254 TUBERCULOSIS. 



that heredity plays an important role. Heredity has its 

 influence in the transmission of lowered vitality. If 

 there is hereditary predisposition to consumption, marked 

 by the slim body, fiat chest, thin limbs, delicate com- 

 plexion, weak voice, etc., there is also an acquired pre- 

 disposition to it produced by modes of life, insufficient 

 and improper food, unhealthy habitation and want of 

 fresh air, worry, over-exertion, both bodily and mentally, 

 as well as disease. Of all these factors perhaps none 

 exerts as great an influence as want of out-door exercise 

 and fresh air. 



Consumption is a house air disease. Animals which 

 perish in captivity nearly always die of consumption as 

 the result of bad air and little exercise. The general 

 mortality from phthisis is about 15 per cent, whereas 

 from the accurate tables prepared by Dr. Baer the mor- 

 tality in prisons is from 40 to 60 per cent, the highest in 

 the prisons of Austria, where it was 61 per cent, and the 

 lowest in Bavaria, 38.2 percent, and the average amounts 

 to the fact that about one-half the inmates of penal in- 

 stitutions die of phthisis. In these instances there are 

 two powerful factors to consider, close confinement and 

 a cell that has in all probability been infected with tu- 

 bercle bacilli by a former occupant. Prof. Von Ziems- 

 sen says that over 60 per cent of the Sisters of Charity 

 in the Munich hospitals die from tuberculosis. These 

 are generallj'' chosen from among robust, red-cheeked 

 country girls, but their arduous and sedentary duties, 

 undoubtedly predispose them, and almost constant con- 

 tact with tuberculous patients does the rest. One of the 

 difficulties in the way of tracing the disease to any par- 

 ticular source of infection is the fact that after gaining 

 access into the system it may remain latent for a long 

 time — even years, before springing into activity. I once 

 treated a young girl for incipient pulmonary tuberculo- 

 sis who improved so much that I thought she was cured, 



102 



