150 



DISCOVERY 



was the women who were gaining all the time far more 

 than the men. Once, more women died of tuberculosis 

 than men. They do so still in backward Ireland. But 

 in England the preponderance of deaths was transferred 

 from women to men in 1868 ; in America the change 

 took place about ten years later, and in Scotland later 

 still. This rate of change corresponded with the rise 

 of the industries in the respective countries. Many 

 trades, from the nature of the dust they produce, or 

 from other causes, are injurious to the lungs, and 

 predispose to tuberculosis. This is notably the case 

 with tin-mining, tool-grinding, and pottery-making, 

 and there are many others ; but it is a curious thing 

 that nearly all those trades which predispose to tuber- 

 culosis are followed by men, and not by women. This 

 fact it is which has caused the tuberculosis mortality 

 to fall so much more profoundly among women than 

 among men. It may be said that tuberculosis has 

 declined in spite of the adverse influence of industrialism,^ 

 but the decline has been from this cause retarded chiefly 

 among men, especially at the ages between 35 and 65 ; 

 and between 45 and 55 the decline among men has been 

 httle more than half as great as it was among women 

 at the same ages. 



Fig. 2 will show how the fall in the mortality 

 from tuberculosis has affected the two sexes at different 

 ages. The figures along the base-line represent ages, 

 the whole period of life being divided into eleven 

 periods, five of them, in the earlier part of life, of five 

 years each, and the rest of ten years each. There is 

 a column for each age, and the two sexes are shown 

 separately. Each column is divided into three parts. 

 The upper limit, measured from the base-line, gives the 

 mean annual mortahty from tuberculosis for the decade 

 1861-1870. The second limit, also measured from 

 the base-line, gives that for the decade 1891-1900. And 

 the third limit gives the same information for the decade 

 1901-1910. Thus we can see at a glance how each 

 sex has benefited at each period of life. Up to fifteen 

 the boys have gained rather more than the girls, but 

 during the working years the gain has been all on the 

 side of the women, and the longer industrial conditions 

 have had to teU, the greater is the disproportion. 



' In rural districts of England and in Ireland, in 1908, the death- 

 rate from pulmonary tuberculosis was very much the same 

 among men and women. But in industrial centres, like Sheffield 

 and Birmingham, the death-rate from this cause during the 

 active working years of life, and especially of its later half when 

 industrial conditions have had time to tell, is twice or nearly 

 three times as high among the men as among the women. 



The ratio of the amount of decline among females to 

 that of males during the whole period under considera- 

 tion is given by the figures below. 



It is only necessary to recognise the adverse con- 

 ditions which, so far as tuberculosis is concerned, 

 industrial life has in the past exerted on the males to 

 see why war conditions have had so great an effect 

 upon the mortality from tuberculosis among women. 

 They went in large numbers into factories for the 

 purpose of making munitions. They did work which 

 only men had done before, and they began to be sub- 

 jected to the adverse conditions which hitherto had 

 affected the men alone. 



The infants suffered least, or rather they did not 

 suffer at all, but the decline in the death-rate from 

 tuberculosis from birth to the fifth year of age, which 

 had been progressing rapidly, especially since the be- 

 ginning of the present century, continued as though 

 no war had been going on. The rate increased a httle 

 among the younger children over five years of age, 

 and it increased rather more among the older children. 

 Why was this ? It was, probably, because of the 

 shortage of food, especially of fatty food, and esi>ecially 

 of milk. Whatever happened the baby was to receive its 

 proper quantity. If there was not enough to go round, 

 the children might go short, and it was the older chil- 

 dren, rather than the younger ones, who had to suffer. 



The experience of the recent past, indeed, has strongly 

 emphasised the importance of food in tuberculosis. In 

 parts of the Continent where semi-starvation or worse 

 has been prevalent, as in Vienna, tuberculosis has run 

 riot. A friend who was a prisoner of war in Germany, 

 in a camp where there were also many Russians, tells 

 me that while the British, who were well supplied with 

 parcels of food from home, remained well, the Russian 

 prisoners, who had no such resources, were dying like 

 flies from tuberculosis. From all accounts we hear 

 that it was the shortage of fats, especially of milk and 

 butter, which produced these results. ' And we cannot 

 be surprised at this. Is not cod-liver oil the staple 

 remedy for consumption ? 



In the decline of tuberculosis which went on so 

 steadily before the war many causes are thought — and 

 no doubt justly — to have contributed. Decrease of 

 overcrowding (brought about by better housing), pohter 

 manners, higher wages (conducing to greater comfort 

 generally, especially more plentiful and more nourishing 

 food), the cult of the open window, all these have 

 played their part. For tuberculosis, though indeed it 



Ratio of Female to Male Decline in the Death-rate from Tuberculosis between 

 THE Decades 1861-1870 and 1901-1910, the Decline among Males at e.\ch Age 



BEING TAKEN AS 100. 



Ages. 

 Ratios 



All ages. 0-5, 5-10, 10-15, 15-20, 20-25, 25-35, 35-45. 45-55. 55-65. 65-75 

 128, 96, 68, 94, 107, 114, 129. 150, 196, 184. 154 



