THE ADMINISTRATIVE ASPECTS OF TUBERCULOSIS 19 



Dispensary will normally be under the direct management of the 

 Medical Officer of Health, and will constitute a special department of 

 his work. 



The organisation of hospital service — sanatorium and other— would 

 naturally be part of the duties of a Phthisis Committee ; but the details 

 will vary according to the institutions available in or for the District." 



XI. General Sanitation. 



" It should be unnecessary to remind Local Authorities that these 

 direct measures towards the control of Pulmonary Phthisis must be 

 supplemented by indirect measures, the unremitting and systematic 

 removal of nuisances, prevention of overcrowding, enforcement of good 

 ventilation, reconstruction of insanitary houses, improvement of insanitary 

 areas, improvement of drainage of soil and houses, stringent supervision 

 of meat, of cowsheds, of dairies, cleansing of streets, proper disposal 

 of refuse, &c. Direct prevention should go hand in hand with general 

 sanitation." 



XII. Conclusion. 



It is often said that the law as it stands is not adapted to the 

 administrative control of Pulmonary Phthisis. It is alleged that new 

 powers are necessary ; that the present powers may bear too hardly on 

 individuals or particular classes ; that the peculiar economic relations of 

 phthisis may involve such interference as would disturb the existing 

 organisation of society to its foundations. It is suggested that if the 

 clauses of our Public Health Act were enforced for phthisis as for 

 infections like enteric fever or small-pox, the lives of thousands would 

 be made intolerable ; that, in the great industries, workmen would 

 boycott their infected or infective fellow-workmen, and that the hardship, 

 the misery, the poverty necessarily resulting would be a greater evil than 

 the persistence of the disease or its slow evanescence. These fears date 

 from a time when the knowledge of infection and its habits was rather a 

 superstitious belief than a reasoned doctrine. They claim to be founded 

 in a sensitive care for the economic welfare of the working classes ; they 

 are more reasonably assigned to an uninformed imagination. At the 

 very moment when such fears are the commonplace of discussion, tens, 

 hundreds, thousands of cases are clamouring at the doors, thinking little 



(93) 



