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42
an opinion on the question as to whether the Managers should undertake the new duties suggested."
The duty of " obtaining information " had been entrusted to one of the Board's medical inspectors,.
Dr. H. Timbrell Bulstrode, who, so far back as 1903, in his "Milroylectures on The Causes, Prevention
and Control of Pulmonary Phthisis, delivered before the Royal College of Physicians, and
published in " I he Lancet" had expressed his views on the question generally; declaring sanatoria,
as " curative agents," to be " almost indispensable " ; and, " in the matter of prevention," as being
likely to " curtail the prevalence of the disease, by aiding education." The sanatorium question,
moreover, was " 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 of the
disease being " 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, it was said, pulmonary tuberculosis assumes a higher infective
power than it manifests in the relatively healthy conditions of a hospital for consumption ";
whilst 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."
Views of International Congresses and of Local Government Boards.—It may not be out of place
here to mention that the International Congress on Tuberculosis, held in London, in 1901, declared
sanatoria to be " an indispensable part of the measures necessary for the diminution of tuberculosis";
similar testimony was borne by the Congress held in Paris in 1905, and by the Local
Government Board for Scotland, in 1906. At an earlier date the Local Government Board for
Ireland had striven, by every available means, to induce the Boards of Guardians to provide separate
accommodation for the isolation of consumptives, which one half of them are stated to have done.
Official Action.—The Poor Law Inspectors of the Local Government Board for England,
moreover, lose no opportunity for impressing on Boards of Guardians the need for isolation of
consumptives; and rightly so, seeing that the Board, in 1903, informed the National Association for the
Prevention of Consumption, that phthisis comes within the definition of an " infectious disease,"
and that provision may be made for persons suffering therefrom under the Isolation Hospitals
Act, 1893—an Act " for enabling County Councils " (other than the London County Council, as the
Act does not apply to London) " to promote the establishment of hospitals for the reception of
patients suffering from infectious diseases"—a duty which, in the Metropolis, was devolved upon the
Asylums Board by the Metropolitan Poor Act, 1867. The Board added that " although pulmonary
tuberculosis is not one of the diseases [named], the provisions of the Act may, under Section 26, be
applied to that disease," by an order of the County Council, which, however, requires the approval
of the Board.* In July, 1905, moreover, the Board, in response to an inquiry made by the Board of
Guardians of the Bath Union, informed that body that they would be justified in compulsorily
detaining a person suffering from consumption, attended with copious expectoration—for the reason
that he would1 be in a condition to spread this infectious disease.
The Asylums Board's Decision.—In February, 1906, the General Purposes Committee of the
Asylums Board reported on the reference of April, 1905, and, " in the absence of any authoritative
expression of opinion by the Local Government Board, and as a result of [their] consideration of
the question in all its bearings," [they] recommended—
" That the Managers do forward to the Local Government Board a copy of the memorial
addressed to the Managers by the Metropolitan Branch of the Incorporated Society of
Medical Officers of Health on the 15th April, 1905 ... on the subject of the provision of
hospital accommodation for the treatment and isolation of patients suffering from pulmonary
phthisis; and
" That the Local Government Board be further informed that, having regard to the
uncertainty which prevails as to the probable nujnber of patients who would come under the
scheme referred to in the memorial, and to the great prospective cost to the ratepayers
of the Metropolis, the Managers would be glad to receive the judgment of the Local Government
Board upon the prayer of the memorial referred to."
The report was adopted.
The Local Government Board's Decision.—In March, 1906, the long awaited decision of the
Local Government Board was received; it informed the Managers that the subject [of the suggested
establishment by them of sanatoria for the treatment of patients suffering from phthsis] "has
received much careful consideration on the part of the Board, but that the information before them
at present does not appear to afford sufficient justification for the very heavy outlay which would be
involved in the proposal."
* The Board's letter was published in the issue of The Times for May 23rd, 1903.