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Thus, in the absence of such measures as those which have been specially advocated in
the last few years there has been a fall in the death rate from this disease, so much so that the
phthisis death rate of London in the decennium 1891-1900 was 35 per cent. below that of the
decennium 1861-1870.
It is now proposed to go further and to adopt measures held to be necessary in view of
the belief that a phthisical person may be, unless precautions be taken, a source of risk to others.
In so far as this can be done without prejudice to the sufferer there is reason for believing that
good will result. In any step taken in this direction it is, however, necessary to recollect that
the disease is often one of considerable duration and that many of those who are subjects of
phthisis are supporting themselves and others who are dependent upon them. It is therefore very
important that while having in view the public interest that of the sufferer should be carefully
safeguarded.
The measures which are being adopted in this and some other countries are briefly—
(a) Measures for obtaining knowledge of cases with a view to medical supervision.
(b) The observance of care in dealing with the sputum so as to prevent it being a
cause of disease to others.
(c) The maintenance of cleanliness in the rooms occupied by the phthisical person
and their disinfection on the removal of the patient when necessary.
(d) The treatment of the sick person in a sanatorium in which he is given opportunity
for recovery, but which also serves at the same time to relieve the home, often
the crowded tenement, of his presence.
In large degree what is required is the education of the sick person in the precautions
which should be taken, a matter in which the medical man, in whose care he is, is able to exercise
a useful influence. The provision of sanatoria is matter in which public aid is needed, and it may
be that even after the discharge from the sanatorium of the patient, who has apparently recovered,
further public action will be necessary which will tend to ensure that he is living under conditions
that will not lead to recrudescence of his disease. The problem for London is a vast one. Some idea
of its extent may be gained by consideration of the number of London inhabitants who die
annually from this disease. In the year 1901 this number exceeded 7,500, and when it is
recollected that the average duration of the disease is several years it is seen that many thousands
of persons in London are now suffering from this malady.
In an address delivered by Dr. Koch to the Congress on Tuberculosis, held in London
in 1901, he stated that he estimated the extent of infection by the milk and flesh of tubercular
cattle, and the butter made of their milk, as hardly greater than that of hereditary transmission,
and, therefore, he did not deem it advisable to take any measures against it. As the result
of this statement a Royal Commission was appointed to further consider the identity of human
and bovine tuberculosis and the transmissibility of bovine tuberculosis to the human subject.
The Local Government Board recommended sanitary authorities that, pending the report of
the Royal Commission, there should be no relaxation on their part, or on that of their officers,
in the taking of proper measures for dealing with milk from tuberculous cows and with tuberculous
meat which may be intended for the food of man.
The resolutions adopted at the Congress were as follows—
1. That tuberculous sputum is the main agent for the conveyance of the virus of tuberculosis from
man to man; and that indiscriminate spitting should therefore be suppressed.
2. That it is the opinion of this Congress that all public hospitals and dispensaries should present
every patient suffering from phthisis with a leaflet containing instructions with regard to the prevention
of consumption, and should supply and insist on the proper use of a pocket spittoon.
3. That the voluntary notification of cases of phthisis attended with tuberculous expectoration,
and the increased preventive action which it has rendered practicable, has been attended by a promising
measure of success, and that the extension of notification should be encouraged in all districts in which
efficient sanitary administration renders it possible to adopt the consequential measures.
4. That the provision of sanatoria is an indispensable part of the measures necessary for the
diminution of tuberculosis.
5 That in the opinion of this Congress and in the light of the work that has been presented at
its sittings, medical officers of health should continue to use all the powers at their disposal, and relax
no effort to prevent the spread of tuberculosis by milk and meat.
6. That, in view of the doubts thrown on the identity of human and bovine tuberculosis, it is
expedient that the Government be approached and requested to institute an immediate inquiry into this
question, which is of vital importance to the public health and of great consequence to the agricultural
industry.
7. That the educational work of the great national societies for the prevention of tuberculosis is
deserving of every encouragement and support. It is through their agency that a rational public
opinion may be formed, the duties of public health officers made easier of performance, and such
local and State legislation as may be requisite called into existence.
8. That this Congress is of opinion that a permanent international committee should be appointed
(a) to collect evidence and report on the measures that have been adopted for the prevention of
tuberculosis in different countries; (b) to publish a popular statement of these measures; (c) to keep
and publish periodically a record of scientific research in relation to tuberculosis; (d) to consider and
recommend measures of prevention. This Congress is further of opinion that all international and
great national societies, whose object is the prevention of tuberculosis, should be invited to co-operate.
9. That in the opinion of this Congress, overcrowding, defective ventilation, damp and general
insanitary conditions in the houses of the working classes diminish the chance of curing consumption,
and aid in predisposing to and spreading the disease.
10. That the following question be submitted for the consideration of the next congress on tuberculosis.
The constitutional conditions of the individual which predispose to tuberculosis, and the
means by which they may be modified.
11. That while recognising the great importance of sanatoria in combating tuberculosis in all
countries, the attention of Government should be directed to informing charitable and philanthropic
individuals and societies of the necessity for anti-tubercular dispensaries as the best means of checking
tubercular disease among the industrial and indigent classes.
Cancer.
The deaths from cancer in the administrative county of London during 1901 (52 weeks)
numbered 4,203, the corrected annual average for the preceding ten years being 3,843.