The Great White Death

New Zealand Graphic, Volume XLIV, Issue 2, 12 January 1910, Page 2

The Great White Death

THE NATIONAL, MENACE OF CONSUMPTION

Remarkable Address by

the Rt. Hon. John Burns

The Right Hon. John Burns, M.P., President of the British Local Government Board and a member of the present Liberal Cabinet, gave a very striking aldresa at the opening of the Whitechapel Tuberculosis Exhibition in London recently, from which ice take the remarks following. Mr. Burns, is an ardent housing reformer, and has done much to promote .healthier habitations, open spaces, mori sunlight, and purer food in the homes of the British millions.

YIY HIS disease, called appropriately ‘‘The White Scourge,” but in my I judgment more beautifully expressed by John Bunyan, who called consumption “The Captain of the Men of Death,” has been challenged in its stronghold in recent years, is being fought, and ought to be subdued by all responsible authorities, societies, and individuals. Happily, Britain leads in this crusade, and, true to its public health traditions, it must accelerate its power of attack upon this evil, which has existed too long. In the past forty years tuberculosis has been reduced some 50 per cent. In the past . thirty . years great advance has been made in the methods of its treatment, and in the past five years the greatest progress of all has been made; Every year the world loses 5,000,000 of people through the scourge of tuber-

culosis. Remember that figure. A London perishes annually from one disease, tuberculosis. Britain loses a population from death by tuberculosis equal to the annus! extinction of a town like the City of York—some 80,000 people—and numbers nearly equal to the combined populations of Oxford and Cambridge are W’iped out every year. And here is an extraordinary figure -with which I conclude the statistics on the subject. In the six years ending 1903 for seventy expeditions and one or two wars, there have been fewer ofliciers, soldiers and sailors killed and wounded than there are deaths from tuberculosis in England in one year, and the hundred years of European war, with all its horror, with al) the burden of death and sickness that Napoleon and others imposed upon the Continent in ’ the last century—-all

that loss of life is eclipsed by only thres years’ bills of mortality of the whole world from consumption and its attendant complaints. Apart from the direct loss in death and sickness, there is another loss, an indirect loss—a widowhood, an orphanhood, a loss on the dependents of the bread-winner who is taken away —which is enormous. Nearly three-fourths o£ the deaths from consumption in London occur between the ages of twenty and fifty-five years. No wonder it is thafi 40 per cent of our total pauperism, in and out door, is due to widowhood and to orphanhood. It is probable that one out of every three widows under sixtyfive who becomes chargeable to the Poof, Law or to some form of public funds, becomes so as the rtsult of consumption. This is more clearly understood when it is known that from some areas where casual labour, bad hovsnig, ami

heavy drinking permits, 60 per cent; were paupers because they were consumptives. It is' difficult to estimate* the economic waste, the social loss to society, to relatives, trade unions, and friendly societies, by the sickness, death, and disability that this complaint causes. It means countless millions in moneys it means health — the only wealthwasted to an incalculable degree. Whafi is more, it affects the temper, it depresses the spirit, and it clouds the outlook of everyone who sees thia dread complaint in process of exhausting th® individual. Now there is no single eause for the ravages of consumption, but the chief cause is social inequality. Generally speaking, consumption is the child of

poverty, the daughter of ignorance, the offspring of drink, the product of carelessness. It can be fought by many forces in many ways, led by general Ijvellibeing, higher wages, theap and abundant food, better housing, increased Sobriety. As pauperism diminishes consumption declines; as food cheapens jEubereulosis disappears. The cost of food, its abundance and its variety, has great influence on the decline of consumption. Except where bad housing and drink counteract the effects of high (wages and cheap food, tuberculosis recedes as the general standard of comfort advances. Apropos of alcohol, I have this to say:' It is a fact, as three celebrated doctors Say, that alcohol predisposes the individual to tuberculosis by its paralysing action and its asphyxiating influence on Ithe cellular protoplasm, which is no longer in a condition to resist the invasion of a parasite. Professor Brouardel Bays the public-house is the purveyor Of tuberculosis. In fact, alcoholism is the most potent factor in propagating

consumption; and a celebrated French doctor. Professor Baudron, says it is now generally admitted by those who know, that the most potent factor in the spread of consumption is the publie-house. In all probability at least one-half of all cases of consumption are due to infection in the publie-house. Where twelve litres of drink are consumed, there is 32 per thousand; where thirty-five litres per head are drunk, there it is 107 per thousand. After those figures it is not necessary on the statement of authorities like these to dwell any further upon the evil that drinking habits have upon the predisposition of the people to consumption and tuberculosis. Now I come to one or two more direct and practical proposals for combating consumption, and it is mainly by the common-sense of most, operating through immediate, personal, practical, and direct remedies, and often small things, that tuberculosis can be most effectively combated. Let me give one or two illustrations. Infection of healthy people by the sputum from consumptive victims is one of the most prolific sources of this disease. Anyone who goes through the streets of London will see, and must

admit, that this is less so than formerly. It is less so than formerly, but it is even now very bad in certain districts. In London there is little, if any, excuse for this practice in the streets. There are over 100,000 public spitoons in the streets of London. Let me repeat: there are over 100,000 public spitoons in London that are very rarely used. There are fifty for every mile of street in the Metropolis of London. They consist in the ever-open, night and day, street gullies in the gutter. These should be increasingly used by asthmatic, bronchial, and consumptive people, and I hope the day is not very far distant when to this shall be added as an auxiliary what I saw with delight and pleasure, as an engineer, in Salt Lake City three years ago; that is, to dampen the dust, and dispose by water of the detritus that flies about everywhere—'that is, the dust which increasingly is lifted off impermeable street pavements, more so than with the old granite or flint macadam, into the gutter, and through the absence of water to retain it in the gutter; it is blown about the pavement into the mouth, eyes, ears and nose. I hope the day is not far distant when the wealthiest city in the world, which is rapidly becoming the

healthiest city in the world, will be able to command such a generous water supply, as in Salt Lake City, as to have a continuous trickle of water running down every gutter, night and day. And I am convinced of th«, that if that were done, not only consumption, but a number of other infectious diseases would be considerably diminished many of them removed. Now I come to a practical remedy; that is the abolition of the comfortel and the soother. This is a very serious thing. The bomb, the pistol, and dynamite have killed their scores, but I believe the comforter has killed its tens of thousands of little children. What is more, doctors tell me that it subjects, apart from contagion, the baby’s mouth and throat to malformations that disclose themselves in subsequent years. I am told this is—and I believe it is— a special cause of bad teeth. Later on it means impaired digestion, and the relationship of impaired digestion and consumption between 20 and 45 years of age is a very serious one. 1 express it as my opinion as a layman, that to a great extent the comforter or soother is responsible in many cases for adenoids, which we are told is an increasing complaint. I would endure the charge of

b»ing a Wmuchil with pleasure and with equanimity if with one order I could make the comforter a public nuisance, and schedule it as a dangerous instrument for the children of our town and cities. Now 1 come to one or two other remedies. Recently, in London particularly, we have seen a housing crusade. Well, it is a good crusade. The consumptive is found in the slum, the tuberculosis person in the back-to-back house, ami in London I am glad to say that buFlders have taken our advice, which 1 have publicly given them in and out of season, in never building new houses in London with the damp and dirty basement that has made more consumptive “slaveys,” more tuberculous general servants, who have to live in the gas, with their front window opening on the dustbin, and the back kitchen window probably on a damp and airy court or area, than anything else. The damp and dirty basement of the house has got to go. The intolerable cellar dwelling, I am glad to say, is doomed, and I welcome as one of the indirect remedies against disease among woman and work-girls the abolition of home-work, the institution of a minimum wage by the Trades Boards Bill; ami by all means let us encourage the Home Office to get rid of the insanitary factory and workshop increasingly as the years go on. Wherever there is little light, wherever there is damp, or wherever there is dirt and laziness, tuberculosis finds its lair, ami I beg all of you to remember that cheap food is essential to the decrease. What is more, 1 say here, not being a doctor, that in my judgment a good kitchen is the best pharmacy, a good table the best doctor, and cleanliness is the best cook: and as food decreases in price the tables of tuberculosis generally respond by diminution. Now, what have we all to do in this crusade against consumption? First, the Government has got to lead the way. •My department is particularly responsible for this particular portion of public work. What has it done? What is it doing? What is it going to do? We believe we have done a great deal by our Food Regulations Bill to stop unsound meat coming into this country, and tuberculous meat. We believe that by the more rigid administration of that bill ami the Food and Drugs Bill, through the agencies of the local authorities, who I am sure will co-operate, much good can be done. I hope we shall have our Housing Bill upon the Statute Book, and that by wise! planning of towns, the better laying-out of new communities, we can avoid the organic defects of our big towns and cities, that are the result of prescient co-ordination and arrangement of places where people shall live. [ am glad to say that our Milk Bill has been more favourably received than 1 had ever hoped it would be, and that the Milk Bill, coupled with the excellent Tu4x‘r<ulosis Order issued by the Board of Agriculture, ought to do a great deal in the next few years to diminsh tuberculosis in particular, and infant mortality in general. The crusade which has taken place against infant mortality has already shown itself in a wonderful diminution in the last three years. May I illustrate the progress that has been made? In thirty years my own parish has trebled its population and halved its death-rate; reduced it from 26 per thousand to 13 in 30 years; and in the last ten years the infant mortality of Battersea has dropped from 163 to 107 per thousand births. Do you know why mainly? Parks and open spaces, anti fewer public-houses than in nearly every other parish in the whole of London! That is not an accident. Medical inspection by the Board of "Education, if developed and stimulated as it ought to be. will do an enormous amount of good, and I trust I shall be able to issue soon a circular to follow up. if I may say it, our great Notification of Tuberculosis Order that was issued in January of last year—l hope to issue a circular to poor law authorities on the conditions of the receipt of poor law relief by outdoor consumptive recipients, accompanying that with methods of selftreatment, removal perhaps to another place, advice anil guidance, perhaps other and extended help, all in the direction of cure ami prevention, which we have made up out mind to do. Now may I be allowed to give you another reason why we lead in fighting consumption in Txindon? It i« a simple but signifn-ant fact; it is due almost to an accidental cause. The isolated treatment of advanced cases in Poor law infirmaries has been a great factor in reducing consumption in Ix>ndon. What

docs it do? It removes the ease of infection at the most dangerous period from the poorest tenements; it is helpful to him, and it removes contagion from others; it saves the family from infection, it helps the breadwinner to recover, and by the segregation of consumptive patients in our poor law infirmaries, England has been put at the head of the crusade against consumption of the countries of the world. Now, this must be extended and improved upon, from humanitarian as well as from social and preventive reasons. When I tell you that 35 per cent, of the total deaths from tuberculosis in all London take place in our poor law infirmaries, you have an idea of the extent to which segregation in the poor law infirmary, by proper treatment, has made London lead in this benevolent crusade. What other remedies are there, apart from the sanitary, the medical, the State, and the municipal? 1 repeat: higher wages, with wiser spending; less drink, less betting, the money spent on both to go to the home, the wife, and family; better food, more house room, or more leisure in the shape of rest and holidays; above all, employers of labour, more regular work. It is not more artificial work we want, it is not more work we require; it is the better organisation and regulation of the total work which is now imperfectly, improperly done, in an unorganised and thoughtless way. And one of the best things that rich men eould do—one of the wisest things that captains of industry eould do. would be to raise the wage, give regular employment, as a means of fighting the disease, and even of protecting himself, to the general labourer, the casual labourer, the charwoman, and the poor, lone widow in the Qstreets of London, who puts up a brave, noble, and enduring fight on behalf of the children of whom she is the protector. Raise their wages, till up the swamps of low wages by puuting down the peaks of disproportionate, unorganised, and wasteful expenditure on the part of foolish individuals. My last word, my summing up, is this: Consumption is a house disease; we are here for simple remedies—here is my summary. Consumption is a house disease, almost it is a bedroom disease, and preventable. It is hereditary only —and this is the glad tidings the doctor conveys to us—so far as predisposition is concerned. Spitting is the chief cause; dust is a carrier of infection; milk a source of contagion mainly amongst children: want of light, air, and sunshine, foul air in bedrooms, courts, alleys, and living rooms. The best, simplest, cheapest remedy is to open your windows day and night- Sir William Broadbent, shortly before he died, came to see me, and when he was ill he put his hand on my table and said: “Mr. Burns, if windows were kept open day and night, if many of the simple remedies were carried into effect, consumption might be stamped out in a generation.” Consumption is not so deadly as feared if early and adequate precautions are taken. The Germans say that everyone at the end has a touch of tuberculosis — another way of expressing what the post-mortems prove, that many have it and most recover from it. It is a question of dosage; if repeated under bad conditions the last dose is worse than the first; if disregarded, fatality may ensue, and if combated in its early stages by fresh air and the best of all disinfectants, which does not want a Government inspector to testify its purify—namely sunlight—it can be resisted, subdued, and, I believe, ultimately removed.

“Generally speaking, consumption is the child of poverty, the daughter of ignorance, the offspring of drink, the product of carelessness. . . . Every year the world loses 5,000,000 people through the scourge of tuberculosis.”