EPIDEMIOLOGY OF TUBERCULOSIS KOCH. 



661 



Table 1. — Mortality from pulmonary consumption. 

 [After Sundbarg. Calculated for every 10,000 persons.] 



Considerably higher figures prevail in the chief city of the country, 

 and this corresponds to the usually accepted opinion that the cities, 

 on account of the crowded buildings and the bad dwelling conditions 

 connected therewith and also because of the less resisting power of 

 their inhabitants, are more unfavorably situated as regards tubercu- 

 losis than is the open country. Stockholm had in 1750 a mortality 

 of 73.2, which in 1830 had advanced to 93.1 ; that is to say, nearly 

 100 per 10,000, or 1 per cent. 



The increase of mortality from phthisis in Stockholm is said by the 

 Swedish physicians to be caused by the misuse of alcohol. The rate 

 of 100 per 10,000 is only met with where the most unfavorable sani- 

 tary conditions are encountered, for example, in jails, at least in 

 former times ; and also among the perishing races of North American 

 Indians where alcohol is also the principal cause of decay. Accord- 

 ing to the concurrent testimony of various travelers, the inhabitants 

 of Greenland, compelled by the northern climate to live crowded to- 

 gether in their huts, thus greatly increasing the possibility of infec- 

 tion, suffer in an extraordinary degree from tuberculosis, reaching, it 

 appears, even a higher figure than 100 per 10,000. 



A death rate of 50 per 10,000 occurs rather frequently in the last 

 quarter of the nineteenth century, especially in cities. I will cite as 

 examples among the German cities: Diisseldorf, 55; Elberfeld, 59; 

 Osnabriick, 52; Cologne, 50|; Munich, 50. Especially high figures 

 occur in Austria-Hungary where there is 50 for Buda-Pesth ; 58 for 

 Presburg; 66 for Fiume; 72 for Vienna. 



From these figures we have a gradual descent until we reach a total 

 absence of mortality. In certain regions, as in central Africa, tuber- 



