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of puberty (qua tuberculosis) in girls may have as some compensation an added resistance to tubercle in
women at the grand climacteric. Moreover, the evidence already adduced as to outward movement
of older women from the towns to the country no doubt plays some part here. It would seem there
has been a marked tendency of late years for women to revert to a country life at an age when the stress
of urban conditions might especially be expected to be manifested.
Chapter VI. (Collis and Greenwood, p. 143) contains an admirable summary of practical measures
to be taken with a view to mitigating the ravages of tuberculosis. "What is the matter with the poor
is largely poverty. Not through any special intensive measures of campaigning against the tubercle
bacillus, not even by the segregation of the actively tuberculous, does there seem any real hope of salvation.
We have to improve the homes of the working classes in the first place—it is a sound popular
instinct that inspires the popular outcry against urban and even rural housing conditions; in the second
place we have to secure better factory conditions; here it is not so much sanitation in the popular sense
as hygiene in the wider apprehension of the term." So far I follow the argument, but I do not feel happy
about the concluding sentence which harks back to the danger of a man reaching home " in a condition
of definitely lowered resistance to an infection which must still be regarded as ubiquitous." On this I
hope to be able to read, mark, learn and inwardly digest Dr. Greenwood's forthcoming Milroy Lectures.
My own suspicion has all along been that the real primary cause, as distinguished from the secondary
associated organisms, should not be regarded as ubiquitous.
Tuberculosis mortality and racial susceptibility.
A paper entitled The Mortality of Race Stocks in Pennsylvania and New York, 1910, by L. I.
Dublin and C. W. Baker (American Statistical Association, March, 1920), throws further light from a newpoint
of view upon some of the questions reviewed in the preceding discussion. Mr. Dublin had already
published (Amer. Economic Review, Sept., 1916) a similar enquiry with regard to New York State, and
this is extended in the present enquiry to Pennsylvania. Great diversity was found among the immigrant
peoples in the earlier enquiry. The Russians (mainly Jews) and the Italians showed low death rates ;
Irish and Germans very high rates, " especially from the tuberculous and the so-called degenerative
diseases." The later enquiry confirms and amplifies the conclusions of the former.
In the first instance the death rates are composed of (A) the native-born of native parentage ;
(B) the native-born of foreign or mixed parentage; and (C) the foreign-born. At the youngest ages
there are but few foreign-born, and the figures are unreliable. " But beginning with age 20 and continuing
throughout the rest of life the rates for the native-born of native parentage are decidedly the lowest
of the three groups, the only exception being among the foreign-born females in New York ages 20-24 ; the
advantage, moreover, of the native stock becomes greater with advancing age. A comparison of the
two branches of the foreign slock shows a remarkable similarity in the death rates from age 10 onward.
The one striking exception is at the ages 25-44, during which period the foreign-born males have very much
lower death rates than the native-born of foreign parentage." Thus from 20-44 the foreign-born of both
sexes show to much less disadvantage than at higher ages; at 25-44 the immigrant men show lower
rates than the native-born of foreign parentage, and at 20-24 the immigrant women actually show lower
rates than the native-born. In general, Pennsylvania compares favourably with New York, but foreignborn
males 15—44 constitute an exception to this rule, there being exceptional "hazards in mines and
mills which are more serious in Pennsylvania than in New York." There is thus clear indication that
the young adults and those of early middle-age belonging to the newly arriving foreign stocks have
considerable resisting powers to disease, but a like deduction cannot be drawn for those at higher ages;
this suggests further enquiry. Before referring to this question, however, the figures for immigrants from
the six main contributing countries may be examined. In the following table an analysis is made of the
facts as to these six countries :—
Date at which extent
of immigration became
marked.
Whether rates better
(†) or worse (—) than
those of
Country
of
origin.
New
York.
Pennsylvania.
Comparison with phthisis rates in
America.
Austro-Hungary About 1890 + 0 — Rates low for phthisis in both
sexes at 20—44.
Groups in which foreign- Russian mn Do. ? + — Do. Do.
ers compare on the Italian Do. O + — Rates low for men up to 60,
whole favourably with for high in young women,
the natives males
25-44
German From 1850onwards — — — Pulmonary and degenerative
but a falling off of diseases largely responsible
late years for high rates (German
women not so as regards
Groups in which foreign- phthisis.)
ers compare unfavour- British From 1850, falling —† —† —† Special stress is laid upon pneuably
with the natives. of of late years monia, cancer and Bright's
disease ; but the phthisis
rates are also high.
Irish From 1850, falling — — — Pulmonary tuberculosis very
off of late years high.
Statement made that "It is difficult to understand thi9 condition of unfavourtble mortality in view of the fact
that the rates for the British in their own country are among the most favourable in Europe."
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