This decline of the tuberculosis death-rate is, of course, only a part of the general improvement of physique which is taking place under civilization. If we could only get out from under the influence of the "good old times" obsession and open our eyes to see what is going on about us! There is nothing mysterious about it. The soundest of physical grounds for improving health can be seen on every hand. We point with horror, and rightly, to the slum tenement house, but forget that it is a more sanitary human habitation than even the houses of the nobility in the Elizabethan age. We become almost hysterical over the prospect that the very fibre of the race is to be rotted by the adulteration of our food-supply, by oleomargarine in the butter, by boric acid in our canned meats, by glucose in our sugar, and aniline dyes in our candies, but forget that all these things represent extravagant luxuries unheard of upon the tables of any but the nobility until within the past two hundred, and in some cases, one hundred, years. Up to three hundred years ago even the most highly civilized countries of Europe were subject to periodic attacks of famine; our armies and navies were swept and decimated with scurvy, from bad and rotten food-supplies; almost every winter saw epidemics breaking out from the use of half-putrid salted and cured foods; only forty years ago, a careful investigation of one of our most conservative sociologists led him to the conclusion that in Great Britain thirty per cent of the population never in all their lives had quite as much as they could eat, and for five months out of the year were never comfortably warm. The invention of steam, with its swift and cheap transportation of food-supplies, putting every part of the earth under tribute for our tables, meat every day instead of once a week for the workingman, and the introduction of sugar in cheap and abundant form, with the development of the dietary in fruits and cereals which this has made possible, have done more to improve the resisting power and build up the physique of the mass of the population in our civilized communities, than ten centuries of congestion and nerve-worry could do to break it down.
We shake our heads, and prate fatuously that "there were giants in those days," ignorant of the thoroughly attested fact, that the average stature of the European races has increased some four inches since the days of the Crusaders, as shown by the fact that the common British soldier of to-day—Mr. Kipling's renowned "Tommy Atkins," who is looked upon by the classes above him in the social scale as a short, undersized sort of person—can neither fit his chest and shoulders into their armor, get his hands comfortably on the hilts of their famous two-handed swords, nor even lie down in their coffins.
We are at last coming to acknowledge with our lips, although we scarcely dare yet to believe it in our heart of hearts, that not merely the death-rate from tuberculosis, but the general death-rate from all causes in civilized communities, is steadily and constantly declining; that the average longevity has increased nearly ten years within the memory of most of us, chiefly by the enormous reduction in the mortality from infant diseases; and that, though the number of individuals in the community who attain a great or notable age is possibly not increasing, the percentage of those who live out their full, active life, play their man's or woman's part in the world, and leave a group of properly fed, vigorous, well-trained, and educated children behind them to carry on the work of the race, is far greater than ever before. Even in our much-denounced industrial conditions, made possible by the discovery of steam with its machinery and transportation, the gain has far exceeded the loss. While machinery has made the laborer's task more monotonous and more confining, the net result has been that it has shortened his hours and increased his efficiency.
Even more important, it has increased his intelligence by demanding and furnishing a premium for higher degrees of it. Naturally, one of the first uses which he has made of his increased intelligence has been to demand better wages and to combine for the enforcement of his demands. The premium placed upon intelligence has led both the broader-minded, more progressive, and more humane among employers, and the more intelligent among employees, to recognize the commercial value of health, and of sanitary surroundings, comfort, and healthy recreations, as a means of promoting this. The combined results of these forces are seen in the incontestable, living fact that the death-rate from tuberculosis among intelligent artisans and in well-regulated factory suburbs is already below that of many classes of outdoor and even farm laborers, whose day is from twelve to fourteen hours, and whose children are worked, and often overworked, from the time that they can fairly walk alone, with as disastrous and stunting results as can be found in any mine or factory. Child-labor is one of the oldest of our racial evils, instead of, as we often imagine, the newest.
All over the civilized world to-day the average general death-rate of each city, slums included, is now below that of many rural districts in the same country. If I were to be asked to name the one factor which had done more than any other to check the spread and diminish the death-rate from tuberculosis I should unhesitatingly say, the marked increase of wages among the great producing masses of the country, with the consequent increased abundance of food, better houses, better sanitary surroundings, and last, but not least, shorter hours of labor.
Underfeeding and overwork are responsible for more deaths from tuberculosis than any other ten factors. Rest and abundant feeding are the only known means for its cure.
This is one of the reasons why the medical profession has abandoned all thought of endeavoring to fight the disease single-handed, and is striving and straining every nerve to enlist the whole community in the fight. Its burden rests, not upon the unfortunate individual who has become tuberculous, but upon the community which, by its ignorance, its selfishness, and its greed, has done much to make him so. What civilization has caused it is under the most solemn obligation to cure.
One more brigade of irregular troops on the extreme left remains to be briefly reviewed, and that is those forces resulting from the successive exposure of generations to the physical influences of civilization, including the infectious diseases. For years we never dreamed of even attempting to raise any levies among these border tribes of more than doubtful loyalty. Indeed, they were supposed to be our open enemies.
When we first attempted to take a world-view of tuberculosis, the first great fact that stood out plainly was that it was emphatically a disease of the walled town and the city; that the savage and the nomad barbarian were practically free from it; that range cattle and barnyard fowls seldom fell victims to it, while their housed and confined cousins in the dairy barn and the breeding-pens suffered frightfully. It was one of our commonplace sayings that we must "get back to nature," get away from the walled city into the open country, revert from the conditions of civilization in a considerable degree to those of barbarism, in order to escape. While, as for heredity, its influence was almost dead against us. How could a race be exposed to a disease like tuberculosis, generation after generation, without having its vital resistance impaired?