increasing amounts to stimulate the flagging energies, thus making a bad matter worse. Some who contract the disease in this way have occupations directly conducive to alcoholism, such as workers in the liquor trade, barmen, waiters and hotel servants, people who are thus employed because they are, from their physical and moral make-up, 'unfit' (as the evolutionist might say) for another and a better sort of work.
Poverty, with all that the word implies—underfeeding, deficiency of sunlight, defective ventilation, overcrowding, uncleanliness, bad drainage, rank-smelling and damp-walled houses—stands enormously in a causative relation. There are plenty of data to demonstrate that tuberculosis is preeminently a disease of humanity's submerged strata.
It was estimated in Hamburg, for instance, among the several income tax classes (inclusive of the dependents of the tax-payers) that for incomes of from nine to twelve hundred Marks the death rate from consumption is 55.4; for incomes of from twenty-five to fifty thousand Marks the death rate is 7.5—a proportion against the poorer classes of nearly eight to one.
One may grasp the idea in a glance upon the maps of New York City districts which its Health Board has prepared under the medical directorship of Dr. Herman M. Biggs. By far the greatest number of our consumptives are in the poorer districts; eleven of them, for instance, dying in one year in a house in the 'lung block.' Instructive, too, are the thousand odd photographs which the New York City Tenement House Department has taken during the two years just passed, showing air shafts twelve inches wide and six stories deep; more than 360,000 'dark rooms' whose only means of ventilation, if they have any ventilation at all, is through such air shafts. Enlightening, too, is Mr. Ernest Poole's brochure on 'The Plague in its Stronghold.' Such grim humor as the following may also have illuminative value: Three families occupied an apartment of three rooms, one living in the front room, another in the rear room, the third in the middle room; and they all got along very well together until the family in the middle room wanted to take in boarders.
Besides these predispositions to tuberculosis there are many others. There are the family relations. If one member is consumptive, his sputum may in various ways be infective. It may be spat upon the floor, and if there is an infant, it will, in playing about, pick up bacillus-laden objects and, after the habit of infants, put them in its mouth. Then after weeks or months the child becomes tuberculous. So that on such accounts as these it was formerly considered that the disease itself was of hereditary origin. Then 'neglected colds,' fevers and exhausting diseases, such as typhoid or malaria, enervate the body and make it a fruitful soil for microbic germination. Direct injury,