DISCOVERY 



149 



Though the promised land may be obscured by mists 

 which diminish visibility and make it difficult to esti- 

 mate its distance, yet we command a Pisgah height 

 from which the eye — aided no doubt a little by 

 the telescope of imagination — can see the cur\-e of the 

 mortality from tuberculosis steadily approaching its 

 base-line, and, somewhere away near the horizon, we 

 don't quite know how far off, but at least within the 

 range of assisted vision, actually joining its base-line 

 and extinguishing itself in it. When we arrive there 

 tuberculosis will have gone the way of leprosy and 

 have become extinct. 



But the causes which have brought about this fall, 

 will they continue to act ? May it not be that they 

 have already nearly exhausted their influence ? What 

 were those causes ? Are they of a nature likely to be 

 permanent ? Moreover, may not other causes, 

 possibly, come into action which will reverse the 

 process ? 



Such a cause was the war. In the year 1913 there 

 were 49,476 deaths from tuberculosis ; in 1918, the 

 latest year for which I have the figures, there were 



fourteen years, and probably we do not know the 

 worst yet. 



The war has exerted its influence on tuberculosis, 

 both in the army and in the civil population. Many 

 persons thought that the open-air life of the soldier 

 would prove beneficial to those in the early and un- 

 recognised stages of consumption. But it was not so. 

 Above all things the consumptive needs is to be taken 

 care of and protected from hardship, even in the 

 earliest stages of the disease. Though plenty of fresh 

 air is, no doubt, a good thing, it will not make up for 

 exposure and fatigue, which are the very worst things. 

 Many a case of infection with tubercle bacilli which, but 

 for the war, might have done well was converted, by 

 active service conditions, irom a retrogressive into a 

 progressive tuberculosis. Many a case of quiescent lung 

 trouble broke down under the strain and ended fatally 

 in consumption. 



But the civil population suffered also, and more than 

 the army, from this cause, because the great majority 

 of early consumptives were left at home. Let us see 

 how the various constituent elements of the home 

 population were affected. 



Fig. 2.— UiUSTRATlNG THE F.\I,I, IN THE MORTAi-ITY FROM TUBERCULOSIS A510NG >IEN AND WOMEN. 



58,073, an increase of 8,597 deaths from tuberculosis 

 of all kinds. (But as a matter of fact the increase was 

 entirely an increase of pulmonary tuberculosis, deaths 

 from other kinds of tuberculosis ha\Tng actually de- 

 creased.) For so bad a year we must go back to 1904, 

 so that the war may be said to have set us back 



WTiile deaths from tuberculosis increased among both 

 sexes, it was the women who were more particularly 

 affected, and especially the women at the most active 

 periods of life. Why was this ? The answer is easy. The 

 key is given by the fact that during the years before 

 the war, when tuberculosis was slowly dying out, it 



