1908] on The Present Phase of the Tuhercutosis ProUem. 299 



existing machinery whereby cases are selected for sanatorium treat- 

 ment, and with this end in view every encouragement ought to be 

 given to the poorer classes to seek medical advice at an early stage 

 of their illness, and, above all, nothing should be done, as for instance 

 by social ostracism of tuberculous subjects, to prevent them from 

 seeking medical advice at the earliest indications of illness. Any 

 system which would tend to prevent the recognition of early cases 

 of the disease is likely to defeat its own end by leading to the 

 concealment of cases. 



Here, again, the Germans are much ahead of us by virtue of their 

 admirable compulsory insurance system for the working classes which 

 is in operation in the Fatherland, and by means of which working 

 men earning under 100/. per year are compelled to insure themselves 

 against old age, sickness, and invalidity. 



It is that part of the system relative to invalidity which concerns 

 itself more particularly with tuberculosis, and through its agency, 

 patients are, in effect, encouraged to seek medical advice at the 

 earliest moment. If they are found to be tuberculous, they are sent 

 forthwith to a sanatorium provided out of the surplus funds of the 

 insurance system, and their wives and families are supported in their 

 absence. All this is done without any taint of charity, inasmuch as 

 the workman has, during health, contributed weekly his portion to 

 the system. To all the benefits appertaining to this vast system, which 

 is a standing example to the world of tlie value of self-help and 

 thrift, the workman when ill has a legal and honourable claim, and 

 the effect of this system is to raise the working man into a higher 

 social plane than without it he would occupy. It is admitted on all 

 hands that tuberculosis is largely a social malady, and anything which 

 will tend to furnish to the poor advantages in ill-health which are 

 otherwise beyond the reach of their class, has the effect of attaching 

 them, qua sickness, to a class materially above them. The death-rate 

 from tuberculosis in Germany has, since the introduction of this 

 system, evinced a remarkable fall, and Germans who have paid 

 special attention to the subject attribute the fall mainly to the 

 social organisations brought about by the insurance system. 



Herr Bielefeldt, who has devoted a life-time to the study of this 

 question, writes : " Among all the factors entering into operation in 

 the anti-tuberculosis battle in Germany, the German Workmen's 

 Insurance undoubtedly occupies the foremost place." 



I have myself seen something of this system in Germany, and I 

 have no hesitation in expressing an opinion that a system such as this, 

 if adapted to this country, would exert a marked effect upon; the 

 behaviour of tuberculosis, more marked in all probability than that 

 which would be exerted by any other single factor in the whole anti- 

 tuberculosis programme. 



[H. T. B.] 



