38 TUBERCULOSIS, HEREDITY 



patients return to one-roomed tenements ; even if there 

 are two rooms, there is only one room with a fire, and the 

 patient lives there by day, resting on the 'kitchen bed', 

 and often sleeps there at night ; sometimes the patient 

 as husband or wife shares the same bed with wife 

 or husband and one or two children. Even the very 

 sputum bottle is only a trap, if it has to be emptied at 

 a sink and under a flowing tap with all the food-vessels 

 about! Whatever district visitors may accompHsh 

 with patience and persistency in matters of hygiene, 

 a study of the Glasgow Report will show how very 

 little the sanatorium has so far achieved as a school 

 of hygiene ! 



So much for sanatorium treatment. As far as the 

 available data go, they provide no evidence that this 

 treatment is producing marked results; they supply no 

 refutation of the position that the fall in the phthisis 

 death-rate is due not to the reduction of infection but 

 to the development by heredity of a racial immunity. 



I now pass to my second factor of modern treatment 

 — the dispensary system. It is asserted that where 

 the infection-factor is taken into account locally, each 

 case followed up, and instructions given as to conduct 

 and treatment, there the phthisis death-rate falls in a 

 most marked manner. In no town has this been so 

 completely achieved as in Edinburgh. Edinburgh has 

 become a model for other places in this matter. All 

 honour to the men and women who teach our country- 

 men to be self-respecting and others-respecting. Good 

 will always be done on such lines. Look too at the fall 

 in the phthisis death-rate for Edinburgh (Fig. VIII) ! 



Here are the diagrams given by the Local Medical 

 Officer of Health. During the last ten years of the 



