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was a marked tendency for advanced cases to die in hospitals and
infirmaries which would have a favourable influence in reducing the
amount of infection in the homes. The war had tended to slow down the
machinery of tuberculosis schemes and he regretted that "contact"
examination had not received the attention that it deserved owing to
inevitable causes. He pleaded for closer co-operation between medical
officers of health, general practitioners and tuberculosis officers. In
conclusion, he urged that as the death-rate from tuberculosis in Germany
had been doubled and in this country tuberculosis still claimed one in
every ten deaths, it should be regarded, not as a problem which could
be postponed till after the war, but ought to demand the earnest attention
of local authorities as a menace which was assuming ominous proportions
during the war.
The two chief responsibilities that are entrusted to a local authority
are the health and the housing of its citizens. It has long been recognised
that the root cause of tuberculosis infection lies in bad housing. Poverty,
intemperance, and overcrowding are inter-related fattors. Tuberculosis
is a social or family disease. In the stagnant air of gloomy overcrowded
basement dwellings tuberculosis is encouraged to spread. By far the
greater number of consumptives have been infected in infancy or childhood
by tuberculous parents amidst such conditions. No specific medical
treatment has yet been discovered for tuberculosis. Prevention must,
therefore, be the watchword. Four lines of action appear to suggest
themselves:—
(1) Improved social and economic state of the workers.
(2) Better housing conditions—abolition of basement dwellings,
and in other areas of the custom of making the largest and
best lit room the " workroom."
(3) Municipal isolation of the infectious cases.
(4) Special care of the children of consumptives especially during
adolescence.
The hope of the anti-tuberculosis campaign lies in preserving the health
of children who are the contacts or relatives of consumptives. A considerable
proportion of those children show either suspicious signs of tuberculosis
or the disease in a quiescent or dormant form. As in 1916 we have
directed our chief efforts to obtaining convalescent or sanatorium treatment
for those cases. Even in regard to contacts who show no signs of
the disease we prefer to keep them under observation at the dispensary
in order that the examination of their lungs may be repeated. Contact