Apply these figures to the country. The Bureau of the Census indicates 150,000 deaths a year. On this basis we have 1,200,000 living cases of tuberculosis. Let us not forget, however, that 150,000 recorded deaths is far below the actual number, for it is easy to show in most of our communities that many deaths properly to be assigned to tuberculosis are reported under other terms, and the area of the United States from which no statistics are forthcoming includes precisely those States where the mortality is high and the prevalence of tuberculosis demonstrably widespread. We are still absolutely certain that the mortality from this disease is at least 200,000 each year, and the number of living active cases more than a million and a half.
Such, numerically speaking, is our problem. What are the efforts for its solution?
Since the discovery of the bacillus as the cause of this disease in 1882, an organized campaign has gradually been developed. The inferences from the discovery of the cause were perfectly inevitable and indicated the lines of operation. It became entirely clear that tuberculosis, being due to a specific germ, was infectious, and it was equally clear that the bacillus and its life history being known, the disease was theoretically preventable. Here, too, the outlines of the campaign are simple, even though the details of operation are varied and the end in view baffling to attain.
It was inevitable that the first sporadic efforts based upon slight experience should have been more or less random, and that years of trial and proving should precede the establishment of definite method. Some degree of order is, however, emerging, and we are witnessing an increasing clearness of purpose and definition of attack in the preventive movement against tuberculosis which is now sweeping over the country and the civilized world.
While recognizing the unfortunate complexity of the social conditions whose maladjustment is perhaps the chief underlying factor in the problem, while recognizing fully the obligation to lend all possible aid to the betterment of those conditions, the administration of the campaign against tuberculosis has still conceived its specific task to be a direct attack on the sources of infection; this, because experience has indicated such procedure to be the best and most feasible means of prevention. As the logical conclusions of laboratory discovery and clinical experience began to express themselves in organized movement, it was recognized that the preliminary task in prevention was one of education; an education which should impress upon the public mind not only the fundamental facts that tuberculosis is infectious and preventable and the methods of its infection and prevention, but an education that should bring about an improved knowledge of public and private hygiene, and particularly an education which should create a public sentiment which could appreciate conditions and would support and even demand those measures which expert advice and experience might indicate as necessary. This educational propaganda, now so familiar, has been in the United States the particular province of private organization. The union of professional and lay effort in this latter day crusade has been one of the most inspiring of social phenomena and has already resulted in accomplishments of imposing dimensions.
With our political organization such as it is, this enlightened public sentiment is an absolute essential if the responsibility for the situation is to be an official one, and not left for the suggestive and stimulating but less final and efficient efforts of private philanthropy.
The insistence upon official responsibility has been made an essential point in our American campaign and toward its intelligent acceptance by public authorities all efforts are directed. As may well be appreciated, the attainment of this desired end is slow, even though ultimately inevitable.
In planning the campaign, an ideal program was not difficult to lay down. It included as fundamental:
1. The education of which I have spoken, not only as it applies to tuberculosis but as contributing to the solution of that problem of misery which is, after all, the chief problem of the day and which reduces in the last instance largely to terms of good or ill health.
2. Enactment or enforcement of protective laws of which the basis was that notification and registration agreed upon as preliminary to official knowledge and control of the situation.