DIAGRAM 1. SHOWING RELATIVE PREVALENCE OF THE NINE MOST PROMINENT CAUSES OF DEATH FOR YEARS 1885-1888, INCLUSIVE.

the contagious diseases, its real importance is revealed in a much more startling manner. Diagram No. 2 shows the number of

DIAGRAM 2.

SHOWING NUMBER OF DECEDENTS FROM NINE CONTAGIOUS DISEASES FOR THE YEARS 1884-1888 INCLUSIVE.

deaths in this State from nine contagious diseases during the five years ending with 1888. Consumption heads the list with a total of 4,039 deaths, diphtheria follows with 983, less than one fourth as many as consumption, while small-pox, a disease terribly feared by the public and a single case of which produces widespread alarm, is charged with only two deaths during the same period, a number far too small to be represented in the diagram. This diagram alone is sufficient to show the ignorance that exists regarding the relative danger to life from the contagious diseases.

Small-pox, through the beneficent means of vaccination, has been robbed of its terrors, and in the table given rates with

mumps; yet a single case of the former disease causes more general alarm than the loss of a thousand lives from consumption. While such opinions are entertained by the public, in opposition to facts proven by accurate registration of deaths, it is evident that prevailing sentiments and notions must be corrected before due attention will be given to legitimate and proper measures for the restriction and prevention of consumption, diphtheria, and typhoid fever.

The effect of preventive measures has already been made manifest in a marked degree, in the relatively low death rate from scarlatina compared with what it formerly was. The death-rate from consumption should also be reduced so that within a single decade the deaths from this cause should be materially reduced, and in one generation it should be at least one half less than it is

now.

Diagrams Nos. 3 and 4 are given for the purpose of disproving the very erroneous idea prevailing in regard to the time of life at which persons are most subject to the disease. Diagram No. 3 is made up from the death returns in this State for a period of five years, from 1884 to 1888 inclusive, and includes 4,039 deaths; while diagram No. 4 is based upon the Massachusetts returns for a period of fifteen years ending with 1887, and embraces a total of 132,384 deaths from consumption. The similarity of the two diagrams is very striking, and they are worthy

DIAGRAM 3.
SHOWING DEATH RATE FROM CONSUMPTION IN NEW
HAMPSHIRE PER 10,000 OF THE POPULATION LIVING AT EACH AGE
PERIOD, FOR THE YEARS 1884-1888 INCLUSIVE.

DIAGRAM 4. SHOWING DEATH RATE FROM CONSUMPTION IN MASSACHU SETTS PER 10,000 OF THE POPULATION LIVING AT EACH AGE PERIOD FOR THE YEARS 1863-1887 INCLUSIVE.

of consideration. The slight variations can readily be explained by conditions, social and otherwise, affecting the population, but that there is a definite law governing the mortality in certain age periods, is very evident from the diagrams given.

There is a very generally accepted belief that there is a greater susceptibility to consumption between the ages of twenty and thirty than at any other period of life. It is true that there are a greater number of deaths from consumption during this age period than at any other time of life, because the living population is correspondingly greater; but that there is any greater liability to the infection of the disease, so far as the individual is concerned, is not true. In this State the highest rate of mortality from consumption, based upon the living population of the several age periods, is from eighty years upwards, while in Massachusetts the highest rate occurs between the seventieth and eightieth years.

The diagrams also very forcibly illustrate the very slight susceptibility to the disease that exists between the ages of five and fifteen. It will therefore be seen that a person is not, during his entire lifetime, exempt from a liability to the disease; and, also, that the age period during which there is the greatest mortality from consumption does not necessarily present the highest death rate from the disease. Persons who assert that they have

passed the "consumptive period of life," have no true knowledge of the history of the disease, but have probably formed this opinion from observing that a greater number of deaths from consumption occur between the ages of twenty and thirty than at any other age of life, without taking into consideration the much greater population at that age period.

The preceding diagrams are presented for the purpose of illustrating as accurately and as vividly as possible the following points: 1. The widespread prevalence of pulmonary consumption, and 2. Its liability to appear at any age of human life.

With all the facts and figures that have been presented, it should be ineffaceably impressed upon the mind that pulmonary consumption is a preventable disease, and that with the observance of the simplest sanitary measures, which are now known to be sufficient to restrict the disease, hundreds of families have it in their power to save lives that under the prevailing sanitary neglect are inevitably doomed to this disease. State and local boards of health are, by circulars and through the public press, earnestly endeavoring to diffuse accurate information regarding preventive methods to be employed. The measures recommended are simple, and need only to be carried out with minute attention to details in order to be effective.

The following circular upon the prevention of pulmonary consumption was recently issued by the State Board of Health of Maine, and while not materially differing from instructions issued by other boards, is to be heartily commended to the public:

That insidious disease which we call consumption, phthisis, or tuberculosis of the lungs, is the most terrible destroyer of lives with which civilization has to contend. Centuries ago consumption was regarded as an infectious disease, in Southern Europe, and extravagantly rigorous laws were in existence regulating communication with consumptive patients. At the present time the fact of the infectiousness of consumption is firmly established in a scientific way, and enough is known of the natural history of the infective agent, the bacillus of tuberculosis, and of the ways in which it is communicated to man, to enable us to lay down rules with more positiveness than hitherto for the prevention of the disease.

The source of infection is twofold: from tuberculous animals to man, and from one human being to another. The tuberculosis of animals and human consumption are of the same nature. From domestic animals there is danger of contracting the disease by the use of flesh, and especially by the use of milk

rom those which are tuberculous. Many children die in their earlier years from various tubercular diseases, tubercular inflammation of the brain, "consumption of the bowels," etc., and it is now assumed, with much probability, that the great majority of these die from infection received in the milk from tuberculous cows, or in that from mothers suffering from tuberculosis in some form. By far the greatest source of infection, however, is consumptive human beings; but, fortunately, the ways in which the contagion is disseminated are but few, and by intelligent care they may be effectually controlled.

Practically, from the human source, we may consider the expectoration (the sputum) as the only serious danger. The consumptive sputum usually contains an abundance of the infection, the bacilli, and these microscopic organisms are found to be capable of retaining their vitality and their infectious qualities for a long while, even after the sputum has been thoroughly dried.

It has long been known that tuberculosis may be communicated to animals experimentally by feeding them with tuberculous matter, by injecting it into their tissues, or by causing them to breathe air into which tuberculous sputum had been atomized. More recently, since the discovery of the bacillus tuberculosis, it has been found that the bacilli may be cultivated upon artificial media, and that when thus cultivated and free from all other matter which might possibly be infective, tuberculosis may still be communicated to animals in the ways which have been mentioned above, and with great certainty.

Experiments, the conclusions from which can hardly be questioned, have shown that the breath of the consumptive patient is not infectious, and that the same may be said of the sputum as long as it remains moist. Another line of investigation has proved that the careless consumptive patient is a focus of infection, and a danger to all persons who come much in proximity to him, especially to those who dwell in the same rooms with him. The reason of this is that the expectoration of the patient spit upon floors, carpets, pocket handkerchiefs, or clothing, becomes dried and pulverized, and, floated in the air, still contains the infectious germs, and cannot be inhaled without great danger.

Though infection may be regarded as the principal, the essential cause of consumption, there are, nevertheless, various untoward influences which have much to do with increasing the death rate from this disease, and should never be disregarded. The most important of these are the breathing of impure air, particularly that of unventilated sleeping-rooms and living-rooms, the use of food not sufficiently nutritious, and dwelling upon a soil which is damp. How far heredity is a cause of consumption is, from the nature of the question, hard to determine. Since the infectiousness of the disease has been shown, many family groups of consumption, "house epidemics," may fairly be assumed to be from infection rather than from hereditary influence. Some able writers would discard heredity as one of the causes of tuberculous disease; but others, more conservative in their views, while believing that direct inheritance is rare, think that certain peculiarities of constitution, favoring susceptibility, are transmissible from parent to child.