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they live, or because they obstinately set aside the simplest
rules for the prevention of infection, are a danger to their
companions. In some way or other we must look after
these sick people, either by procuring for them more
favourable conditions, for example, as regards dwelling
places, or by so sheltering them in suitable institutions
that they cease to be a danger to their neighbours.
"After the experiences we have had of other infectious
diseases, we must come to the conclusion that in no
other way can anything be attained, and therefore I should
like urgently to advise that for the future this task
should be kept to the fore in the battle against tuberculosis
until it has been accomplished."
Evidently the new departure undertaken by the Richmond
Board of Guardians is one which is bound to be followed in other
districts.
When it is remembered that tubercular disease slays 61,000
persons every year in England and Wales—an awful total of ten per
cent. of all the deaths—(Richmond 1902 of the 426 deaths, 42 were
due to tuberculosis), while under ordinary conditions all other
infectious diseases, including small-pox, account for but a third of
the toll exacted by tuberculosis in its various forms, the duty of
public bodies charged with the protection of the public health
becomes obvious.
Further arrangements however, are required, as it is of very
great importance that the individual, before he becomes a pauper,
should be able to obtain the advantages of the open air treatment
immediately the nature of his disease is diagnosed. As soon as the
patient is well enough he should be instructed in gardening or
farming—in connection with an Institution—and thus avoid having
to return to the occupation and surroundings which he has already
proved are a source of danger. Once having recovered, by following
an outdoor life, either in this country or in one of our colonies, and
by exercising reasonable care, in the majority of cases the cure
would be permanent.