672 



ANNUAL EEPORT SMITHSONIAN INSTITUTION, 1910. 



The striking fact that with us the cities often have a lower con- 

 sumption death rate than does the surrounding country is apparently 

 due partly to the want of hospitals and partly to the bad habits of the 

 rural inhabitants, in that they, even when they have at their dis- 

 posal ' several living rooms, select the meanest and 'smallest for a 

 sleeping room. As an example of the distinction between city and 

 country, the following statistics for certain Prussian provinces may 

 serve (Table 9) : 



Table 9. — MortoUty from, pulmonary consumption per 10,000 inhabitawts. 

 [After Ilirsch, Ilistorico-Geographic Pathology.] 



Province. 



Marienwerder 



Danzig 



Konigsberg . . . 



Bromberg 



Erfurt 



Breslau 



Hannover 



Osnabriick 



Cologne 



In the 

 city. 



25.4 

 23.9 

 24.9 

 31.3 

 26.9 

 37.3 

 33.8 

 48.7 

 47.6 



In the 

 country. 



13.5 

 14.1 

 15.5 

 18.6 

 27.0 

 27.5 

 44.4 

 52.2 

 53.4 



But in cities, also, housing conditions are poor. There are numer- 

 ous dwellings that consist of a single room, in which families, often 

 with several children, live, cook, and sleep, often in a single bed. 

 According to Rubner there are in Hamburg, Berlin, and Breslau 

 10 to 14 per cent of overcrowded dwellings, if we consider as such a 

 room with but one window housing more than 5 persons. 



Kayserling has estimated that, of the phthisical patients who 

 die in their own rooms 40.6 per cent inhabit but one room, 41.7 per 

 cent but two rooms; that in Berlin, during three years, 8,229 per- 

 sons were exposed to the greatest danger of infection because of con- 

 sumptives dying in one-room dwellings. It is well known that con- 

 sumptives in the last stages of the disease, when they are helpless 

 and expectorate sputum crowded with tubercle bacilli, are especially 

 liable to spread infection. 



If we adhere to the view that the most effective protection against 

 infection is the isolation of consumptives in hospitals, and then 

 reflect further that the number of such adult persons for which, on 

 account of tuberculous disease, hospital treatment is necessary, 

 amounts in the German Empire to from 150,000 to 200,000 annually, 

 and that it is quite impossilile to place these all in hospitals, nothing 

 else remains but to isolate the greater part of them in their own 

 dwellings. If it were possible to assign to each patient a separate 

 sleeping room, this might be to some extent effected ; but how can it 

 be done if the entire dwelling consists of only a single room? 



