THE REPORT OF THE BRITISH LOCAL GOVERNMENT BOARD ON TUBERCULOSIS & SANATORIA.

Auckland Star, Volume XXXIX, Issue 67, 18 March 1908, Page 6

THE REPORT OF THE BRITISH LOCAL GOVERNMENT BOARD ON TUBERCULOSIS & SANATORIA.

■ 9 BY R. H. BAKEWELL, M.D. (Author of "Some Common Causes of Consumption."' etc.)

There are some occasions on which iCSSay be correct, but very ill-natured to say exultingly, "I told you so:'' There are others when it ia not only legitimate to say so. but it is really a duty to assert oneself. For years I have iven doing my little best to counteract the scare that has been set jioing by the Health Department of this colony about the infectious nature of pulmonary consumption. 1 have mere th.iri once mentioned the investigations carried out by Dr. (.'. T. Williams, one of the consulting physicians of the Prompt on Hospital, for consumption and diseases of the chest, into the life histories of 900 servants, nurses, medical officers and others in contact with the .-ick inmates of that Hospital, and his triumphant proof that a smaller proportion of • hem became consumptive than that of the general population. I have defied any person to bring forward one single ca.-e in which a healthy person had been infected l>v the bacillus of consumption -nnveyed from a person suffering from the disease. 1 have ridiculed the absurd precautions that we were exhorted to lake against infection, and mine has been vox c-la mantis in deserto. 1 have been looked on as old-fashioned, as not up-to-date, and the scare has gone on until at last one was afraid to cough if a numb went down the wrong way. and places in which a consumptive patient had resided for ever so short a lime, had 1o be srrnhhed and disinfected as if someone had died of smallpox in them. Now. the popular voice in England and all English-speaking colonies has always been very strongly heard in all cases of really infectious diseases. Let anybody try to .net help for a person suffering from smallpox, scarlatina, erysipelas, ty- J phoid or enteric fever, diphtheria, or the. like, and he will soon line! out that he will have to pay very highly for such help. even if he can get it at all. outside the family. I have known, frequently, per- j sons thrust out into the public srreel with smallpox on them. But there is not, and never has been, any such feeling with respect to tuberculosis. I'remember i in my younger days we used to laugh at the Italian physicians who considered consumption an infectious disease, and were indignant when we neard of innkeepers refusing to receive consumptives as boarders. i There were unquestionably cases in i which a near relative, a wife or sister, I anxiously attending and nursing a con- ; sumptive patient, had contracted the dis. \ ease, but these were easily explained. I Such attendants were, even if healthy to begin with, soon reduced to that statu of debility and anaemia in which they would naturally be liable to a disease ' . w.hich was essentially one of slow de- j gradation of the tissues and secretions of:_ the body, If blood relations, they had probably the same tendency to tuberculosis as the persons they at- , tended. In those days, moreover, the i necessity for perfect ventilation and abundance of fresh air was recognised by few. physicians, and hardly at all by the | public. .Every effort was made to ex- j cinde draughts of cold air. and the at- | mosphere of the skk room was rendered ! poisonous by the quantity of breathed . air it contained, and by the decomposi.tion of the sputa coughed up by the! pajtient. In addition to these dements of danger, were the anxiety a___, mental j distress caused by the gradual or vapid increase of the disease of one who was' very dear to them, and the feeling of . despair which then was lnviriablv the ' result of the verdict of "consumption,"! when it had been pronounced by the physician. I can well v.menilx'i- that j some years after I had become a quali- \ tied practitioner. I told the medical man to whom I had been ap- ! pTenticed- that I had cured several ca=es j oi consumption: he merely laughed at mc. and said "if they were curoci they ; were not consumptive, for ii tubeiele j had once been deposited it t-ouid never, be cured." I When I first came to this colony. and , was practising in Dunedin (in 187?), I' was astonished at the number of consumptive cases I was called in to ex- . amine. Having seen in the West Indies the deleterious eEects of ill-ventil-1 ated rooms, and overcrowding at night among the negroes, 1 soon found that the saane causes were at work in Dunedin. The houses were nearly all very small,- the bedrooms contained' often three or four bunks; there was no ciiianney; the doors were invariably shut at night, and the windows, with very few exceptions, could only be opened by the lower sash bein° raised a few incises, and propped up by a piece of wood! This was to save tho expense of pulleys and weights. The con- j sequence of this, state of thing 3 was ! that as the nights were nearly always cold, the inhabitants of the room virtually breathed again and again the same foul air, which was only slightly purified by the air that crept in under or above ' ill-fitting doors and through tears in the wall paper. The rooms were very rarely plastered, and the> paper was pasted on ! ''scrim.'' It was these gaps in the paper that saved these sleepers from, suJfocation. I read a paper at the Otago branch of the New Zealand Institute, which I 1 subsequently published as a pamphlet, i on "Some Common Causes of Consumption." In this I denounced in pretty j forcible language the abominable prac- ' tic-e of keeping door and windows shut in bedrooms, especially as there was never any chimney. The pamphlet had such an effect that I believe no houses were subsequently built without sashes: that opened both top and bottom, and j many persons had their windows altered ' and kept the door wide opened all ! night. The absolute necessity for almnd- ! ance of fresh air in the treatment of con- j sumptives I have always strenuously advocated. The Medical Department of the Local Government Board in England has, it \ appears, by the report just issued, of j which a- summary was received by the ' last mail, for lhe last six years been I carefully investigating the subject of' consumption, and the- result, have been published in a long and very interesting I report, illustrated by photogravures, and containing many very interesting and valuable statistics. The report is made by Dr. Bulstrode, r£ n i. ? e P artmen tal medical officers. 1 Dr. bulstrode has had a most distinguish- : c. rueer , s a M.A. and Doctor of Mcdi- I .cine oi the University of Cambridge a Doctor oi Public Health, a Licentiate'of l the Lena, College of Physicians of London and v Member of the Royal College iof Surgeons of England. He has done ttiwh. and very valuable woik as an, In-

spector of the Local Government Board, and has published other articles besides his official reports, in the medical periodicals. His name and official position are sufficient to ensure a careful and respectful consideration of the conclusions to which sis years of study and investigation have led him. In the first place, Dr. Bulstrode proves that "the magnitude of the e\il has been greatly overrated, and that consumption. or tuberculosis of the lung, instead of threatening to become a cause of increased mortality, has for many years been steadily declining. In the year IS3S it destroyed in England and Wales 50.02.5 lives, a mortality equal to 39.9 for each 10.000 persons living. In 1006 it destroyed 3!) .746 lives, a mortality equal to 11.1 for each ten thousand persons living." What do you say to that. Dr. Malcolm Mason? From 1855 each decennial period has been marked by a steady decline in the mortality, "from 30 in 10.- ---| 000 in 1855, to 25 in 1865. to 22 in 1575. Ito IS in 185.5, to 14 in ISOS, and to 11..3 in 1905.'' "The Times,'' from whose leader, I quote, goes on to say: "If the rate of decrease of those thirty years were to bo continued for thirty more,'the disease 1 would totally disappear, and be extinct nt the end of the period, following in this respect . . . leprosy, relapsing and typhus fevers, and the fevers communicated by mosquitoes, all of which have. i Dr. BuUtrode points out, "for the time, 'at least, disappeared from this country."' 'What do you say to that. Dr. Mason? Why all these terrifying notices about in- | fection. if the disease is rapidly deelin- ' ing ? Dr. Bulstrode goes on to say that j consumption is far less fatal than is generally supposed, and that "large num. i bers of persons, dying from other diseaj so?, present unmistakable evidence oi j having been infected by it at some unknown earlier period,'' and of having in point of fact been cured. 1 could have told him this fifty-five years ago. when i was making post-mortems at the Middlesex Hospital, and saw numerous cases of lungs that had been the abode of | tubercle, which had thrown off the dis- | ease, and cicatrised. | Dr. Bulstrode asserts that the liability jlo direct infection through the respirai tory passages, and then freely inhaling the bacilli expelled by patients, "is bc- | lieved to have been seriously exaggerate j cd." and it is maintained by many pa- ■ thologists that persons are more freI quently : nfected by niilk."or in the Mesh oi j bovine animals." In other words, the I danger of becoming consumptive by sim- \ ply visiting tuberculosis patients is very ! slight, and what we have mainly to guard I against is milk and beef that contain tubercle bacilli. I For myself. I think the bacilli have nothing to do with the formation ot tubercle in the lungs, any more than i i think the mould on a piece of leather cxi posed to the damp and heat of the pre- | sent week, has anything to do with the I formation of the leather. I bplieve fur- ; ther investigations conducted by impartial men. when the present microbie craze | has subsided, as it certainly will do will show that the bacilli of tubercle i are deposited there simply because they find in the decaying and dying epithelium cells, a suitable soil for their growth ami development, just as green mould doe= on damp leather or on cheese under cerj tain conditions of temperature. I I cannot give more space to an analy ] sis of the. articles in Dr. Bustrode's re i port, which I have had to take from arti , cles in "The Times," "Lancet,"' and "Brii tish Medical Journal." but it may lv j well to point out that Dr. Bulstrode ! does not. think that the establishment ]of sanatoria for consumptives "has pro ! duced any perceptible effect upon the 1 rate of decline of consumptive mortality either in England and Wales generally Jor in the counties possessing such insti- ; tutions as compared with those that arc I destitute of them." He gives statistic- . supporting this opinion. 1 intend to gel a copy of this report, and when 1 do iif 1 am alive. 1 hope to be able to harass I Dr. Malcolm .Mason a little more. j Dr. Bulstrode urges a nettor supervision -sion over dairy farms, and the supplies oi I meat, as the chief factors in the propagaj tion of tubercle. i Onehunga, March 15, 190 S. I 1 .