View report page

50
cases." Reference has also been made to the efforts of the Local Government Board for Ireland
to stimulate the Boards of Guardians to make provision of separate accommodation for consumptives.
In this connexion mention may be made of the views of Professor McWeeney, bacteriologist
to the Board, and who attended the Paris International Congress as the representative of the department.
Premising that tuberculosis is the " most wide spread of infectious diseases," the " purpose
of (his) report is to give such an account of the defensive measures successfully adopted elsewhere,
as may enable the public health authorities to select for trial those which may seem most suitable
to the conditions, administrative, fiscal, and climatic, that prevail in Ireland"; the objects being of a
"two-fold nature; (1) to cure those who are already attacked, and (2) to prevent the disease from
spreading to the healthy " : the need for such measures being emphasized by the fact that
tuberculosis is more prevalent in Ireland than in Great Britain. As regards sanatoria,
Dr. McWeeney says the case in their favour seems conclusively proved"; so that,
as regards Ireland, " there can be no question as to the necessity f.r providing a
number of these institutions, commensurate with the requirements of the working class
the only question arising being, how the expenses of installation and up-keep are to be met."
This question would seem to have been satisfactorily solved by a recent decision of the Dublin
Corporation to levy a penny rate towards the establishment of a sanatorium for the consumptives
of Dublin City and County—and rate-aid would, indeed, appear to be indispensable
if the fight against tuberculosis is to be waged successfully, anywhere. The Local Government
Board for England have hitherto taken no steps, such as those above adverted to, to promote the
establishment of sanatoria; but the efforts of individual inspectors have been directed to secure
provision of separate accommodation in the Poor Law infirmaries. Special mention may be made
of the advice given by Dr. Downes,* chief medical inspector, for Poor Law purposes, of the Local
Government Board, to whom it is due that the Metropolitan Boards of Guardians have made
large provision, in separate wards, at the infirmaries, for this unhappy class of sufferers in receipt
of " relief."
" The Role of Sanatoria and Dispensaries in the battle against Tuberculosis," is the heading
under which the Delegates! of the British Government to the International Congress on Tuberculosis,
held at Paris in 1905, deal with the Sanatorium question in their report, presented
to both Houses of Parliament by command of His Majesty. " There was (they say) an animated
discussion upon this subject, a discussion which was taken part in by representatives of many
nations." " The prevailing tone of the discussion " is stated to have been " more favourable to
sanatoria and dispensaries than the papers" read; and, amongst other resolutions adopted, one
affirmed that " the principle of sanatoria and dispensaries must be recognised "; it being "understood
that, as means for controlling tuberculosis, they have about them no exclusive or predominating
advantages." Sanatoria were characterised as " hospital establishments reserved for cases
of pulmonary tuberculosis capable of cure or lasting improvement"; and as being " equally the
agents of prevention and popular education." The (London) International Congress on Tuberculosis
(1901), it may be remembered, declared " the provision of sanatoria (to be) an indispensable
part of the measures necessary for the diminution of phthisis."
Professor Koch in the " Nobel" lecture (1906), already adverted to, gave consideration to
the sanatorium question, asking, " What is to be done with the patients who are to be
regarded as dangerous " ? Declaring that " we may count upon a decrease of tuberculosis . . .
if a considerable fraction of (dangerous) patients are admitted to suitable establishments," he went
on to say that such cases, i.e., those in the last stage of the disease, ought to be lodged in hospitals
—as is now so largely done at the Metropolitan Poor Law Infirmaries. It will not have been
forgotten, moreover, that the " Milroy " Lecturer (1903) described sanatoria, " as curative agents," as
being " almost indispensable," and, in the matter of prevention, as being " likely to curtail the
prevalence of disease, by aiding education, and by reducing the number of advanced cases." " No
one " (he added) " who has studied the working " of Sanatoria, can doubt that they are " of great
value in a curative sense." The views of this gentleman are especially interesting, as it was to him
that the Local Government Board delegated the duty of " obtaining information," which was to
enable them to " express an opinion on the question " as to whether the Asylums Board should
undertake the duties of Sanatorium Authority with respect to pulmonary phthisis. The report
in which the Inspector's matured views will be set out, has not, I understand, been presented to the
Board; its publication is awaited with interest, and not without hope that it may modify,
favourably, the Board's views on the important questions with which it may be expected to deal.
• At the Conference of Poor Law Authorities in October, 1900 Vide my Annual Report for 1900, page 33.
† Dr. Theodore Williams, Consulting Physician to the Consumption Hospital, Brompton, and Dr. Timbrell Bulstrode,
Medical Inspector, H.M. Local Government Board.