Of a group of men picked at random from the population, why will some eventually die of tuberculosis and the others resist infection? Is it a matter of environment?—are open-air schools, sanitary tenements, proper hygiene, the kind of measures that will change this condition? Such is the doctrine widely preached at the present day. It is alleged that the white plague may be stamped out, if the open cases of tuberculosis are isolated and the rest of the population is taught how to live properly. The problem is almost universally declared to be a problem of infection.
Infection certainly is the immediate problem, but the biologist sees a greater one a little farther back. It is the problem of natural selection.
To prove this, it is necessary to prove (1) that some people are born with less resistance to tuberculosis than others and (2) that it is these people with weak natural resistance who die of phthisis, while their neighbors with stronger resistance survive. The proof of these propositions has been abundantly given by Karl Pearson, G. Archdall Reid and others. Their main points may be indicated. In the first place it must be shown that the morbidity from tuberculosis is largely due to heredity—a point on which most medical men are still uninformed. Measurement of the direct correlation between phthisis in parent and child shows it to be about .5, i. e., what one expects if it is a matter of heredity. This is the coefficient for most physical and mental characters: it is the coefficient for such pathological traits as deafness and insanity, which are obviously due in most cases to inheritance rather than infection.
But, one objects, this high correlation between parent and child does not prove inheritance,—it obviously proves infection. The family relations are so intimate that it is folly to overlook this factor in the spread of the disease.
Very well, Professor Pearson replied, if the relations between parent and child are so intimate that they lead to infection, they are certainly not less intimate between husband and wife, and there ought to be just as much infection in this relationship as in the former. The correlation was measured in thousands of cases and was found to lie around .25, being lowest in the poorer classes and highest in the well-to-do classes.
At first glance this seems partly to confirm the objection—it looks as if there must be a considerable amount of tubercular infection between husband and wife. But when it is found that the resemblance between husband and wife in the matter of insanity is also .25, the objection becomes less formidable. Certainly it will hardly be argued that one of the partners infects the other with this disability.
As a fact, a correlation of .25 between husband and wife, for tuberculosis, is only partly due to infection. What it does mean is that like tends to mate with like—called assortative mating. This coefficient of resemblance between husband and wife in regard to phthisis is about the same as the correlation of resemblance between husband and wife for eye color, stature, longevity, general health, truthfulness, tone of voice, and many other characters. No one will suppose that life partners "infect" each other in these respects. Certainly no one will claim that a man deliberately selects a wife on the basis of resemblance to himself in these points; but he most certainly does so to some extent unconsciously, as will be described at greater length in Chapter XI. Assortative mating is a well-established fact, and there is every reason to believe that much of the resemblance between husband and wife as regards tuberculosis is due to this fact, and not to infection.[59]
Again, it is objected that the infection of children is not a family matter, but due to tuberculous cows' milk: how then does it appear equally among the Japanese, where cows are not tuberculous and cow's milk rarely used as an infant food: or among such people as the Esquimaux and Polynesians, who have never seen a cow?
But, it is argued, at any rate bad housing and unsanitary conditions of life will make infection easier and lower the resistance of the individual. Perhaps such conditions may make infection easier, but that is of little importance considering how easy it is for all city dwellers—for the population as a whole. The question remains, will not bad housing cause a greater liability to fatal phthisis? Will not destitution and its attendant conditions increase the probability that a given individual will succumb to the white plague?
Most physicians think this to be the case, but they have not taken the pains to measure the respective rôles, by the exact methods of modern science. S. Adolphus Knopf of New York, an authority on tuberculosis, recognizes the importance of the heredity factor, but says that after this, the most important predisposing conditions are of the nature of unsanitary schools, unsanitary tenements, unsanitary factories and workshops. This may be very true; these conditions may follow after heredity in importance—but how near do they follow? That is a matter capable of fairly accurate measurement, and should be discussed with figures, not generalities.