10 QUATERCENTENARY STUDIES IN PATHOLOGY 



pauperism. But among the causes of pauperism one of the chief is 

 Pulmonary Phthisis. And, as it is the duty of the Parish Council to 

 take medical charge of the sick, they must incidentally treat phthisis. 

 This they cannot do without proceeding, to some extent, on the modern 

 lines both of prevention and of treatment, and on those lines they have 

 largely proceeded. For several years the Local Government Board 

 for Scotland have, through their Superintendent of Poorhouses, 

 systematically year by year inquired into the methods employed 

 in the Poorhouses for the isolation and treatment of phthisis and 

 other forms of tuberculosis. The result has been that, in the 

 majority of the 6g Poorhouses, segregation of phthisical cases is more or 

 less completely carried out. In several, the open-air methods have 

 been organised. The cases isolated are usually chronic, advanced and 

 dying cases, which, as a result of the relative segregation established by 

 residence in the Poorhouse, have, in greater or less degree, been 

 removed from the general social circulation. As time goes on, the 

 numbers so segregated will certainly increase. Every patient segregated 

 even for a time is at least one focus of infection temporarily extinguished. 

 But again as time goes on the Public Health relations of the disease will 

 become more manifest, and the action of the Local Authority for Public 

 Health will become more imperative. 



Of the other public institutions, such as hospitals and dispensaries, 

 many make some effort towards treatment, and a few are reserved 

 exclusively for phthisis. Among the pioneers in this path is Dr. R. W. 

 Philip, Edinburgh, who, nearly twenty years ago, established the Royal 

 Victoria Dispensary for Tuberculosis and the Royal Victoria Hospital at 

 Craigleith. The details hereafter given of the proper functions of a 

 municipal or county dispensary are based on the results achieved by Dr. 

 Philip, who has time and again pressed upon the public the necessity for 

 official organisation and correlation of agencies. His fundamental idea, 

 as given in detail below, is that the Municipal Dispensary should be, as 

 it were, the Court of First Instance for every case, selecting those 

 suitable for Sanatorium or for palliative treatment, or for complete 

 isolation ; investigating the homes, controlling the industries, distributing 

 information, and, in general, serving as a directive bureau and exchange 

 for the record and correlation of all preventive and curative agencies. 



It is obvious that the charitable organisations shade into the private 



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