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altered in the list of notifiable diseases in the Public Health Acts. In the "Nomenclature of
Diseases" of the Royal College of Physicians, pp. 11, the disease is understood to include all
forms of septic trouble occurring in puerperal women. If names were adopted, such as
puerperal pyæmia, septicæmia, or sapræmia, it would be much easier to guage the severity of
the disease, to discover the source of infection, and to take preventive measures against its
spread.
Measles.
The notification of measles is a subject which is constantly recurring. Experiments in
this direction have been tried in various towns, but, unfortunately, have been followed by no
practical diminution in the prevalence of the disease. As already pointed out, the great
difficulty in measles is that it is undoubtedly highly infectious before the characteristic rash
appears, and children are very seldom isolated until the mischief has been done. Certificates
stating that measles was prevalent have been granted to the following schools, in order that they
might obtain the Government grant:—
Clarence Street Schools,
St. Paul's (infants) School,
St. Mary's Schools,
Holy Trinity Schools.
I regret to see that the Education Department are doing away with epidemic grants. I fear
it will lead to the detention at school of children who are unwell and may be exhibiting the early
symptoms of some zymotic disease or else the hurrying back to school of contacts, in order to
keep up the attendance.
Tuberculosis.
Following up the transactions of the British Congress on Tuberculosis in 1901, I
submitted the following report to the Public Health Committee in January, 1902: —
I attended the British Congress on Tuberculosis, held in London, July, 1901, as delegate
appointed by the Metropolitan Borough of Bermondsey, and beg to submit the following general
report on tuberculosis, together with a copy of the resolution, passed at the Congress:—
Tuberculosis is now looked upon as an infectious disease. The primary cause is a small
microbe known as the tubercle bacillus. It exists in the atmosphere, in some places, adhering to
and floating about with particles of dust, but is specially prevalent in the dust of houses,
railway carriages, tramcars, etc., which have been recently occupied by persons suffering from
phthisis.
This bacillus was discovered by Robert Koch in 1892, and according to him, a pure
culture, if exposed to diffuse daylight at a window for five or seven days, is killed. Tubercular
sputum when dried will retain its virulence in a room at the ordinary temperature for at least
2½ months, and if exposed in a thin layer to sunlight, for from one to two days, it is killed. The
form which tuberculosis takes in the human body differs according to the mode of entry. If the
germs are inhaled and find a nidus, the resulting disease generally attacks the lungs and is
known as phthisis. If swallowed, it mostly attacks some abdominal organ. The former method
of acquiring the infection is much the commoner.
This is borne out by the fact that in Bermondsey last year the deaths from phthisis were
243, and from all other tubercular diseases 120. Professor Koch, in his address before the
British Congress on tuberculosis, laid it down as an axiom that it is both preventable and curable.
Before the discovery of the bacillus, phthisis or consumption, which is the most important
division of the disease, both from its frequency and importance, was looked upon as hereditary,
and little was done to check its spread. Now, however, this view has been entirely abandoned
and heredity as a cause per se has been relegated to a very subordinate position. Heredity
is now looked upon as furnishing two factors which favour the spread of the complaint, and
these are both indirect. The first and least important factor is that the child of phthisical
parents often inherits a body which is ill developed and make 3 a feeble resistance to the inroads
of the organism. The second and most important factor is that consumption in the parents
forms a bad environment for the offspring and abundant opportunities for acquiring the
infection.
I have spoken of the bacillus as being the primary cause, and I shall place the secondary
causes under one head, viz.: all those which lower the vitality of the human organism, and so
make it a suitable breeding ground for the bacillus. People in good health frequently inhale the
tubercle bacillus when going into places where it is prevalent, but the body resists its inroads and
casts it out again or else kills it, but those whose constitutions are weakened in any way,
instead of throwing out the infection, harbour it and allow it to grow and increase. In many
cases the human body, even after successful invasion, carries on a war with the enemy, as is
evinced by the great protraction of the disease (in some cases to 20 years) which often occurs.
Among the factors which cause this deterioration of health, intemperance, unhealthy dwellings,
ill-ventilated and dirty workshops and unhealthy occupations take the foremost place.
As before mentioned, the number of deaths in Bermondsey during 1900 of phthisis was
243, and of other tubercular diseases 120. This is equal to a death rate of 1.8 per thousand
living for phthisis and of 2.7 per thousand living for all tubercular diseases. The corresponding
rates for London during that year were 1.75 and 2.42. The number of deaths in Bermondsey
during 1900 in the following diseases, viz.: small-pox, measles, scarlet fever, whooping cough,
diphtheria, typhus, enteric and continued fever, cholera, together was 325, being a death rate
per thousand living of 2.48. The corresponding rate in London for the same diseases was 1.4.
It is, therefore, quite plain that tuberculosis alone claims more victims than all the principal
zymotic diseases put together.
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