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43
In 32 instances there had heen exposure to infection from relatives,
and in 9 to infection from lodgers or other inmates of tenement houses.
In both the first and last groups many of the persons affected had no
history of phthisis among their relatives. Doubtless, there were many
more cases especially among the common lodging-house class, but those
mentioned were definitely recorded.
It was at one time held that consumption was a hereditary disease,
then with the discovery that tuberculosis was produced by a germ there
was a tendency to regard infection as of chief importance.
All are liable to be attacked by the tubercle bacillus, and statistics
derived from the post-mortem examinations of persons dying from other
causes show that a very large percentage have been attacked but have
been able to resist, so that traces only of the damage done can be
recognised. Children are not born with the disease, but various tests
which can now be applied show that before they reach the age of 15
years 30 or 40 per cent., and even more, have been infected. The
bacillus is of slow growth and may remain in the body for a long time
without causing marked symptoms, and this probably accounts for the
occurrence of consumption in adolescents and young adults, as
by that time under favourable circumstances the presence of the
organism begins to produce marked effects, hence the importance of
measures to prevent infection of children and of raising their powers
of resistance, so that they may be able to overcome and destroy the
bacillus before it has time to grow.
While the disease is not hereditary yet a certain amount of susceptibility
to it may be transmitted so that a smaller dose of infective material
may set up the disease than would be the case in persons with high
powers of resistance. Even persons of the latter class may be unable
to resist a very large dose or repeated small doses such as may happen
when in close daily contact with a careless patient. Successful infection
occurs when the power of resistance has been lowered by some other
illness, by insufficient food, by intemperance, by overwork, by insanitary
conditions, particularly defective ventilation and dampness, by dusty
occupations, &c. Examples of all these are to be found among the cases
notified during the last 12 months.
In the campaign against tuberculosis it is necessary—
(a) To remove such conditions as those specified.
(b) To remove opportunities for infection, especially for those with
low powers of resistance (natural or acquired).
(c) To bring infected persons and susceptible persons under treatment
at a very early stage.
It is with these objects in view that a scheme has gradually been
built up in Westminster, by which all the various organizations