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42
scattering the morbid material secreted by the diseased lungs every time
he coughs, and his relatives close beside him inhaling the poison, must
appeal with considerable force to all of us.
The disease though infectious is only so to a certain extent, and to
those persons in a lowered state of health.
The chief predisposing causes are—
(1) Poor food of a vegetable kind.
(2) Dark and ill-ventilated dwellings where sunlight and fresh
air cannot enter.
(3) The breathing the air over and over again in crowded rooms.
(4) House dampness.
(5) Dust.
(6) Absence of proper exercise.
(7) Chronic spirit drinking.
The defences are nutrition, ventilation, and sanitation.
The first two are matters that the individual must assist in obtaining,
whilst the last comes under the care chiefly of the Sanitary Authority.
The question whether the tubercle bacillus can flourish outside the
human body, that is saprophytically on the paper covering the walls of
rooms which phthisical persons have inhabited, although of the most
vital importance to the health authority is still unsettled.
It is but fair to mention that Dr. Niven, Medical Officer of Health of
Manchester, when he held a similar office at Oldham in 1896, was the
first to advocate this notification and to persuade the Oldham Medical
Society to formulate a complete scheme of preventive measures, which
however, was not adopted by the Oldham Town Council.
In Brighton Dr. Newsholme, the Medical Officer of Health inaugurated
voluntary notification of Poor Law and Institution cases of
Phthisis in 1898, but without any payments being made to Medical
Practitioners. In 1899 the Town Council agreed to pay the usual fees of
2s. 6d. and Is., and in that year 113 cases were notified to the Medical
Officer of Health. Since then other County Boroughs have adopted this
voluntary notification of Phthisis, and at the present time such is the
amount of educated opinion at the back of this movement, that I believe
it will be universally adopted within the next few years. It is no part of
my duty to prophesy when compulsory notification will be assented to
by the Local Government Board.