THE ADMINISTRATIVE ASPECTS OF TUBERCULOSIS 5 



families swept away, member after member, each when his day came? 

 Were we not filled with horror at the inherited taint? Did not the 

 insurance companies, do they not still, base their calculations on the 

 belief that a phthisical inheritance ought to mean a loaded premium ? 

 And in some sense, they are perhaps justified. But the countenance 

 began to lighten and the action to grow athletic when it was, again after 

 long research, made clear that tuberculosis is not inherited — that it is 

 mainly a thing of the environment. It is, in fact, a struggle between 

 two organisms, a lower and a higher. The lower is the invader, the 

 parasite ; but the higher has now become the master. The vague hopes 

 of the earlier days are now planted firmly on a basis of definite 

 inductions. The bacillus can be isolated ; it can be killed ; it can be 

 traced into a thousand by-ways ; it can be stopped at a thousand points 

 of its path from one mouth to another ; it does not pass from generation 

 to generation. 



To the administrator, the isolation of the bacillus made the problem 

 simple. To the reformer, the growing belief in the non-inheritance of 

 the disease has offered a new basis of action. The reformer is justified 

 in taking as his objective a possible society without tuberculosis. The 

 administrator has now to devise the methods of attaining that end. 



II. Tubercular Death-roll for Scotland. 



How does it stand with Scotland ? Here I have no case to prove ; 

 I seek only to indicate what can be done. But a single figure may be 

 taken as a starting point. For the present period, some six thousand 

 persons die in Scotland every year of pulmonary phthisis ; some four 

 thousand die of other forms of tuberculosis. These figures are probably 

 less than the truth ; for good as our methods of diagnosis are, multitudes 

 of cases still escape scientific scrutiny. Probably, five times ten thousand 

 gives some approximation to the number of tubercular persons living in 

 Scotland. In this, however, our data are still insufficient. But for our 

 present purpose one solid fact is enough — ten thousand persons die of 

 tubercular diseases, and a vast number will soon follow them. The 

 administrative problem is how to delay for the longest possible time the 

 death of the infected, how to reduce the number of possible infections, 

 how most rapidly to convert a widespread plague into an occasional 

 outbreak. 



{79) 



