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[1902
will also be useful, as Koch said in his great address, " in order to learn
where help and instruction can be given, and especially where the disinfection,
which is so urgently necessary when consumptives die or change their
residences, has to be effected."
It will not, however, be necessary to notify all cases of Consumption, but
only those in which the sputum is tuberculous—i.e. contains the bacilli of
Consumption—or those that, owing to the condition of their households, are
sources of danger to others living with them.
Disinfection will be necessary in all cases where consumptives die, or
when they change their residences, lest the infection should be contracted
either by those who continue to live in the house or who might possibly
succeed in the occupancy of the premises.
In this respect let me say that I have recently had a search made in the
mortality returns of the last five years as to the number of houses in which
one or more deaths from this disease have occurred, and I find that Phthisis
resulting in death happened in 2,326 houses, and that in as many as seventynine
of these two deaths occurred at shorter or longer intervals; and that in
three, 3 deaths occurred. I also find that in two Common Lodging Houses
2 deaths occurred at intervals, in three 4 deaths, in one 5 deaths, in one
6 deaths, and in one 12 deaths.
How far the infection has been passed on from the primary cases in these
houses it is impossible to say; but knowing, as we now do know, that dried
expectoration, especially when it becomes pulverised, in which the germs of
the disease retain their vitality so long, is the most fruitful agency in the
propagation of the disease, it is not too much to assume that very many of
these deaths were directly traceable to them. If this be so, then it at once
becomes manifest that it is the duty of the Sanitary Authority to adopt
measures that will tend to prevent the recurrence of the disease in the same
house.
In Manchester in 1901,1,339 cases of Phthisis were notified to the Medical
Officer of Health. Of these 625 were notified from the Union Hospitals or by
the Poor Law District Officers; 373 were notified from the various hospitals
and dispensaries; and 341 were notified by private medical practitioners.
The materials accumulated in the course of investigation proved that the
administrative measures do avert the subsequent occurrence of phthisical cases
in a house infected with tuberculosis. Dr. Niven, the Medical Officer of
Health of that City, declares that although " only about one-third of all the