that tuberculosis is not handed down as gout and insanity are known to be, it is right that the public should be taught that the old notion of its heredity is erroneous, and that the main thing to be held in view is the avoidance of the pestiferous bacillus. But it is right also that they should be taught—and they have been so taught from all platforms of which I know anything—that the marriage of a person actually laboring under consumption or of two persons belonging to families in which a marked liability to take on consumption has been decisively manifested are imprudent and to be condemned.
The belief for which Dr. Maudsley makes our intemperate platform orators responsible, that phthisis is curable because the tubercle bacillus has been discovered must have been promulgated, if it exists, by persons in a state of complete obfuscation; for every medical tyro knows that phthisis was curable and was cured in many cases long before Koch's enlightening revelation, and that the espial of the bane, did not at once guide us to an efficacious antidote. But surely Dr. Maudsley will not deny that the discovery of the one true cause of the disease puts us in an infinitely better position for circumscribing its ravages, for preventing it, ay, and for curing it than we were before. We know now that it is the outgrowth not of any subtle tendency passed on from generation to generation, but of a fungus which invades the body from without, by certain channels and has a definite life history; which outside the body has certain favorite haunts and may be destroyed by certain agents and inside the body may have its growth encouraged or retarded by certain conditions, which it is in our power to create or modify. Phthisis is still killing upwards of 40,000 persons in England and Wales annually. Tuberculosis in all its forms is killing upwards of 57,000, but the mortality from phthisis and tuberculosis has fallen enormously and is still falling. Twenty years ago—and during that time there can be no question as to improved diagnosis or change in nomenclature vitiating statistical returns—phthisis caused upwards of 49,000 deaths; to-day it is causing only about 40,000 per annum; tuberculosis caused upwards of 20,000 deaths; to-day it is causing not more than 17,000. Twenty years ago the annual death rate from phthisis was 1,827 per million, against 1,203 in 1903; the death rate from other forms of tuberculosis was 567 per million, living against 459 in 1903. In as short a period as twenty years the death rate from phthisis was reduced as much as 25 per cent. Surely these figures justify platform speakers in some degree of exultation if not of insobriety, and warrant them in exhorting the people to persevere in the use of the means which have secured such splendid results, and to supplement these by other means suggested by our new knowledge of the cause of the disease. The reduction in the mortality from phthisis and tuberculosis has been due, we know, to subsoil drainage, and the
