TUBERCULOSIS 455 



enough to improve the sanitation ; to balance the increasing 

 retrogression continuous improvement is necessary. Doubtless, if 

 the poor Jews of the slums, who as a class are probably the most 

 resistant in the community, were removed to better surroundings, 

 they would have lower death-rates from tuberculosis than before ; 

 but only for a few generations. Gradually the rate would rise 

 until the mortality balanced the retrogression. Even among our 

 wealthier classes consumption claims its toll of victims, and it is 

 difficult to believe that the environment in cold and crowded 

 England can ever be made so unfavourable to the bacilli as it 

 already is in the warm, sun-bathed, and sparsely populated 

 Polynesian Islands where the native races are undergoing ex- 

 termination. Isolation, such as that practised in sanatoria, is, 

 owing to the vast multitude of sufferers, impracticable as a general 

 preventive measure. Speaking practically sanatoria effect cures 

 only amongst highly resistant people who have been weakened in 

 worse surroundings A great number of those who improve in 

 them return to perish in their own homes. Consumption is never 

 detected in its earliest stages. The victim does not suspect his 

 disease until it is well advanced. Long before it has been recog- 

 nized, the bacilli have been disseminated by means of his cough 

 not only in large masses of sputum, but in a fine spray. It is con- 

 ceivable of course that we shall one day discover a medicine which 

 will act as effectively in tuberculosis as mercury in syphilis and 

 quinine in malaria ; but, since tuberculosis has so long been studied, 

 this is, at least, improbable. It would seem, then, that the only 

 hope of permanently reducing the mortality from tuberculosis lies 

 in selection probably, in the first instance at least, not a selec- 

 tion enforced by legal penalties, but one due to the presence 

 of an enlightened public opinion which will regard as morally 

 reprehensible the fertile marriages of phthisical types. 



