TUBEUCULOSIS IN AUSTRALIA. 557 



solution of which is somewhat elusive. The question is discussed at 

 length by Dr. Bulstrode in his monumental report (and the writer 

 takes this opportunity of gratefully acknowledging a very free use of 

 the material contained thereiij), where the following factors are dis- 

 cussed in turn. Change in the type of the disease, poverty, alcohol- 

 ism, occupation, qua dust, overcrowding, soil dampness, insanity, 

 the passing of the Public Health Act, the discovery of the tubercle 

 bacillus, Housing of the Working Classes Act, commencement of noti- 

 fication of phthisis and sanatoria; and, as a result of a veiy exhaus- 

 tive considerations, he arrives at the following veiy guarded conclu- 

 sion : — ■■' The precise value of each factor must depend largely upon 

 the importance which science eventually attaches to l^ovine tubercu- 

 losis and to case-to-case infection" (loc. cit., p. 99). 



Newsholme discusses the same question with especial reference 

 to — Improved sanitation, improved nutrition of the people in general, 

 education and isolation, and improvement in tlie purity of the milk 

 supply. Newsholme's conclusion is very definite. He says : — " The 

 conclusion to be drawn from these facts is that institutional seoTeg;a- 

 tion, notably of advanced cases, is the most powerful single means 

 Hvailablp for controlling phthisis" (loc. cit., proof p. 27). How will 

 these vaiious factors apply in Australia 1 Poverty, alcoholism, occu- 

 pation, qua dust, overcrowding, soil dampness, Housing of the Work- 

 ing Classes Act, commencement of notification of phtliisis, improved 

 nutrition of the people, will hardly be thought to apply at all in Aus- 

 tralia. Change in the type of the disease and insanity may have 

 some influence, but they cannot statistically be put in evidence. 



The advent of a Public Health A.ct and its theoretical corollary, 

 improved sanitation, cannot have had any influence, as the commence- 

 ment of the decline in phthisis death-rate was uniformly between 

 1883-1888 in the various States, and the dates of passing of effective 

 Health Acts vary from 1890 in Victoria to 1904 in Tasmania. 

 Improvement in the purity of the milk supply : This, per se, is diffi- 

 cult to demonstrate statistically, but Newsholme has arrived at a 

 result indirectly. " We have seen that he (von Behring) claims that 

 infection by cow's milk in infancy is the chief source of adult tubercu- 

 losis." If this be so, then the total death-rate from phthisis ought to 

 be high in different countries, in accordance with the proportion of 

 infants in each country who are fed on cow's milk, and not suckled 

 by their mothers. There are no figures directly dealing with this 

 point, but it is a well-established law that infantile mortality is low- 

 in accordance with the number of mothers who perform their natural 

 duty to their infants. Hence, there should, if von Behring's views 

 are correct, be an inversef relationship between infantile mortality 

 and phthisis death-rate. 



Newsholme then gives a table of phthisis death-rates and infan- 

 tile mortality in various countries, and says: — ''There is, in fact, no 

 such relationship between the magnitude of infantile mortality and 

 that of the phthisis death-rate" (Newsholme, Inc. cit., proof p. 12). On 

 Fig. 1 are set out the curves of the infantile mortality figures and 

 phthisis death-rate for the past 20 years in various States. Tlie 



t It is so sta^^ed in the proof-sheet* of Npw.sholme'.s article; but it would seem 

 that the relationship should be a direct one rather than inverse. 



