he same states. Instead of centuries of civilization having made us
more susceptible to the disease than those savages who probably most
nearly parallel our ancestral conditions of a thousand to fifteen
hundred years ago, we seem to have acquired from three to five times
their resisting power against it. Not only this, but those races among
us which have been continuous city-dwellers for a score of generations
past have acquired a still higher degree of immunity.

In every civilized land the percentage of deaths from tuberculosis among
the Jews, who, from racial and religious prejudices, have been prisoners
of the Ghetto for centuries, is about half to one-third that of their
Gentile neighbors. In certain blocks of the congested districts of New
York and Chicago, for instance, the Jewish population shows a death-rate
of only one hundred and sixty-three per hundred thousand living, while
the Gentile inhabitants of similar blocks show the appalling rate of
five hundred and sixty-five. Similarly, by a strange apparent paradox,
the highest mortality from tuberculosis in the United States is not in
those states having the greatest urban population, but, on the contrary,
in those having the largest rural population.

The ten highest state tuberculosis death-rates contain the names of
Tennessee, Kentucky, West Virginia, Virginia, and South Carolina, while
New York, Pennsylvania, and Massachusetts are among the lowest.

The subject is far too wide and complicated to admit of any detailed
discussion here. But, explain it as we may, the consoling fact remains
that civilized races, including slum-dwellers, have a distinctly lower
death-rate from tuberculosis than have savage tribes which are exposed
to it even under most favorable climatic and hygienic conditions; that
those races which have survived longest in city and even slum
surroundings have a lower death-rate than the rest of the community
under those conditions; and that certain of our urban populations have
lower death-rates than many of our rural ones.

As for the immediate effect of heredity in the production of the
disease, the general consensus of opinion among thoughtful physicians
and sanitarians now is that direct infection is at least five times as
frequent a factor as is heredity; that at least eight-tenths of the
cases occurring in the children of tuberculous parents are probably due
to the direct communication of the disease, and that if the spread of
the in