EPIDEMIOLOGY OF TUBERCULOSIS KOCH. 673 



These considerations show that the decrease in consumption in 

 recent times depends upon various factors, of which the two most im- 

 portant ones are the care of those affected by isolating them in hos- 

 pitals and the improvement of housing conditions, especially as 

 regards the sleeping rooms. 



It is apparent from this that vast obstacles have yet to be over- 

 come before we can succeed in reducing still lower the mortality 

 from consumption, and finally reach a level which will possibly be 

 below the lowest existing at the present time, namely, 7 per 10,000 

 persons. 



We are now enabled to realize the great benefit that accrues from 

 having an exact knowledge of the statistics of mortality from con- 

 sumption in countries and cities. The mortality curve informs us 

 at once whether the conditions are favorable or unfavorable, whether 

 the mortality is decreasing and the measures taken are still effective, 

 or whether improvements, supplementary regulations, etc., should be 

 instituted. So in Norwa}^ the course of the consumption curve 

 induced the authorities to take in hand the building of hospitals, and 

 thus cause it to descend. 



New York resolved, as soon as it was shown that the curve began 

 to flatten and show greater variations, to take more care of the sick 

 and to increase the number of beds assigned to consumptives from 

 2,500 to 5,000. In Berlin, for the same reason, there was erected a 

 special hospital for pulmonary consumptives, with 1,000 beds. 



It is very desirable that exact mortality statistics should be every- 

 where obtained and that studies of the same should be extended to 

 smaller and smaller districts, so as to ascertain more fully the con- 

 ditions that control the development of tuberculosis, especially in the 

 case of small hamlets and country districts, and thereby to relieve 

 them. 



In our own country statistics are already developed far enough to 

 enable us to scan the death rate from consumption in single districts. 

 1 have here the record of mortality in two departments, which ex- 

 emplifies in a striking manner the interesting problems that result 

 from a comparison between different districts. (Table 10.) 



Table 10. — Deaths -from tuherculosis in 1907 per 10,000 inhaMtants. 



Allenstein department (10.33) : 



Osterode 7. 2 



Johannisbiirg 7. 7 



Sensbiirg 8. 5 



Neidenburg 9. 5 



Rossel ]0. 



Ortelsburg 11.0 



Lyck 11.5 



Lotzen 11. 5 



Allenstein 13. 



97578°— SM 1910 43 



