1908] on The Present Phase of the Tuberculosis Prohlem. 285 



In each case it is relatively stationary. But it must be borne in mind 

 that the term " pauperism " is liable to be a misleading one, unless the 

 user of the term is very familiar with the history of pauper adminis- 

 tration, and that oscillations in the curves of indoor, outdoor, or total 

 pauperism, may be produced by forces other than poverty ; they may 

 be produced, in fact, by a stroke of the pen in the shape of a 

 departmental memorandum relaxing or tightening the administrative 

 strings which govern the distribution of indoor and out-door relief, 

 and which attract into or repel from the net of pauperism a large 

 floating margin which suffices to materially influence the curves. 



But I am assured by those who are masters of the history of poor- 

 law administration in this country, that the curves of pauperism indi- 

 cated upon Chart III. do, having regard to the numbers dealt with, 

 sufficiently indicate the true position of affairs. 



My main object, however, in touching upon this question of 

 phthisis causation, has been to bring out the fact that the disease may 

 be attacked by indirect (social) measures aimed at promoting the 

 resistance of the host, as well as by direct measures aimed more 

 particularly at the circumvention of the bacillus. Indeed, the history 

 of tuberculosis in this country suffices, I think, to prove that the 

 effects of indirect measures have already been very great. 



Such indirect measures have involved mainly better social condi- 

 tions which have meant a greater approximation of the poor in the 

 matter of resistance to the conditions of the better-off. This approxi- 

 mation has not only meant an increased resistance and diminished 

 opportunities for the development of the disease, but also better 

 opportunities for the recognition and treatment of the disease, which 

 have resulted in a diminished death-rate. The recognised and 

 intimate association between overcrowding and phthisis clearly indi- 

 cates that the diminution of overcrowding in our large towns must 

 have exerted a beneficial effect upon the death-rate from tuberculosis, 

 and one of the most hopeful lines of attack is obviously to be found 

 not only in still further diminishing overcrowding, but by means of 

 such legislative measures as Mr. Burns' Town Planning Bill to pre- 

 vent in the future the erection of conditions in which overcrowding is 

 associated with the absence of light and air. Provisions such as are 

 embodied in this Bill will have the effect not only of diminishing 

 tuberculosis but also other diseases, and, apart from specific diseases, 

 of inducing that condition of individual well-being which is as much 

 to be desired as the absence of certain infectious diseases. 



In dealing with tuberculosis, we are presumably concerned with 

 a receding foe, and the problem which we are now called upon to 

 solve is how best, by direct and indirect means, are we to accelerate 

 the decline of the malady. There is, doubtless, need for far more 

 co-ordination between the several anti-tuberculosis forces than is at 

 present the case, and such forces could, it seems to me, best be 

 co-ordinated in the office of the medical officer of health. 



