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68
cannot excite surprise that this disease should continue to spread
amongst the working classes after consideration of the facts detailed
under (b) (c) (d) (e) above.
It will be remembered that all of these patients were in receipt
of poor law medical relief. Whatever they may have been
earlier, they had drifted into this class at last. And it seems as
if this must be so with the bulk of the cases occurring amongst
the working classes. Pulmonary consumption is, in most cases,
a chronic disease, lasting, it may be, years. If the breadwinner
of a family is attacked, his family begin immediately to
suffer in their social and domestic circumstances; for he soon
becomes incapable of the necessary exertion to maintain his
family, as before the onset of his illness. Most working people
have no reserve to meet emergencies like a long illness. The
status of the patient and his family suffers, he ceases to work
regularly, his income declines, and he becomes too poor to afford
nourishment for himself and family. His ability to pay for
medical attendance and treatment ceases. The members of his
family may not be capable of work, or work may not be obtainable.
They and most of their families drift into the class receiving
poor law relief. Such is briefly the course of a case of pulmonary
consumption amongst the working classes.
When poverty stares both the patient and his family in the
face, then the nutrition of all suffer, and the otherwise healthy
members of the family fall easier victims to the infection of
the patient. If the nutrition of those surrounding
the patient at home could be maintained, they would not be so
readily attacked by the germs of the disease. Poverty reduces
the resistance of everybody to the onset of disease, because it
reduces nutrition and the natural immunity possessed more or
less by every healthy organism. Another point to remember is
that when poverty attacks a family the housing accommodation
reduced to a minimum; they crowd into dwellings too small