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35
THE PREVENTION AND TREATMENT OF CONSUMPTION.
In the report for 1903 (pp. 37-43), and under the above heading, I submitted a resume of the
history of the movement to constitute the Metropolitan Asylums Board the Sanatorium Authority
for London. Success has not yet been obtained; but progress has been made by sustained efforts
to form and educate public and professional opinion with regard to it.
At present London is dependent, as regards "chargeable" consumptives, on the accommodation
provided at Poor Law Infirmaries and Workhouses. The provision made in special hospitals
for non-chargeable persons is small, quite inadequate, and difficult of access under the system of
subscribers' letters which generally prevails, a system which necessarily entails delay in getting
suitable cases, in the early stages of the disease, under hospital treatment. An increased amount of
public attention to the need for extending sanatorium accommodation was brought about in the
autumn of last year by the holding of a largely attended meeting of the Council of the Charity
Organisation Society, convened for the discussion of a paper I had been invited to read on
"The Need of Sanatoria for Persons suffering from Consumption, and how it may be supplied."
The paper is reproduced here as furnishing a summary of the history of the movement to date, and
of my views on the subject, which is one of great and national interest from the public health
standpoint.
The Council of the National Association for the Prevention of Consumption and other
Forms of Tuberculosis, in a leaflet entitled "How to prevent Consumption," state that "Consumpton
(with other forms of tuberculosis) causes one death in every eight in this country,"
and that "of all deaths in the United Kingdom between the ages of twenty-five and thirtyfive,
nearly one half are due to consumption." They estimate, moreover, that " in Great
Britain, at the present moment, at least a quarter of a million persons are suffering from
consumption." It would be difficult to find words more suitable to express the importance of
the subject, which is truly one of national importance.
In 1902, more than 57,000 deaths in England and Wales, and 10•7 per cent. of the mortality
from all causes, were due to tuberculous diseases, the deaths being equal to a rate
of 1,741 per million of the population at all ages and of both sexes; the mortality amongst
males being 42 per cent. in excess of that amongst females. Consumption alone was the
cause of nearly 41,000 of the deaths, and of 71 per cent. of the total mortality from tuberculosis;
the deaths being equal to a rate of 1,233 per million living. In London the deaths
from tuberculosis were 10,337, and 12•5 per cent. of total deaths; those from consumption
7,621, and nearly 74 per cent. of the mortality from ail tuberculous diseases.
Great, however, as is the mortality from this cause, it is continuously declining, and has
diminished to the extent of at least one-half during the last fifty years, thanks to sanitary
legislation, more efficient sanitary administration, improvement in the housing of the people,
and a general uplifting of the condition of the poorer classes.
But a still greater reduction has occurred in regard to the "principal infectious diseases,"
small-pox, scarlet fever, enteric fever, etc., the deaths from which, and diphtheria, in London,
in 1903, aggregated 1,523 only; scarcely more than a fifth of the number from consumption
alone.* The reduced mortality from these diseases is due, in part, to the causes that
have led to the diminished fatality of consumption; but more largely to the provision of
isolation hospitals, since 1871, and, since 1889, to the operation of compulsory notification.
When the same measures shall have' been adopted in regard to consumption, not less favourable
results may be confidently anticipated.
*By way of illustrating the relative importance of phthisis and the so-called dangerous infectious diseases, the
subjoined figures relating to the mortality in London, and in Kensington, in 1903, may be cited.
The deaths in London from consumption were 7,124, those from small-pox, scarlet fever, diphtheria, and fever,
1,487.
The deaths in Kensington from consumption were 212, those from the four zymotic diseases, 47.
The death-rate in London from consumption was 1•55 per 1,000 of the population, that from the four zymotic
diseases, 0•32 per 1,000.
The death-rate in Kensington from consumption was 119 per 1,000 persons livine, that from the four zymotic
diseases, 0•26.
The percentage of deaths in London from consumption to deaths from all causes was 10•2, that from the four
zymotic diseases, 21.
The percentage of deaths in Kensington from consumption to deaths from all causes was 8•6, that from the four
zymotic diseases, 1•9.
It thus appears that, judged from the standpoint of fatality, consumption is nearly five times more important
than the four named zymotic diseases combined. It has to be observed, moreover, that whilst one attack—of small-pox,
for example, usually confers life-long immunity from the disease, the recovered patient, moreover, as a rule, being
none the worse for it, the unfortunate person who contracts pulmonary tuberculosis (consumption) is, in default of
opportunity for getting open-air treatment, condemned to a more or less lingering, and almost certainly fatal, illness;
becomes a misery to himself, a constant anxiety to his friends, and, too often, a burden to the community.