View report page

309
The Zymotic Death-rate for the Borough was 0 61 per 1,000
per annum, as against 0 93 in the preceding year.
CONSUMPTION.
The death-rate for Consumption (Pulmonary Tuberculosis) in
the Borough for 1919 was 0.84 per 1,000, as against 1.2 for London
generally.
Medical opinion is rapidly coming to the conclusion that the
crucial factor that determines the onset of this disease is not exposure
to infection per se, but the exposure to infection of an individual
whose natural resistance is reduced. The circumstances which lead
to a reduced resistance are those which impair health, and notably
bad air, poor and insufficient food and clothing, and work which
overtaxes the strength of the individual; but the offspring of tuberculous
parents are born with a poor resistance. Thus, the causes of
Tuberculosis are largely economic and the prevention is therefore
largely in the hands of the social reformer. Better housing and
the means to secure a more hygienic standard of living, the avoidance
of excessive strain and too prolonged hours of work in badly ventilated
premises, will all operate towards the reduction of the disease
by reducing the numbers of those with lowered resistance. But
lowered resistance must be associated with exposure to infection
if a person is to acquire Tuberculosis- and it is in connection with
the advanced cases that these two factors are associated with the
greatest effects. An advanced case of phthisis is very often an
individual who has been for some time incapable of earning a living
wage, and therefore he and those dependent on him are often on the
border-line of poverty. He is giving off large numbers of germs in
surroundings (overcrowding, etc.) which favour their transference
to others, and these others who are exposed to such "massive
infection" have had their resistance lowered by all the circumstances
connoted by poverty. Our Tuberculosis Scheme, as I have said
in my previous reports, provides no effective remedy for this state
of things, and, indeed, the real remedy is both difficult and costly.
It is to be found in powers for compulsory removal of those thus
exposing others to grave risks, and in suitable provision for their
isolation in hostels.