the Week of Proper 3 / Ordinary 8
Tuberculosis Death-Rate of New York City
1911 Encyclopedia Britannica
"TUBERCULOSIS * DEATH-RATE OF NEW YORK CITY AND OF THE United States* 1900 To 1920 * All forms of tuberculosis. t U.S. Registration area which in Iwo included 82% of the population or 87,486,713 inhabitants. G. J. Statistician New York Tuberculosis Association.
The registration of deaths became more exact and complete.
A consideration of the conditions described on page 358 of Vol.
XXVII. as being widespread late in the 19th century shows how much registration had been needed. Registration, the creation of state, not Federal, legislation was provided for only gradually by the necessary state laws. In 1910 the Registration Area of the United States covered 58.3% of the population; by 1920 nearly three-fourths of the states, with about 80% of the population of the country. The fact, therefore, that the tuberculosis death-rate shows a marked decline at the same time that the reporting of deaths has come under better control accentuates the great improvement. As has always been the case, pulmonary tuberculosis accounts for about seven-eighths of the deaths from tuberculosis of all forms. In 1920 the rate (pulmonary tuberculosis) for large cities ranged from 54 per 100,000 for Portland, Oregon, to 281 for Denver, to which city many tuberculosis patients have resorted. Chicago's rate was 83 and Philadelphia's 121; Boston's was 126, the same as that of New York City.
The decline in mortality was due to many factors, which in 1921 could not be formulated and estimated. The influenza epidemic played its part, but in a manner not definitely understood. The great wave of this disease swept the country in the autumn of 1918. It is significant that for the first time on record there was in that year a marked autumnal increase of tuberculosis deaths above the normal. For example, in Oct. 1917, the deaths from tuberculosis in New York State were 1,089, a rate of 122.2. This was an average incidence which had been maintained for years. In Oct. 1918, the month of the influenza epidemic, 1,520 deaths from tuberculosis were reported - an increase of about 50%. Oct. 1919 showed only 813 deaths, and Oct. 1920 726 deaths. It is conceivable that influenza carried off thousands of consumptives who would have contributed to the tuberculosis mortality later; and, that these potential deaths for later years, thus compressed into 1918, reduced the rate during the succeeding years. Nevertheless, influenza can have been only one of several or many factors. Economic and social movements played their part. It seems certain that tuberculosis to no small extent has yielded to the remarkable organized efforts directed against it in the United States.
The keynote of the American struggle against the disease has been organization. Founded in 1904, the National Tuberculosis Association developed into probably the most effective public health body in the United States. With its subsidiary state and local societies it reaches into every hamlet. Few men and women, interested actively in tuberculosis, are working otherwise than in connexion with the National Association. Perhaps its greatest achievement is that it calls the attention of a vast proportion of the population to tuberculosis and educates them in it through its unique way of raising funds to carry on its work. Every year, during the month of Dec. its subsidiary societies sell, at one cent each, stamps called Christmas seals, which may be used (not as postage) to fasten and embellish envelopes. Their sale in 1921 had reached the enormous yearly total of more than 500,000,000 and yielded more than $4,000,000 for the work of the Association.
The elements of the routine treatment of tuberculosis changed but little during 1910-20, but therapeutic resources expanded greatly. In 1920 there were more than 600 sanatoria for the treatment of pulmonary tuberculosis in the United States. These were maintained by states, cities, counties, private individuals and corporations, and by endowments. Under N.Y. State law every county must erect and maintain an institution for the care of its tuberculous population. Some trade unions and fraternal organizations established sanatoria for their members. The Metropolitan Life Insurance Co. of New York built for its employees one of the best sanatoria in the country. The trend away from sanatorium treatment which is to be observed on the continent of Europe has not been manifest in the United States. Artificial pneumothorax is the only surgical measure which has gained anything like a vogue: American observers are unanimous as to its usefulness in selected cases. Heliotherapy and phototherapy for surgical tuberculosis were used, but only sporadically, and very few reports as to their results appeared in American medical literature. Chemotherapy was under extensive experimentation at the Phipps Institute in Philadelphia and at the University of Chicago: results have not warranted its application to human tuberculosis. Tuberculin treatment is practised with more discrimination than formerly.
The decade was notable for the use and development of the X-ray in the diagnosis of pulmonary tuberculosis. As an aid to diagnosis it became indispensable in routine tuberculosis practice. It is the better American opinion that the roentgenologist must work hand in hand with the practitioner and that good diagnostic judgment is attained only by the proper analysis and evaluation of information yielded by physical examination, laboratory procedures and X-ray observation together: no single one of these will alone suffice in routine diagnosis. Diagnosis of tuberculosis by tuberculin was practically abandoned, few cases having proved amenable to this method.
The practitioner of 1920 regarded tuberculosis from a point of view quite different from that of 1910. The relatively recent disclosure that tuberculosis exists as a latent infection in almost all people and that infection confers a measure of specific immunity to reinfection gave rise to the almost necessary presumption that adult pulmonary tuberculosis develops from infection acquired in childhood and that the adult is insusceptible to exposure to infection from without. By 1915 this opinion had become almost a dogma. But during 1918-20 opinion became less positive; an increasing number of studies by American authorities showed that conditions are only relative. Although early infection and immunity therefrom are conceded, it is maintained that infection is capable of complete healing and that immunity may greatly diminish or even disappear; and that, therefore, there is every likelihood that reinfections - and active disease from them - are possible at any period of life.
too 0 250 ' '200 ' 'ISO - 1913f1914)915[ ' The study of tuberculosis and medical education in connexion with it received a great impetus from several directions. The Phipps Institute at Philadelphia was established at the opening of the decade; a tuberculosis research laboratory at Johns Hopkins University in 1916; and one in connexion with the National Jewish Hospital for Consumptives at Denver in 1918. Edward L. Trudeau, the recognized pioneer and leader of tuberculosis activities in the United States, died in 1915. During the last year of his life there was planned the Trudeau School of Tuberculosis, the first of its kind, to give systematic instruction to physicians. This held its first session at Saranac Lake, N.Y., in 1916, and was so successful that several others were established in other parts of the country. As a memorial to Trudeau, funds were raised to establish the Edward L. Trudeau Foundation, which aims to carry on research work and the Trudeau School and assist in the administration of the Trudeau Sanatorium. In 1916 The American Review of Tuberculosis, a monthly scientific periodical, was founded by the National Tuberculosis Association. It was in 1921 the only tuberculosis journal in the United States and had done much to stimulate the study and investigation of the subject.
Perhaps the most significant and unique achievement of the period was the Framingham (Mass.) Health and Tuberculosis Demonstration. Supported by the Metropolitan Life Insurance Company and the National Tuberculosis Association, this agency undertook a tuberculosis survey of a community of 15,000 people, to extend through six years. The work began in 1916. By 1920 the greater part of the population had been studied in its medical, economic and sociological relations. The survey established many facts, which seemed likely to serve as important data upon which future campaigns against tuberculosis might be based. Between 1916 and 1920 the tuberculosis death-rate of the community fell from 121.5 to 64.5 per 100,000. At the same time it was shown that the ratio of active cases to deaths was 9 or 10 to 1, instead of 3 to 1, the ratio which records of the community had previously shown. The survey supplied standards of diagnosis and treatment, of case detection, of school, factory and home control, of necessary expenditures against tuberculosis, etc., which promised to be of service not only to the whole nation but to the world at large.
(A. K. K.)
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Chisholm, Hugh, General Editor. Entry for 'Tuberculosis Death-Rate of New York City'. 1911 Encyclopedia Britanica. https://www.studylight.org/​encyclopedias/​eng/​bri/​t/tuberculosis---death-rate-of-new-york-city.html. 1910.