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available not only for the chargeable poor but also "for that class above the very poor who
were not able to pay for sanatorium treatment." Cases not likely to recover should, he said, be
sent to places where facilities could be given for friends to visit them. Provision of this sort
now exists, some two thousand beds having been set apart for this hopeless class of sufferers at
the Metropolitan Poor Law infirmaries.*
Again, Dr. Bulstrode, who is known to be "obtaining information" for the Local Government
Board, spoke in his Milroy Lectures (1903) with no uncertain sound on the question.
Sanatoriums, "as curative agents," are described by him as "almost indispensable." "In the
matter of prevention" they are "likely to curtail the prevalence of the disease by aiding educa"tion,
and by reducing the number of advanced cases"; and "no one who has studied the work"ing
of them" can doubt that they are "of great value in a curative sense." The sanatorium
question is "not so much one of the infectivity or communicability of phthisis, as one of inability
to do much good to a poor patient in his insanitary home and surroundings." The infectivity is
"proportional to bad home influences—scant accommodation and insanitary conditions—productive
of low vitality of the host of the tubercle bacillus": "in unwholesome circumstances and
"prolonged exposure, pulmonary tuberculosis asssumes a higher infective power than it manifests
"in the relatively healthy conditions of a hospital for consumption." Again, the facts as to
"cured " tuberculosis as seen in the post mortem room, "show how much good may be done in
"aiding the healing process by sanatoriums, and by better conditions of living."
Should the foregoing views meet with acceptance at Whitehall—and they are based on
information obtained—a great victory will have been won in the fight against tuberculosis.
On the relation of tuberculosis to poverty, Dr. Bulstrode states that "the effects of poverty"
cannot be dissociated from "those of the conditions with which poverty is almost invariably allied,
"and of which they are but the expressions."
Consumption is, in truth, a disease of the poor. Evidence of this is given in the table (at
page 54) of the status of sufferers, whose cases or deaths formed the subject of investigation
by the Council's officers last year. It is worthy of note, in this connection, that in the four
years 1902-5, of 879 deaths from consumption in Kensington, 357 (40.6 per cent.) took place at the
Borough infirmary, to which not a few respectable men and women, impoverished by illness,
drifted against their will, as their only remaining place of refuge.
With regard to the economic side of the question, the British Medical Journal (September
23rd, 1905) is responsible for the statement that the average amount of the sick pay of one of
the great Friendly Societies to a consumptive member, is three times as great as in the case of
any person dying from another disease. Dr. Bulstrode, moreover, cites Dr. Herrmann Biggs,
the leader of the Sanitary Authorities of New York, as being responsible for estimates of
annual loss to the United States of America from the ravages of the tubercle bacillus, at
£66,000,000; the value of lives lost in the City of New York † alone, with addition of loss by
enforced idleness prior to death, being estimated at £4,600,000—compared with an expenditure
of £100,000 on preventive measures. What all this means has been expressed in another way
by Dr. Hay ward, who, the Milroy Lecturer states, has calculated that "if there had been no
"phthisis, the average length of life for each individual born, would have been increased by two
'and a half years." Be this as it may, there can be no doubt that if the same care were taken to
prevent and cure tuberculosis, as is taken to control and treat scarlet fever, etc., consumption
would soon become a far less prolific contributory to the roll of mortality.
It is not to be thought for a moment that sanatorium treatment alone is going to extirpate
tuberculosis—there is a great field for the work of Sanitary Authorities, as has often been
pointed out in these reports—but that hospital treatment and isolation would do much towards
this end there can be no question. And, after all that has been said and written since the
establishment of the National Association, in 1899, no one, I think, can doubt that the Local
Government Board and the Asylums Board would confer a lasting benefit on the inhabitants of
this Metropolis by acceding to the prayer of the "Memorial" presented to the Managers by
the great representative deputation in April last, of which an account follows.
* Particulars ot this accommodation are given at page 48.
† The population of New York is 3,500,000, that of London being at least a million greater.