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available for these people, and a proportion of them prefer to die
in their squalid surroundings than enter a Poor Law Institution.
So long as these potent sources of infection continue to exist in our
midst, so long must the evil remain. We are spending large sums
in the cure of early cases, but we neglect the most obvious and
beneficent preventive measure. Phthisis mortality occurs especially
among the poor, and measures for its reduction must also include
those which afford assistance, not only to the sufferer, but often to
the families which are dependent upon him.
Consumption is preventable; if treated early enough it is curable;
and yet we are still allowing thousands of people to die of a
disease which they need never have contracted. It has been truly
said that if one-tenth of the number of deaths due to Tuberculosis
were due to Plague, Cholera, or Small-pox, there would be a public
outcry against the inadequacy and futility of our measures for protecting
the public health against such epidemics. The disease generally
begins in an insidious manner, and where the working man is concerned
he does not give up his work or even consult a medical man
on account of these early symptoms. He has no money to pay
doctors for slight ailments; and as he has a family to support, he
fights against the disease so long as he is physically capable of doing
so, by which time the disease has reached a stage in which a cure
is almost impossible and sanatorium treatment cannot be expected
to have a permanently good result. This Consumption is as deadly
as it is because in most cases of the disease amongst the poor it is
well advanced before a proper remedy is sought. The hospitals deal
with thousands of cases which never come to the knowledge of the
Sanitary Authority; but they have not the machinery for dealing with
prevention, and as the cases are not followed to their homes the
early cases which are often to be discovered there are not sufficiently
early dealt with. It is important that these very early cases should
be sought out and taken in hand almost before they know themselves
that they are ill, in our campaign against the disease among the
poorer classes.
The Tuberculosis Dispensary System is designed to secure these
ends, and has proved markedly successful. The scheme was first
d 2