QUOTE : Far more potently than any miracle medicine, relatively uncelebrated shifts in civic arrangements--better nutrition, housing, and sanitation, improved sewage systems and ventilation--had driven TB mortality down in Europe and America. Polio and smallpox had also dwindles as a result of vaccinations. Cains wrote, "The death rates from malaria, cholera, typhus, tuberculosis, scurvy, pellagra, and other scourges of the past have dwindled in the US because humankind has learned how to prevent these diseases.... To put most of the effort into treatment is to deny all precedent.