AND ENVIRONMENT 31 



on the subject before writing a word myself in the 

 matter, and his view had been quite definite on this very 

 point : ' There has been no sensible change in the con- 

 ditions under which a medical man diagnoses a death as 

 due to phthisis in the last 15 j^ears.' 



The last argument I have heard used is the curious 

 one that the diagnosis of lethal tuberculosis itself is 

 so faulty that the Registrar-General's death-rates from 

 phthisis are of no value for any purposes at all! 

 That is, I think, the last wriggle of those who dislike 

 the broad conclusion that modern advance in our know- 

 ledge of tuberculosis has not been accompanied by 

 increased fall in the phthisis death-rate. But if it were 

 true, what then ? Why, the whole of the so-called 

 ' Fight against Tuberculosis ' is based on erroneous 

 premises, for that Fight has proceeded on these very 

 statistics — namely, by the assertion that there is a fall 

 in the phthisis death-rate and that it has been produced 

 by the application of our increased knowledge ! 



Publications of the Massachusetts General Hospital. Medical and Surgical 

 Papers, vol. iii, October, 191 1, No. 3, p. 406 : — 



Phthisis (^Active). 

 Correct diagnosis in 32 cases or 59 % 



Error of omission in 16 cases or 30 % 



Error of commission in 6 cases or 11 % 



54 cases 



Miliary Tuberculosis. 

 Correct diagnosis in 28 cases or 52 % 



Error of omission in ao cases or 37 % 



Error of commission in 6 cases or 1 1 % 



54 cases 

 Numerous cases of obsolete or healed phthisis were left out of account wholly. 

 'The 30% of unrecognized cases was made up mainly of cases seen for 

 the first time within a few hours of death, when all distinctions are blurred,' 

 p. 407. Still in the cases discussed above we are dealing with the highest 

 diagnostic skill — one far above the average of that of the general practitioner. 

 It will be seen how serious is still the error of omission. 



