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rapid fall and that the curves .seemed to indicate that an actual rise in the phthisis death-rate 
might in the near future be reasonably anticipated. This \ iew was rendered still more probable 
when I plotted the returns for 1910 to 1914. Since then the Great War has rendered it almost 
impossible for us so to feel owv way in mortality statistics, that we can get returns comparable 
with the pre-war data. It seems to me, however, just worth while to see what our graphs 
will look like with the war years added to them. I must thank Dr Stevenson of the General 
Register Office for a renewal of his unfailing courtesy in providing me with the required data, 
and furthermore for several valuable suggestions as to the source <if the remarkable results 
manifested. 
If we could trust the accompanying diagrams tlie anticipated ri.se in the phthisis death-rate 
has already occurred. But complete trust would be ver^' nuich misplaced. In the first place 
our phthisis death-rate is for civilians, and since able-bodied civilians have been largely drawn 
into the army, there has naturally been a heavier death-rate of all kinds, and therefore a heavier 
phthisis death-rate than in pre-war times. There might therefore be nothing really significant 
in the marked male death-rate rise. On the other hand this explanation hardly applies to the 
rise — it is true not so marked — in the female death-rate. At the same time the whole nation, 
male and female, has been more crowded together in factories and subject to far greater strain 
than in i>re-war days. This would naturally tend to emphasise the death-rate of women as well 
as of men. If we turn, however, to our second diagram we .see that not only has the phthisis 
death-i'ate increased like the general death-rate, but it has been increasing at a more rapid rate 
than the general death-rate. This can only be accounted for on the assumption that phthisis 
moi'e than all other diseases will be emphasised by war-strain. It can hardly be said that we 
were relieved of war-strain during 1918, indeed some of the hardest months of work and some 
of the periods of heaviest depression occurred in that year ; there was further a most severe 
epidemic of influenza, and many deaths, Dr Stevenson tells me, recorded as influenza and phthisis 
were tabulated under the latter. Yet notwithstanding strain and influenza the proiwrtion of 
phthisis deaths to deaths in general fell (see Diagram ii). 
A noteworthy feature is that the tuberculous mortality in lunatic asylums increased in an 
extraordinary manner from an average of 1800 deaths in 1912-14 to 5605 deaths in 1918. 
Dr Stevenson tells me that this will practically account for half the increase in tuberculous 
deaths for the total population in that time. Now this raises very important questions which 
ought to be answered. Were the lunatics who died of tuberculosis lunatics before the war, and 
again were they tuberculous before the war ? Or did more lunatics become tuberculous owing 
to bad conditions — removal of much nursing and medical supervision — during the war ? Or 
again did the tuberculous lunatics enter the asyUuu during the war ? That is : Were the 
phthi.sical, .simply becau.se of their phthisis, less able to avoid mental breakdown luider the 
severe war conditions ? If so they would probably have died of phthisis outside the asylum 
in non-war conditions, and it would not be legitimate to cite the increased tuberculous deaths in 
asylums as something anomalous. 
On the whole it is risky to form a very definite judgment, but having regard to the female 
phthisis death-rate and to the percentage of the phthisis death-rate on the general death-rate, 
war difficulties do not seem to me sufficient to obscure the genei'al trend of our graphs (as 
indicated before the war), namelj' that somev\here about 1915 the fall in the phthisis rate which 
had been less rapid since 1895 would cease altogether and probably be followed by a rise. The 
next five years will show whether this be true or not. We should expect a fall in the phthisis 
death-rate immediately, but on the average the value will remain higher than that of 1915. 
Cambridge: pbinted by j. b. peace, m.a., at the dnivbesity pbess 
