TUBERCULOSIS AS AN ECONOMIC AND SOCIOLOGIC FACTOR 1 83 



more fatal infectious diseases. There are at all times many persons 

 disabled by it. Some of them live for two or more years and then 

 die; others recover after a long illness. No doubt in the United 

 States there are constantly ill with this disease at least 400,000 indi- 

 viduals. 



Tuberculosis is not confined to cold or temperate countries. In 

 tropical districts where accurate records are taken it is found to be 

 quite prevalent. In the city of Honolulu, for example, for the year 

 ending June 30, 1909, tuberculosis caused 16.6 per cent of all deaths. 

 The annual death rate for this disease per 100,000 living persons was 

 390 as against 178 in England and Wales and 174 in the United States 

 for 1904. In like manner, Ceylon, the Philippine Islands, Porto 

 Rico, and other tropical countries are known to have astonishingly 

 high death rates from consumption and other forms of tuberculosis. 



No more striking statement of the prevalence of the disease has 

 been given than that in the weekly bulletin of the health department 

 of the city of Chicago for November 27, 1909, which is well worth 

 quoting: 



Consumption, a preventable disease, kills upward of 4,000 Chicago people 

 each year. There are 10,000 living cases approximately in Chicago today. 

 Consumption costs Chicago about $23,600,000 each year. It is the most pauper- 

 izing of all diseases. Consumption kills more people than diphtheria, scarlet 

 fever, smallpox, typhoid fever, cancer, appendicitis, meningitis and influenza 

 combined. Consumption will kUl upward of 50,000 Chicagbans in the next ten 

 years. You may be one of them. 



Table I shows mortality^ from tuberculosis in various places. 

 The localities are selected to show the great variation in different 

 parts of the world. The high death rates in California and Colorado 

 are to be accounted for by the presence of many invalids in those 



■ It may be well to point out that "annual death rate" means the average number of deaths each year 

 in a population of i,ooo living persons. If a town have 1,000 inhabitants, and of these an average of 18 die 

 each year, the "annual death rate" is 18. If, of these 18 who die, 3 are victims of tuberculosis, the propor- 

 tional deaths due to this disease will be 3: 18, i^^ or J. In other words, tuberculosis kills \ of the population , 

 or 16.6 per cent. If a city have 2,000 inhabitants with 18 deaths per annum, the annual death rate is 9. 

 Thus it is seen that annual death rate is not a percentage — it is not figured on the hundred — but is the ratio 

 per 1,000 of living persons. In working with death rates for single diseases, it is customary to express the 

 rate per annum as a ratio to 100,000 living persons. By this means it becomes possible to discard fractions. 

 In the example cited above where the annual death rate from tuberculosis was 3 per 1,000 it would be, of 

 course, 300 per 100,000. 



