out as an invisible spray when we speak, sing, cough, sneeze. Sputum-pots can not control this. The saliva of cases of phthisis may teem with the bacilli. The tuberculin reaction tests carried out by Hamburger and Monti in Vienna show that 94 per cent, of all children aged eleven to fourteen have been infected with tubercle. In most the infection is a mere temporary indisposition. I believe that the conditions of exhausting work, and amusement in confined and overheated atmospheres, together with ill-regulated feeding, determine largely whether the infection, which almost none can escape, becomes serious or not. Karl Pearson suggests that the death statistics afford no proof of the utility of sanatoria or tuberculin dispensaries, for during the very years in which such treatment has been in vogue, the fall in the mortality from tuberculosis has become less relatively 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 increased, together with the confinement of workers to sedentary occupations in artificially lit, warm, windless atmospheres. The same conditions pertain to places of amusement, eating-houses, tube railways, etc.
Central heating, gas-radiators and other contrivances 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 vigor of the nation. The open fire and wide chimney ensure ventilation, the indrawing 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. Wakefield tells me, the mortality of the fisherfolk from tuberculosis is very heavy. It is generally acknowledged to be four per 1,000 of the population per annum, against 1.52 for England and Wales. Some of the Labrador doctors
