30 TUBERCULOSIS, HEREDITY 



mass of death-certificates, would to-day, owing to his 

 better education, attribute to tuberculosis deaths which 

 15 years ago he would have attributed to other things ? 

 But it is not sufficient that he should attribute some 

 deaths now to tuberculosis which 15 years ago he 

 would not have done ; that some must be so great that 

 (i) it swamps all the deaths that he formerly attributed 

 to phthisis and now knows not to be phthisis ; (ii) that 

 it swamps also the natural fall in the phthisis death- 

 rate and the great artificial fall said to be due to the 

 fight against tuberculosis. 



Now remember that we are not dealing here with 

 the question of whether persons in an early stage of 

 illness have or have not suffered from phthisis, but 

 whether persons who have actually died under care will 

 nowadays be returned in large numbers as dying of 

 phthisis, whereas 15 years ago they would be said to 

 have died of something else. The numbers must be 

 very large ihdeed, for if you look at the rate for women 

 under the old dispensation, the death-rate should now 

 have fallen to about 6 per rooo, while it actually is 

 about 9. In other words, an increase of 50 % of deaths 

 of women must be due to improved diagnosis of phthisis ! 

 I cannot accept this for a moment, and for two very 

 good reasons: (i) because I found, on going into the 

 statistics, that improved diagnosis, at any rate at an 

 early stage, seemed to tell quite the other way, i. e. that 

 a considerable number of cases, 10 to 20 %, considered 

 as possibly phthisis were on fuller investigation found to 

 be something else ; ^ and secondly, because I had taken 

 the precaution of consulting one of our chief authorities 



* That there is no great excess of accuracy even nowadays in the ante- 

 mortem diagnosis of phthisis is evidenced by the following results taken 

 from a paper by Richard C. Cabot, M.D. : 'A Study of Mistaken Diagnoses,' 



