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discussed at the recent Paris Health Congress. Recent reports on
the cause and prevention of tuberculosis seem to have established
the theory that infection by the tubercle bacillus is a general
feature of modern civilised communities. A great deal of attention
has been paid to the investigation of the evidence that tuberculosis as
a disease is almost universally met with post mortem, and that infection
by the tubercle bacillus is almost universally distributed early in life.
The evidence upon which this theory rests, viz. : that tubercle is
very generally distributed in populations, is both pathological and
bacteriological.
Pathological evidence implies the existence of the disease, tuberculosis.
Since 1838 the evidence has been accumulating as to the
frequency with which this disease is found in the dead body. Ghon's
statistics apparently prove that 70 per cent, of the post mortem examinations
on children 11 to 14 years old, show recognisable lesions.
Bacteriological tests are an evidence of infection by the bacillus
with or without the production of lesions. If tuberculin tests are to be
accepted as specific, then Hamburger has shown that 95 per cent, of
children between the 12th and 13th years are already infected.
At the same time that our knowledge of the universality of the disease
has been increasing, urbanised populations have been showing a marked
decrease in the death rate from Pulmonary Tuberculosis. In England
and Wales between 1860 and 1903 the death rate per 100,000 of the
population decreased from 256 to 123, in Paris from 450 to 380,
in Hamburg from 390 to 188, in Copenhagen 307 to 149, in Belgium
during 1890 to 1903 from 181 to 125, and in Prussia during the same
time from 312 to 193.
In the chief industrial countries of the world there has also been
going on an urbanisation of the populations, so that between 1861 and
1901 in England, the proportion of the population living under urban
conditions compared to 100 living under rural conditions increased from
173 to 335.
Dr. Newsholme in quoting these figures points out that though the
death rate from Tuberculosis is nearly always greater in urban than
rural districts, the countries showing most urbanisation have secured the
greatest reduction in and the lowest death rate from Tuberculosis. The
conclusion that he draws in his paper at the Paris Congress in 1905 is
that the death rate from Tuberculosis has declined to the greatest extent
in those countries in which the ratio of institutional to domestic relief
has been highest.