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Tuberculosis in New York City
July-August
~27
TUBERCLE
i945
Tuberculosis in New York City modified to bring about the fall in mortality, but the soil which it is attacking; the soil is represented by the negro race and the social conditions under which it lives in New York City to-day. When the white race lived under similar conditions eighty years~ ago in England the agedistribution of the mortality from tuberculosis was similar. Here, we see, in New Yor,~ City, at the same time, the infection of tuberculosis producing mortality rates with such diverse age-distribution among two separate parts of the same community; a diversity so pronounced as to have led Brownlee to ask whether there were not more than one strain of human tuberculosis, each of which attacked at a different age-period. Clearly, then, our control of tuberculosis does not rest with control of the bacillus, but with control of the soil, i.e. with improved social conditions which are reflected in the extended expectation of life as compared with eighty years ago. During the period x939-43 there were 6, io 4 female deaths in New York City and z2,214 male deaths, with death-rates of 32 and 66 respectively. Household contacts of tuberculous cases examined in I943 numbered ~6,485 and 3 per cent were found tuberculous. The annual total of deaths due to tuberculosis during the years was 3,664; the number of hospital and sanatoria beds available was about Io,ooo which would not appear to have been used to full capacity. The average lengt~ of stay of cases in institutions was 17o days. A comparison is instituted to establish that in the five-year period I939-43 tuberculosis caused far more deaths in the States than had the war up to mid-October, i944, the figures being 295,I53 as against io6,353. In certain countries the tuberculosis death-rates in i943 per IOO,OOO population w e r e : United States . . . . 41"9
TUBERCULOSIS REFERENCE STATISTICAL Y E A R B O O K . Year 1943 with Comparative Summaries for I942 , and Five-Year period 1939-i943. New York Tuberculosis and Health Association, i944 . This mimeographed report contains a wealth of statistical material relative to the campaign against tuberculosis in New York City, the whole being prefaced by a useful summary from the able pen of G. J. Drolet, which stresses the main facts. The mortality from tuberculosis in the City rose slightly in I943; it was, as usual, much higher among the coloured population than among the white, at I88 per ioo,ooo population as against 38. But against this increase in mortality, a fall took place in the number of new cases registered. The position is thus exactly opposite to that prevailing in England recently. The disease, as indicated by new cases and by mortality rates, was far more prevalent in the Lower West Side of Manhattan and in Central Harlem (which correspond with the East End of London) than in the Flatbush and Gravesend sections of Brooklyn (which correspond with the West End). The death-rates over the five-year period I939-1943 were 212 in Central Harlem and 22 and 2I in the Brooklyn districts; the distribution of the negro population largely determines such wide differences, as negroes suffer far more than do whites. This fact, as well as the uneven age-distribution of tuberculous mortality, differing for each race and for the two sexes, is shown in the accompanying graph; here, the curve for the male negro closely resembles in shape that for white males in England and Wales in the middle of last century (originally pointed out by Brownlee). The early adult apex is well shown by the curve for the negro female; it still lingers for females in this country, but at a much lower level. A second apex, seen in late middle life for the male negro and the white male, prevails to-day for white males in this country, and this now represents the last redoubt for tuberculosis. This graph clearly show that it is not the virulence of the disease which has been
Canada . . . . . . England and Wales Scotland . . . . . .
52" 5 .. 6I" 9 79" z
TUBERCULOSIS DEATH-RATES ACCORDING TO AGE, SEX AND COLOUR N E W YORK CITY, ANNUAL AVERAGE, F I v E - Y E A R PERIOD I 9 3 9 - 4 3 Ra%e per
I00,000 Each Age
~ m m ~ l ' a ~amm
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'eD~176176 'eD~
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-in-9
9 emee p~176
9 era.e 9 J o p 9
0 ABe:-
Oeseesed 4mtoel
I
0-4
5-9
10-14 15-19 20-24
25-34
35-44
45-54
55..~
I
05-?4
75
~27
TUBERCLE
i945
Tuberculosis in New York City modified to bring about the fall in mortality, but the soil which it is attacking; the soil is represented by the negro race and the social conditions under which it lives in New York City to-day. When the white race lived under similar conditions eighty years~ ago in England the agedistribution of the mortality from tuberculosis was similar. Here, we see, in New Yor,~ City, at the same time, the infection of tuberculosis producing mortality rates with such diverse age-distribution among two separate parts of the same community; a diversity so pronounced as to have led Brownlee to ask whether there were not more than one strain of human tuberculosis, each of which attacked at a different age-period. Clearly, then, our control of tuberculosis does not rest with control of the bacillus, but with control of the soil, i.e. with improved social conditions which are reflected in the extended expectation of life as compared with eighty years ago. During the period x939-43 there were 6, io 4 female deaths in New York City and z2,214 male deaths, with death-rates of 32 and 66 respectively. Household contacts of tuberculous cases examined in I943 numbered ~6,485 and 3 per cent were found tuberculous. The annual total of deaths due to tuberculosis during the years was 3,664; the number of hospital and sanatoria beds available was about Io,ooo which would not appear to have been used to full capacity. The average lengt~ of stay of cases in institutions was 17o days. A comparison is instituted to establish that in the five-year period I939-43 tuberculosis caused far more deaths in the States than had the war up to mid-October, i944, the figures being 295,I53 as against io6,353. In certain countries the tuberculosis death-rates in i943 per IOO,OOO population w e r e : United States . . . . 41"9
TUBERCULOSIS REFERENCE STATISTICAL Y E A R B O O K . Year 1943 with Comparative Summaries for I942 , and Five-Year period 1939-i943. New York Tuberculosis and Health Association, i944 . This mimeographed report contains a wealth of statistical material relative to the campaign against tuberculosis in New York City, the whole being prefaced by a useful summary from the able pen of G. J. Drolet, which stresses the main facts. The mortality from tuberculosis in the City rose slightly in I943; it was, as usual, much higher among the coloured population than among the white, at I88 per ioo,ooo population as against 38. But against this increase in mortality, a fall took place in the number of new cases registered. The position is thus exactly opposite to that prevailing in England recently. The disease, as indicated by new cases and by mortality rates, was far more prevalent in the Lower West Side of Manhattan and in Central Harlem (which correspond with the East End of London) than in the Flatbush and Gravesend sections of Brooklyn (which correspond with the West End). The death-rates over the five-year period I939-1943 were 212 in Central Harlem and 22 and 2I in the Brooklyn districts; the distribution of the negro population largely determines such wide differences, as negroes suffer far more than do whites. This fact, as well as the uneven age-distribution of tuberculous mortality, differing for each race and for the two sexes, is shown in the accompanying graph; here, the curve for the male negro closely resembles in shape that for white males in England and Wales in the middle of last century (originally pointed out by Brownlee). The early adult apex is well shown by the curve for the negro female; it still lingers for females in this country, but at a much lower level. A second apex, seen in late middle life for the male negro and the white male, prevails to-day for white males in this country, and this now represents the last redoubt for tuberculosis. This graph clearly show that it is not the virulence of the disease which has been
Canada . . . . . . England and Wales Scotland . . . . . .
52" 5 .. 6I" 9 79" z
TUBERCULOSIS DEATH-RATES ACCORDING TO AGE, SEX AND COLOUR N E W YORK CITY, ANNUAL AVERAGE, F I v E - Y E A R PERIOD I 9 3 9 - 4 3 Ra%e per
I00,000 Each Age
~ m m ~ l ' a ~amm
m b ~
lul
/ I/
% \ 9
:/ : I
~oo
%
".
% %
m
:I
~9
I
'e %
fl
".
:i io0
~ema] e
'eD~176176 'eD~
:~
le~ J~ lie Io
ee
-in-9
9 emee p~176
9 era.e 9 J o p 9
0 ABe:-
Oeseesed 4mtoel
I
0-4
5-9
10-14 15-19 20-24
25-34
35-44
45-54
55..~
I
05-?4
75