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sense of responsibility and unselfish care for others (altruism in its finest
sense) which would make compulsory measures as unnecessary as they
are impracticable.
The death-rate from phthisis is much higher among poor people than
among rich, the difference being probably due in part at least to greater
exposure to infection and re-infection, and we have to consider the
reasons for this greater exposure and the extent to which it can be
lessened.
It depends greatly on how people live when they do not know or
suspect that they are sources of infection, and partly on how they can
be persuaded to live when they have become aware of it.
Fortunately, cases who are infective unconsciously, do not usually
distribute a large number of germs and so do not expose those around
them to such massive doses of infection as is done by those in advanced
disease. The ordinary habits of refined people leave so little opening
for the spread of infection that they are sufficient to protect those in
contact with doubtful cases unless sputum is present, when somewhat
more care should be taken even if bacilli are not found. These habits
could be followed in all decent working-class homes, and are quite frequently
found there. The presence of tubercle bacilli in any person's
sputum necessitates more rigid precautions before one could expect
those in contact, particularly children or those not fully recovered from
previous infection, to be safe; it must be admitted that a very large
number of working-class houses do not permit of this care. Even here,
however, perfectly satisfactory arrangements can be made in those cases
where there is a regular income sufficient to maintain the family in
decency during health, provided that the accommodation is sufficient and
properly planned. It is the business of social science to show how this
state of affairs could be made more usual.
The slow process of obtaining control of the sources of infection
may be greatly hastened by measures which aim at preventing the cases
of chronic tubercle from becoming phthisical. If these cases are cured,
the sources of infection are indeed cut off before they come to the
surface, and it is now recognised that all subjects of active phthisis
must pass through this latent, or chronic, phase before they become
infective. It is also known that natural cure frequently occurs at this
stage and that treatment is successful in a very large percentage of
cases. Further, much chronic ill-health occurs among those who are
the subjects of chronic tuberculosis, which may persist for years
whether phthisis develops or not, and which may be relieved by treatment
of the tuberculosis causing it,