A SANITARY OUTLOOK 353 



act its poisonous products, or reinforce the phagocytes in their attacks 

 on it, but meanwhile sanatorial treatment gives expectations of recovery 

 greater than those of any other kind of treatment that is known to us, 

 and it seems to me inexpedient to say anything which may discourage 

 the benevolent from putting it within reach of the poor and needy, or 

 hinder the poor and needy, stricken with tuberculosis, from taking 

 advantage of it. Even if sanatorial treatment were not superior to 

 home treatment in the number of cures it effected, it is still deserving 

 of support because it withdraws, for a time, from their own homes and 

 from places of public resort persons who are jets of deadly dust, and 

 thus diminishes the diffusion of tuberculous disease. And surely even 

 the arrest of the disease, which Dr. Maudsley admits is secured by sana- 

 torial treatment in advanced cases, is worth having. Even a damaged 

 life is sometimes sweet to its possessor and precious to those who hold 

 it dear; and it will be a sad day for humanity when the prolongation 

 of life under all circumstances ceases to be the chief aim of the medical 

 profession, and when euthanasia procured or suffered, is recognized as 

 a justifiable mode of exit from the sick room. But beyond all this, 

 even in hopeless cases, in which no arrest is secured, sanatorial treat- 

 ment is not without its merits, for all patients who have undergone it 

 return to their homes educated in the procedure that is necessary to 

 make them innocuous to others, and trained how to deal with their in- 

 fectious expectoration, and thus again the propagation of the disease 

 may be in some measure limited. 



But Dr. Maudsley is not only sceptical about sanatorial treatment, 

 but apparently doubtful of the wisdom of any sort of curative treat- 

 ment in tuberculosis. The ordained function of the bacillus in the 

 universe is, he suggests, to make away with weak humanity. The loss 

 to the community by the death of consumptives is not, he hints, as real 

 as is imagined. " Might not the ultimate cost to the commonwealth," 

 he asks, " be greater, were those persons allowed to go on living and 

 breeding in it." The assumptions here are that consumptives inevi- 

 tably breed consumptives, and that the tubercle bacillus invariably 

 fastens on weak humanity, and both these assumptions are erroneous. 

 Recent inquiries have shown that the influence of heredity in consump- 

 tion is not so great as was at one time believed. Dr. Claud Muirhead 

 found, after an elaborate investigation, and with peculiar facilities for 

 arriving at the facts, that out of five hundred and twenty-four cases of 

 death from phthisis, only one hundred and twenty, or 22.89 per cent., 

 presented in their family history distinct evidence of direct phthisical 

 taint, and other 62, or an additional 11.83 per cent., exhibited a sus- 

 picious family history of phthisis. That is to say, at the very outside, 

 only 34.72 per cent, of these five hundred and twenty-four persons who 

 died of consumption, exhibited in their family history any evidence of 



vol.. i>xvin. — 23. 



