THE CAMPAIGN AGAINST CONSUMPTION.* [COMMUNICATED.]
IF you are a reviewer of medical books, you come now and again across one which takes away your breath. It looked as dull as its fellows—all good medical books look dull— and you resigned' yourself to the usual Graeco-Latin jargon ; the usual headings of chapters, History, Pathology, Symptomatology, Diagnosis, Prognosis, Treatment, Results ; and the usual statistics, temperature-charts, and reports of cases. Then, all of a sudden, you are conscious that the book is full of passion, and pity, and the tears of things ; you feel behind the long words the vivid presence of the disease ; and you can well-nigh bear the able young doctor who wrote the book swearing angrily at the poverty of treat- ment and results. Through the thunder of medical phrases comes a human voice ; and before you have time to look round you are deep in tragedy, and hear Death knocking, now at the towers of kings, now at the shanties of the poor. So it is with this admirable book, The Conquest of Con- sumption : an Economic Study. It is written by Dr. Arthur Latham and Mr. Garland; and what they do not know, the two between them, about the cause, course, and statistics of consumption is not worth knowing. Here, in pure and quiet English, we have at last a true economic study of ow country's chief disease. What does it cost us in money, let alone lives and suffering, to maintain " our consumptive population " ? This dreadful fact runs through the book, that we have in England and Wales alone a population of two hundred and fifty or three hundred thousand consumptives, dying at the rate of one every quarter of an hour. What is the cost to the living of so many dying ? Is the money well spent? What return do we get for it.? Are we, with our present knowledge of the disease, or are we not, on the right lines?
We seem to be at, or near, the parting of the ways. We are no longer content with the old system and its vague charity. In former days we left the doctors to fight the disease for us ; and they did what they could. Now, we are beginning to. say that the nation ought to do its own fighting, and if it will not, ought to be compelled. The doctors were our mercenaries ; now, we are talking of conscription, universal service, the whole nation in arms against that host of diseases which we
call tuberculosis. For of course the nature of the disease is the same, whether it be in the lungs or in the bones, joints, glands, or skin. The disease is the bacilli of tubercle, multi- plying in a congenial soil, and manufacturing in the blood, as. in a chemical factory, their special products. A century ago,. Lzennec, the inventor of the stethoscope, discovered, or redis- covered, consumption as a distinct and separate disease, different from any mere inflammation of the lungs. More
• The Conquest of Consumption: an Noonomio Study. By Arthur Latham.,
M.D., and Charles R. Garland. London: T. Fisher Untrin. 8d. net.)
than half-a-century ago, Klencke and Yillemin proved by inoculation of rabbits that it is a communicable disease ; and founded on those experiments our present knowledge. Then came that profound change in the world's way of looking at diseases which was wrought by Pasteur. Finally, in 1881, Koch discovered, isolated, proved, and demonstrated under the microscope the very cause of all tuberculosis, the disease itself there in a test-tube, the actual germs of tubercle, and said of them
"Henceforth, in our warfare against this fearful scourge of our race, we have to reckon not with a nameless something, but with a definite parasite. The conditions of its life are, for the most part, already known; and they can be further studied. Above all things, we must shat-off, so far as we can, the sources of the infection."
In 1890 came the failure of the first use of tuberculin against the disease. That failure twenty years ago of the "old tuberculin " gave way, or rather led the way, to the present
well-judged, well-measured, and well-guarded use of the " new tuberculin," plus the fresh air and graduated exercises of a sanatorium. There is no likelihood that any drug will ever be found to act on the tubercular diseases as quinine acts on malaria, and thyroid extract on myxoedensa. All treatment must be slow, continuous, and closely and wisely supervised. And, above all, the consumptive patient must be treated in the early stage of the disease. The majority of cases that are treated early, and steadily, and with care and good judgment, recover.
But we all know the hard fact, that the consumptive poor in town or country have not a fair chance of recovery. Also we know the length and weariness of the way of their dying, and how the disease chooses the young people, boys and girls, young working men, young nursing mothers. The poor have no time to be ill : they cannot afford to lose a job. Even the visit once a week or once a fortnight to the out-patient department may bring them near to that loss. Therefore the consumptive poor stick to work, thousands of them, till their disease is far advanced, and console themselves with cod-liver oil and tonics. At last they are beaten out of work. Then they put down their names on the long waiting-list of this or that general or special hospital ; and they wait, it may be for three months, before there is a bed. No general hospital is glad to have them, and the special hospitals cannot take a quarter of the cases. In bed, when they do at last get there, they are rested, nursed, fed-up, and patched-up ; then the bed is needed for some more urgent or more hopeful case, and they go out, unfit for work, back to worse poverty than before. They go out, indeed, many of them or most of them, just to die all over again, either in the infirmary or in what they call home. All this time they are more or less infective, and cannot so much as spit in the gutter without charging the air with germs. Often the room where they are dying is the room where the children are living ; and though death removes the chief cause of infection, the very walls . and floor, uncleaned, unscrubbed, may remain, we know not how long, able to infect new tenants.
Dr. Chesney, in her recent lectures—and most excellent they are—at the Battersea Polytechnic on " Tuberculosis and its Prevention," says that in the seventeenth century in France they did notify and isolate cases of consumption.
This prudent method was lost. It is a dismal bit of the history of medicine, these precious facts lost, as if they were of no importance. Then came that long bad period when the consumptives were shut in warm rooms in stagnant air, till at last, from the teaching of Klenoke, Villemin, Pasteur, Koch, and the bitter teaching of experience, the doctors took courage, and the prison doors were flung wide. Sunshine and fresh air were found able, more or less, to kill off the germs, which are the disease; therefore our consumptive population, those who could afford it, were set to' fill themselves with sunshine and fresh air. The discovery of the open-air treat- ment of consumptives is often put to the credit of "common- sense." But this common-sense was the practical application of facts found and proved in laboristories, and the whole College of Physicians was really trooping after Pasteur and Koch. Anyhow, what have the Riviera, the Engadine, and our South Coast done for our consumptive poor ? They go on dying in every infirmary and hospital, every village, and every back street. They are, past all doubt, infective. The hospital accommodation for them is hopelessly inadequate. They cannot afford to go to private sanatoria, nor to stay
there long enough. To help them, all Berta of charities and associations—on the cid-fashioned lines, working apart or in rivalry—do something, but not much. The cost to the nation is colossal, and the money, for want of a clear programme and intimate co-operation, is in great part wasted. Meanwhile the national milk-supply tends to spread the disease, and is crafty dairyman can so " fake " tuberculous cows that the inspector will pass them as healthy.
This review, if it be a review, of Dr. Latham's awl Mr. Garland's book may at least induce the reader to buy and study it. The conquest of consumption, they say, will never cease save by establishment of special dispensaries, compulsory notification, compulsory universal insurance against the disease, rigorous and despotic vigilance over the milk trade, segregation of the hope- less cases, and, above all, unity of our many charitable institutions, corporations, teaching centres, Friendly Societies,. Trade-Unions, and municipal powers into one great standing army. If it were possible to enforce the insur- ance against tuberculosis of every person over fifteen years old at three shillings a year, three farthings a week, it would provide money enough to send every one of our con- sumptive poor, at an early stage of the disease, to a national sanatorium for six months. and to help the family during that period. Then in a few years, when the hopeless cases bad died, we should see the beginning of the end of consumption in this country. Only, we must all work together. But what. Government will help us ? Will any Government dare to handle tuberculosis as an infective disease, or to enforce a scheme of national insurance of all adults ? There is no present hope of any such measures ; it is we who must enforce our scheme on the Government; we must advance on them, like the Reds of the Midi, with a Marseillaise. It should be sung nightly in every music-hall. "To arms, citizens ; up with you on the barricades against the White Death ! So long as we were divided, it had dominion over us ; now we are united, and the day of our deliverance is at hand 1 " Doctors are cold-blooded creatures ; they do not (thank Heaven !) give time to the production of poetry and of music. But they may inspire somebody to write the words and the tune of this Marseillaise, which is urgently needed for the war against tuberculosis. And here in this quiet-looking book are prophecy and vision enough for half-a-dozen poets and musicians.
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