8 QUATERCENTENARY STUDIES IN PATHOLOGY 



this we are now able to add direct methods of cure. When cure and 

 prevention can, as they ultimately will, work perfectly together, 

 tuberculosis will fall back to the social status of plague and cholera in 

 the western world. 



How this end may be attained, the pioneer agencies in every land 

 have already shown us. The curative side has been made manifest by 

 the rapid growth of the Sanatorium. The preventive side has yet to 

 receive its full share of attention. Here I propose to indicate how, with 

 our present legal resources, we may, in Scotland, turn our official 

 battalions against Pulmonary Phthisis, which is, for practical purposes, 

 the only grossly infective variety of tuberculosis. 



Let it be assumed that there are three, roughly separated, classes of 

 cases — incipient cases, intermediate cases, and advanced cases. Let it 

 also be assumed that each case runs an irregular history, varying from 

 weeks to years. Let it still further be assumed that thousands of 

 patients, though affected in varying degrees with the disease, are yet fit 

 to pursue their callings and to maintain economic independence for 

 years. Here we have all the factors of the administrative problem. 



To meet these what have we administratively ? We have sanatoria ; 

 general hospitals ; infectious disease hospitals ; poorhouse hospitals ; 

 methods of disinfection ; educational organizations ; housing improve- 

 ment schemes ; improved drainage, water and ventilation ; inspection of 

 factories, of workshops and of work-places ; vast legal powers for the 

 removal of nuisances, the prevention of overcrowding, improvement of 

 house structure, selection of house sites, cleansing of houses, cleansing of 

 persons, the isolation of patients, the supervision of dairies and the 

 milk supply, the examination of cows, the destruction of tubercular 

 meat, the maintenance of paupers and their dependents, dispensaries, 

 and many other minor powers and organizations. To see that the 

 laws are effectively applied for all these objects we have the local 

 authorities for public health, that is the town councils in towns and the 

 district committees in counties ; we have the parish councils, who must 

 deal with phthisis as one of the largest pauper-producing agencies. 

 In the sequel, I shall show how these official and unofficial agencies 

 may be brought into perfect correlation and so secure that one vast 

 organised army shall march forward to the extirpation of the enemy. 



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