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59
effect in reducing the mortality from tuberculosis, but more special
measures are necessary to secure an effective control of the disease.
The most common and destructive form of tuberculosis is tuberculosis of
the lungs or consumption, and it is against this form that preventive
measures should chiefly be directed. In considering what should be
done to attack consumption, two propositions should be borne in mind: —
1.—Consumption is an infectious disease, but the infection can
readily be controlled if the patient can be brought to live under
proper conditions.
2,—Living under such conditions will not only-prevent the
spread of the disease to others, but will also promote the
recovery of the patient, for consumption is a curable as well as
a preventable disease.
The main object of preventive effort is to see to it that consumptive
patients adopt a proper mode of life, and the essentials of such a life
are (1) abundance of fresh air, (2) a sufficient amount of good food, (3)
habits of scrupulous cleanliness. But before a Public Health Authority
can do anything for a consumptive patient it is necessary that the patient
should be known to the authority —in other words, a system of notification
is necessary.
Voluntary notification of consumption has been in operation
in Hampstead since 1902, but the number of notified cases has been
small, probably considerably less than one-sixth of the total cases,
and many of the patients have been notified only when in the last
stage of the disease. The instalment of compulsory notification introduced
by the Public Health (Tuberculosis) Regulations, 1908, has
increased the number of notified cases, and a further increase will
result from the Public Health (Tuberculosis in Hospitals) Regulations,
1911, which came in force on May 1st, and provide for the compulsory
notification of cases of consumption occurring in hospital patients.
In the majority of cases, however, the patient is not notified until
he is in an advanced stage of the disease. Consumption comes on
insidiously; the patient often does not suspect what is the matter with
him, and puts off seeing a doctor until he may be seriously ill. What
is wanted is some means of identifying the disease in the early stage,
and for this purpose it is important that a medical examination should
be made of the members of a family in which a case of consumption has