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It may be urged that the period is too short for any comparison.
This is quite a matter of opinion ; but as I feel convinced that had the
results been in favour of notification they would have been quoted in
support of such action, I feel quite justified in mentioning them. The
death rates certainly do not, up to the present, show that voluntary
notification or its absence have had any effect on the mortality from the
disease.
Several observers in London have drawn attention to the widespread
prevalence of the tubercle bacillus; it has been found in the sawdust
swept up in public-houses, in railway carriages, eating houses, etc.
Hence, supposing we isolate and assuming that by this means we render
innocuous all cases of phthisis, there will still remain the unrecognised
sufferers; and even if these disappear, it would almost seem Utopian to
expect that all other sources of tubercle bacilli would also be removed.
Having mentioned the seed it now brings me to the second factor
in the spread of tuberculosis, namely, the soil, and as to the importance
of this there can be no question. I have in previous reports called
attention to the fact that a very large number of persons are attacked by
the bacillus and escape, either completely or with very slight lesions.
When from any cause, however, whether hereditary predisposition—which
has been unduly minimised of recent years —exposure, and especially the
combination of alcoholic excess and insufficient food, the system becomes
so altered in resistive power as to form a suitable culture-medium for the
bacillus, then phthisis declares itself. Under suitable conditions it may
be cured, but under unsuitable conditions it will progress more or less
rapidly, according to the resisting power of the individual, to a fatal
termination. I therefore strongly incline to the opinion that it is to the
side of the soil that preventive measures must be directed, and this to the
great disparagement of notification and all its consequences, although
Sir William Broadbent, in the letter which is before the Committee this
evening, alludes to the present impracticability of dealing with this, and
states that we must direct attention to the distribution of the seed.
There can be little doubt that tuberculosis is much more prevalent than
the mere number of fatal cases or those voluntarily notified would lead us
to believe. Evidences of healed tuberculous lesions are frequently found in
the lungs of those who have died from other causes, and it is a common
thing for medical officers of the large insurance societies to find unsuspected
cases of this during life. Hence it does not appear to be sound
policy to deal with a cause which eludes us at all points, but our aim
should be to get all persons into the case of those just mentioned, that is,
who are attacked by the bacillus, as we doubtless all are, but who are in
such a condition of body as to resist it. But even now, I think that the
zeal of those who have been strongest in supporting the highly and directlyinfective
nature of the disease is subsiding, and especially among those,
apart from the enthusiasts, who have clinical opportunities of watching
the progress of the disease. It is only necessary in this report to quote
from a statement (Lancet, January 6th, 1906) by the President of the
Royal College of Physicians, who says there is an exaggerated belief in the
person to person infectiousness of phthisis, which is growing under the
advocacy of sanitarian and anti-tuberculosis societies.