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86
of immunising substances in his blood and tissues. I think we can
claim that there is such a thing as acquired immunity. If we are to
accept the view expressed by pathologists and bacteriologists that
infection is general, then we must believe that acquired immunity is
becoming a feature of urbanised populations.
Ninety per cent, of the population are capable of acquiring permanent
immunity. It is in the social conditions which cause a loss of
"elasticity of resistance" that we find the cause of the mortality from
Phthisis. A successful campaign against the disease as a cause of
death in urbanised populations can only be conducted when we no
longer keep part of the population already suffering from latent tuberculosis
under conditions where they are only half fed, badly housed, and
ignorant of what to do with the means of health even if they were
brought to their knowledge. The real future of the problem is partly
evolutionary and partly socio-political. The machinery of the
State campaign against tuberculosis suggests that the central feature
would be found not in the tuberculosis dispensary as a means of preventing
infection, but in the tuberculosis bureau in connection with a
State Public Health Service as a means of ascertaining and controlling
the forces which bring about loss of resistance. The tuberculosis
bureau would, I conceive, deal firstly with notifications and their
classification on social economic lines ; and secondly with the carrying
out of such measures as would bring the resistance in classes wherein
the loss of resistance occurs, into line with those where resistance is
maintained. The knowledge of how to live, sufficient food, and improved
housing, would prevent loss of resistance and do more to bring
about a reduction of the death-rate than an attempt to sweep back an
ocean of infection by a yard broom of segregation. We cannot deprive
nature of her power to kill off those who have inherited vulnerability.
Natural selection will remove those individuals in whom no " elasticity
of resistance" exists. It is only by co-ordination and correlation of
political and hygienic forces, that this resistance of the community to
the disease can be maintained and improved.
Municipal Tuberculosis Dispensary.
The total number of patients examined at the Dispensary during
the year was 841, 391 males and 450 females, and the total attendances
made by these patients numbered 4,312.
Of this number, 193 were insured and 648 non-insured persons.