October 3, 1912] 



NATURE 



149 



the mortality from tuberculosis has become less rela- 

 tivelv to the fall in general mortality. He opines that 

 the race is gradually becoming immune to tubercle, 

 and hence the declination in the mortality curve is 

 becoming flattened out — that nature is paramount 

 as the determinant of tuberculosis, not nurture. From 

 a statistical inquiry into the incidence of tuberculosis 

 in husband and wife and parent and child, Pearson 

 concludes that exposure to infection as in married 

 couples is of little importance, while inborn immunity 

 or diathesis is a chief determinant. Admitting the 

 value of his critical inquiries and the importance of 

 diathesis, I would point out that in the last few years 

 the rush and excitement of modern city life has in- 

 creased, together with the confinement of workers to 

 sedentarv occupations in artificially lit, warm, wind- 

 less atmospheres. The same conditions pertain to 

 places of amusement, eating-houses, tube railways, 

 &c. 



Central . heating-, gas-radiators, and other con- 

 trivances are now displacing the old open fire and 

 chimney. This change greatly improves the economical 

 consumption of coal and the light and cleanliness of 

 the atmosphere. But in so far as it promotes 

 monotonous, windless, warm atmospheres, it is wholly 

 against the health and vigour of the nation. The open 

 fire and wide chimney ensure ventilation, the indraw- 

 ing of cold outside air, streaky air — restless currents 

 at different temperatures, which strike the sensory 

 nerves in the skin and prevent monotony and weariness 

 of spirit. By the old open fires we were heated with 

 radiant heat. The air in the rooms was drawn in cool 

 and varied in temperature. The radiator and hot-air 

 system give us a deadly uniformly heated air — the very 

 conditions we find most unsupportable on a close 

 summer's day. 



In Labrador and Newfoundland, Dr. NA'akefield tells 

 me, the mortality of tiie fisherfolk from tube/culosis 

 is very heavy. It is generally acknowledged to be 

 four per looo of the population per annum, against 

 i'52 for England and Wales. Some of the Labrador 

 doctors talk of seven and even eight per tooo in certain 

 districts. The general death-rate is a low one. The 

 fishermen fish off shore, work for manv hours a day 

 in the fishing season, and live with their families on 

 shore in one-roomed shanties. These shanties are built 

 of wood, the crannies are " stogged " with moss, and 

 the windows nailed up, so that ventilation is very im- 

 perfect. They are heated by stoves and kept at a very 

 high temperature, e.g., So° F. Outside in the winter 

 the temperature may be 30 degrees below freezing. 

 The women stay inside the shanties almost .nil their 

 lime, and the tuberculosis rate is .somewhat higher in 

 them. The main food is white bread, tea stewed in 

 the pot till black, fish occasionally, a little margarine 

 and molasses. The fish is boiled and the water thrown 

 away. Game has become scarce in recent vears ; old, 

 dark-coloured flour — spoken of with disfavour — has 

 been replaced by white flour. In consequence of this 

 diet beri-beri has become rife to a most serious extent, 

 and the hospitals are full of cases. Martin Flack and 

 I have found by our feeding experiments that rats, 

 mice, and pigeons cannot be maintained on white bread 

 and water, but can live on wholemeal, or on white 

 bread in which we incorporate an extract of the sharps 

 and bran in sufficient amount. Recent work has 

 shown the vital importance of certain active principles 

 present in the outer layers of wheat, rice, &c., and in 

 milk, meat, &c., which are destroyed by heating to 

 120° C. .\ diet of white bread or polished rice and 

 tinned food sterilised by heat is the cause of beri-beri. 

 The metabolism is endangered by the artificial methods 

 of treating foods now in vogue. .As to the prevalency 

 of tuberculosis in Labrador, we have to consider the 

 intermarriage, the bad diet, the over-rigorous work 

 NO. 2240, VOL. 90] 



of the fishermen, the overheating of, and infection in, 

 the shanties. Dr. Wakefield has slept with four other 

 travellers in a shanty with father, mother, and ten 

 children. In some there is scarce room on the floor 

 to lie down. Ihe shanties are heated with a stove on 

 which pots boil all the time ; water runs down the 

 windows. The patients are ignorant, and spit every- 

 where, on bed, floor, and walls. In the schools the 

 heat and smell are most marked to one coming in from 

 the outside air. In one school 50 cubic feet per child 

 is the allowance of space. The children are eating 

 all day long, and are kept in close hot confinement. 

 They suffer very badly from decay of the teeth. Whole 

 families are swept olf with tuberculosis, and the child 

 who leaves home early may escape, while the rest of 

 a family dies. 



Here, then, we have people living in the wildest 

 and least populated of lands with the purest atmo- 

 sphere suffering from all those ill-results which 

 are found in the worst city slums — tuberculosis, beri- 

 beri, and decayed teeth. 



The bad diet probably impels the people to conserve 

 their body heat and live in the over-warm, confined 

 atmosphere, just as our pigeons fed on white bread 

 sit, with their feathers out, huddled together to keep 

 each other warm. The metabolism, circulation, 

 respiration, and expansion of the lung are 

 all reduced. The warm, moist atmosphere 

 lessens the evaporation from the respiratory 

 tract, and therefore the transudation of tissue lymph 

 and activity of the ciliated epithelium. The unex- 

 panded parts of the lung are not swept with blood. 

 Everything favours a lodgment of the bacilli, and 

 lessens the defences on which immunity depends. In 

 the mouth, too, the immune properties of the saliva 

 are neutralised by the continual presence of food, and 

 the temperature of the mouth is kept at a high level, 

 which favours bacterial growth. Lieutenant .Siem in- 

 forms me that recently in Northern Norway there has 

 been the same notable increase in tuberculosis. The 

 old cottage fireplaces with wide chimneys have been 

 replaced with American stoves. In olden days most 

 of the heat went up the chimney, and the people were 

 warmed by radiant heat. Now the room is heated 

 to a uniform moist heat. The Norwegians nail up 

 the windows and never open them during the winter. 

 .'\t Lofoten, the great fishing centre, motor-boats have 

 replaced the old open sailing and row boats. The cabin 

 in the motor-boat is very confined, covered in with 

 watertight deck, heated by the engine, crowded with 

 six or eight workers. \\'hen in harbour the fishermen 

 used to occupy ill-fitted shanties, through which the 

 wind blew freely; now, to save rent, they sleep in the 

 motor-boat cabins. 



Here, again, we have massive infection, and the 

 reduction of the defensive mechanisms by the influence 

 of the warm, moist atmosphere. 



The Norwegian fishermen feed on brown bread, 

 boiled fish, salt mutlon, margarine, and drink, when 

 in money, beer and schnapps ; there is no gross de- 

 ficiency in diet, as in Labrador, and beri-beri does not 

 attack' them. They return home to their villages and 

 longshore fishing when the season is over. The one 

 nevv condition which is common to the two districts 

 is confinement in stove-heated, windless atmospheres. 

 In old days the men were crowded together, but in 

 open boats or in draughty shanties, and h.id nothing 

 but little cooking-stoves. 



The conditions of great cities tend to confine the 

 worker in the office all way, and to the heated atmo- 

 sphere of club, cinema show, or music hall in the 

 evening. The height of houses prevents the town 

 dweller from being blown upon by the wind, and, 

 missing the exhilarating stimulus of the cool, moving 

 air, he repels the dull imiformity of existence by tobacco 



