"It is important to remember that although fast killing epidemic disease was rife among the Victorian poor, a significant number of the diseases which took the most lives were disabling prior to death, sometimes for years. This was true of most occupational diseases, including the first recognized occupational disease, phossey jaw, but was also true of tuberculosis, the biggest killer in Engels lifetime, syphilis, rickets, infantile paralysis, measles, mumps, and rubella, scarlet fever, and many more. TB often takes years to kill, especially if it is outside the lungs, and can inhabit the lungs, bones, spine, or skin. TB in bone causes significant orthopedic disability, requiring the use of braces, crutches, or other mobility aids. Rickets causes disability from early childhood and often resulted in death due to social murder as well as death in childbirth due to the fearfully common ricketic pelvis. Syphilis could cause deformity and children born with congenital syphilis experience orthopedic disability or intellectual disability. The list goes on, so often the killing of the poor happens by first disabling them then using the excuse of eugenics to justify letting disabled people die or actively contributing to their deaths''.