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Another point is that the large majority of deaths from phthisis occur between the ages
of 25 and 55, at a period when the lives are most valuable to the family and the State, whereas
the majority of the victims of the other zymotic diseases are in their childhood or early youth.
Enough has been said above to show what a very large share, for one single disease,
tuberculosis takes in its different forms in making up our annual death-rate. Next, as to its
mode of dissemination. The tubercle bacillus can be inhaled or swallowed. The latter generally
happens through the medium of tuberculous foods such as milk, meat, etc., and the former
through inhalations of tubercular sputum, which is by far the most important factor in the
spread of tuberculosis. Every phthisical patient is constantly spitting up phlegm or mucous
from the lungs, containing millions of tubercular bacilli. If this sputum falls where it can
become dried, it gets broken up and mixed with the dust of the room; the innumerable bacilli
thus becoming dry and light, are able, when the dust is moved, to float about in the air. A
certain proportion of the bacilli are also coughed direct from the lungs into the air by the fine
spray which generally issues from the mouth in the act of coughing. These dried bacilli retain
their virulence for months, especially if the house is dark and ill-ventilated, and when inhaled
by a susceptible subject, frequently set up the disease. This is, undoubtedly, the principal
manner in which tuberculosis is spread.
Prevention. —From these remarks it will be seen that preventive measures naturally fall
under two heads —first, those which raise the general health of the community, and which come
under general sanitary measures; secondly, isolation and disinfection. The benefits from the
former measures have long been recognised in England, and the result is seen in an enormous
reduction of phthisical mortality during the last twenty years, the reduction varying in different
districts from 25 per cent, to 50 per cent. Coming to the second series of preventable measures,
I would remark first that by isolation in phthisis I mean the withdrawing of the subjects of this
disease who are coughing up infectious sputum from contact with the general population, and
their treatment in special hospitals and sanatoria. This has three objects in view, viz.: the curing
of the disease in suitable cases, and preventing the spread of infection between the sick and
healthy. The best treatment for phthisis has been found to be a complete reversal of those
conditions which most favour it, viz.: bad air, want of sunlight, etc., and the placing of patients
under the best sanitary condition away from town, where they can get the full benefit of the
fresh air and sunlight. For this purpose the open-air sanatoria are being instituted all over the
world. Phthisis is, however, most common in the labouring and artisan classes, who are
unfortunately unable to avail themselves of this treatment in England, since most of the
sanatoria are erected by private enterprise. It is quite impossible for the class of patient in
which the disease is commonest to carry out this treatment in their own homes, so the result is
that they simply continue to work as long as they can, infecting their fellow-workmen in crowded
workshops, and their families when at home.
In view of these facts and considering the great importance to the State and individuals of
lessening or doing away with this scourge, a proposal is made by Dr. Louis C. Parkes, Medical
Officer of Health for Chelsea, embodied in a letter to this Council, that "open-air sanatoria
should be provided for the treatment of Phthisis on a large scale, where the poorer class of
patients could be sent to for from three to six months according to requirement; and that the
most suitable body to undertake this work in London is the Metropolitan Asylums Board, as
proved by its experience and success in other diseases." "The general hospitals in London are
averse to receiving phthisical patients and the special hospitals are too few to be able to deal
with any but a very small number of cases."
Next to the State, I do not know any more suitable body to undertake such a task than
the Board mentioned above. We are at present spending money on isolating a whole series of
preventable diseases, and leaving out the one that is most important of all and doing very little
to prevent its spread. I would go a step further and provide hospitals or sanatoria for those
cases which are in too advanced a stage to cure, where they could end their days in peace and
not be a menace to the community at large. Now even if patients were not all cured in the
ordinary sanatoria, they would all learn habits of cleanliness, so that when they came out they
would not be so dangerous to their neighbours. With this proposal I quite agree and recommend
the Council to support the Borough Council of Chelsea in their suggestion that the work of
providing open-air sanatoria should be undertaken by the Metropolitan Asylums Board.
My next remarks on prevention come under the head of disinfection. As regards the
rooms, bed, and bedding where deaths from phthisis have occurred, this is already being done
by us. The most important part, however, of disinfection is the destruction of the sputum
of phthisical patients. This can be done in two ways, either by spitting into a cup containing a
suitable disinfectant, or into a paper pocket handkerchief which can be burned before the
sputum is dry.
To effect this reform the people want educating as to the infectiousness of phthisis, and
the best methods of preventing its spread. For this purpose the Congress on Tuberculosis
referred to drew up a series of resolutions, the purport of which was to do away with
indiscriminate spitting in public and private places, by putting up notices pointing out the evils
of this filthy habit, and the printing of small circulars to be placed in the of phthisical
patients, giving information as regards the curability of the disease, and the importance of
disinfecting the sputum.
Had we suitable sanatoria to which we could send patients, the next step would be to
make the disease a notifiable one, so that we might have an opportunity of getting every patient
into them. Although we do not possess the means of isolation referred to, we might do more
than we are doing at present to prevent the spread of the disease in our own Borough, and to
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