6 6.8 11.4 3.6 4.6 rar 1.9 raat 0.5 
Whooping cough----_-- 6.5 1232 8.9 11.6 8.2 12.5 6.7 4.8 3.7 2.2 
Diphtheria -=--5-.- 2 36. 6 40.3 23. 5 Pale 15. 2 15.3 7.8 4.9 3.1 Ti 
Totals see 17.6 112.9 71,5 80.1 45.6 52.2 29.3 22. 4 18.2 6.4 
Diarrhea in babies sal 
(2) -case See eS 15. 2 115.9 98. 4 98.4 55.7 43.4 30.8 19.4 10. 4 7.6 
Data from the Bureau of the Census, based on the expanding Registration Area. Since 1933 this area 
includes all continental United States. Vin i : LB 
The rate for tuberculosis was 4.2 times as high in 1900 as it was in 1940. This is for allages. The change 
has not been the same for all age groups: 
Under 1 year-__------------- 12/6'~26-84 yeare! Mid GALS 5.2 “65-74 years is 00 3.1 
pL 7-5: ne es 8\2. 35-44 years. .2 = 2-5 = 8S 43) “75-84 Wears oe oo 355 seats 3.4 
bate veatse. 22256 see see ee 625; 45=b4-years) 2228. 4 2 3.2 85 years and up-_--_-.-------- 3. 2 
16-24, NOaIB- = So oe Boia 00-O% VOOIS. on 4 2 eccn este 2.9 
Tt will be noted that in 1900 tuberculosis accounted for 11.3 percent of 
all deaths. By 1940 this figure had fallen 2.6 times, to 4.2 percent. 
Another significant point not shown in the table is that the disease 
is becoming pulmonary in type. In 1940, of the 60,428 deaths from 
tuberculosis, 55,576 deaths were pulmonary tuberculosis. Just over 8 
percent were tuberculosis of the central nervous system, gastrointesti- 
nal tract, the bony structures, the skin, the lymphatics, the genitourin- 
ary system, generalized tuberculosis, and infection of other organs. 
Forty years ago this figure would have been much higher. Other 
