TUBEECULOSIS IN AUSTRALIA. 559' 



active, the Kefonn Bill was seriousl}- introduced, and the whole decade 

 culminated in what Justice McCarthy calls "Reformation in a flood," 

 which reformation included the Elementary Education Act. It may 

 fairly be said that about this time there was a great awakening of 

 intelligence among the lower classes — the classes chiefly affected by 

 phtliisis — and this awakening brought with it a complete change in 

 the social system of Englantl. ]\Ien of all classes began to grapple 

 with many evils which they had previously passively regarded as the 

 '■ will of God." I have put my idea veiy inaptly : but what is intended 

 to be conveyed is that the same fundamental cause — the awakening 

 intelligence of the English nation as a whole — is responsible for the 

 rapid progress that England had made in internal affairs, including 

 sanitary reform as a whole, the institution of sanatoria, the lessened 

 incidence of phthisis, and, possibly, even the rapid diminution of 

 typhus. As Sir Shirle}- Murpliy has stated concisely in his Annual 

 IJeport for 1904: — "Phthisis in large degree is a disease of poverty, 

 and in so far as the social condition of the j^eople is improved, the 

 risk of being attacked bj^ phthisis is lessened for all." 



"Dr. Xiven, in his Annual Report for 1906, after analysis of the 

 principal causes which are likely to have promoted a remarkable 

 decline in pulmonary tuberculosis in England and Wales, regards as 

 the chief factors the great advance in material w-ell-being of the work- 

 ing classes, extending over the whole covmtry, and producing increased 

 resistance of the disease."' (Bulstrode, loc. cit., p. 103.) 



The marked exception to the happy unanimity in tliis record of 

 falling phthisis death-rate is Ireland, where there is as yet no awaken- 

 ing intelligence, but merely a dull lethargy. In Australia apparently 

 tlie improvement coincides in its beginnings with the discovery of the 

 tubercle bacillus. I am inclined to think that this coincidence is not 

 merely fortuitous, but that a definite relationship exists, and that the 

 experience of Australia coincides with that of Grermany in this respect. 

 As a practical point, there can be no question tliat Newsholme's con- 

 cluding remark, quoted, above, " that institutional segregation, notably 

 of advanced cases, is the most })owerful single means available for con- 

 trolling phtliisis" must be adopted, but I should prefer to see added 

 some extension of the dogma providing for the persistent and wide- 

 spread education of the community at large. The necessity of such 

 measures is well recognised by the Countess of Aberdeen and her 

 advisers in Ireland. Dr. Newsliolme has, of course, realised the need 

 for sucli education, as his procedure when medical officer of health at 

 Brighton fully shows. It is certainly by S3'mpatlietic administration, 

 but always through the people, that effective sanitaiy progress is 

 olitained. The economic aspect of phthisis is a grave one. Dr. 

 ilerman Biggs (1903) places the expense of tuberculosis to the people 

 of the United States at £66,000,000 annually. 



Newsholme ("The Prevention of Tuberculosis," p. 20). — If, how- 

 ever, we assume that only one year's disablement is caused by every 

 fatal case of consumption, then the direct loss per annum in England 

 and Wales produced by the death of men aged twenty to sixty-five from 

 consumption, reckoning wages at £50 per annum, judging by the 

 experience of 190+, amounts to £1,015,4.00. This is the loss in wages, 

 reckonetl at the above rate. No allowance is made for the cost of 



