48 



NATURE 



[July 8, 1909 



national matter, and it should be considered as a whole, 

 and a town should not be allowed to appropriate a par- 

 ticular area unless it can be shown that in a general 

 survey of available sources of supply that area can 

 economically, from a water point of view, be allotted 

 to it." 



The value of the paper would have been increased if 

 some- information had been given as regards what is being 

 done in other countries in connection with systematic 

 investigation of water resources. There is no doubt that 

 such an investigation is of more value and of greater 

 necessity to the United Kingdom, where the population 

 per acre is large, than to some of those countries which 

 are at present rather sparsely inhabited, but which, at the 

 same time, spend money on proposals such as have been 

 suggested. In the United States this work was under- 

 taken as a national one some years ago, a beginning 

 having been made in 1894-5 by a grant of 12,500 dollars. 

 This amount was gradually increased, until the grant in 

 1905-6 was 200,000 dollars. Since then there has, we 

 believe, been some variation in the amount voted for this 

 purpose. 



Considering the large amount of work which the author 

 must have gone through to prepare this paper, it may 

 seem almost ungracious to suggest that he should add 

 anything further to it as regards other countries, but he 

 has shown such a large capacity for putting information 

 together that we hope he may be tempted to even further 

 research in connection with this subject. 



Maurice Fitzmaurice. 



THE WAR AGAINST TUBERCULOSIS. 

 'T'HE Nationaf Association for the Prevention of Con- 

 sumption and other Forms of Tuberculosis was well 

 advised to open its exhibition or collection of object- 

 lessons in the Borough of Stepney. It may safely be 

 said that the VVhitechapel Art Gallery never had any 

 company of more interested sightseers than the thousands 

 who, at this exhibition a few weeks ago, examined and 

 discussed death-rates, ventilation, graduated labour and 

 the apparatus used in performing it in the treatment of 

 consumption, apparatus for the treatment of tuberculous 

 diseases, playgrounds, pathological specimens, back-to- 

 back houses, overcrowding, food-stuffs and the principles 

 of nutrition, methods of disinfection, and the like. 



Any interested onlooker would have seen at once that the 

 official conferences and set discussions constituted, after 

 all, but a small fraction of the educational work that was 

 being carried on. Here was an exhibition of which the 

 main object was not to direct the attention of the public 

 to any patent medicine or " all curing " nostrum, but how 

 to regulate their daily life, how to avoid disease, and 

 how to get the best food value out of their weekly wages, 

 be these great or small. Nevertheless, the promoters of 

 this exhibition, realising what an opportunity they had, 

 also gathered together a number of medical and municipal 

 delegates interested in the matter, to discuss the best means 

 of preventing and curing tuberculosis. 



Even those dropping in casually found an enthusiastic 

 band of demonstrators, nurses from dispensaries and 

 hospitals, attendants from graduated labour homes, from 

 sanatoria and similar institutions, all hard at work ex- 

 plaining to small groups of interested men and women the 

 meaning of the exhibits of which they were in charge. 

 It was interesting to see the keenness with which both 

 teacher and listener tackled the subject ; and that these 

 demonstrators were doing their work well was apparent 

 from the numerous and intelligent questions that were put 

 at the end of the demonstrations. Even to the sharp, 

 snrewd Londoner the importance of ventilation, of cleanli- 

 ness, of light, of suitable feeding, have been small, but 

 a few exhibitions and demonstrations such as those seen 

 and heard in Whitechapel Art Gallery will soon change 

 all that ; and the President of the Local Government 

 Board has done nothing better for some time than in 

 giving his countenance and support to what promises to 

 be a really living movement. 



What is the object and what are the lessons insisted 

 upon at these conferences? Anyone visiting the exhibition 



NO. 2071, VOL. 81] 



would have it brought home to him in some way or other 

 that between Z85S and 1907 there nad been a fall in the 

 annual death-rate due to tuberculosis from 2700 per 

 1,000,000 living to 1150 per 1,000,000 living. He would 

 also see that, were the fall to continue at the same rate, 

 tuberculosis would be an extinct disease early in the 1940 

 decade. Although this is too favourable a state of things 

 to look forward to, as there will always remain a certain 

 substratum of tuberculous patients and foci that it will be 

 almost impossible to reach, tuberculosis should undoubtedly 

 be an almost negligible quantity in our death-rate by that 

 time. 



How has this fall been brought about? In the first 

 place, even before Koch was able to prove the presence 

 of the infective agent, the tubercle bacillus, in tuberculous 

 lesions, it was realised by those who were studying the 

 disease most closely that it could be transmitted from one 

 person to another, and that crowded and badly ventilated 

 rooms were, therefore, fruitful centres of infection. This 

 was a very great step forward, the full effect of which, 

 however, was not felt until Koch gave his wonderful 

 demonstration of the presence of the tubercle bacilli. He 

 isolated the infective agent — this tubercle bacillus ; its life- 

 history was studied, and its relation to the tissues of the 

 animal body during the course of the development of the 

 disease, demonstrated. In the history of the treatment of 

 any infective disease little progress has been made in 

 fighting agaijist it until the causal agent has been demon- 

 strated. Once this stage has been reached, however, the 

 fight waged against infective disease of all kinds has 

 become more and more effective. In the case of tubercu- 

 losis, the attack can now be delivered along many parallels. 

 Every patient is looked upon as a possible centre of infec- 

 tion, and before setting about the cure of the patient 

 those dealing with the case have set themselves the task 

 of attacking the bacillus from every quarter and at every 

 point. It is realised that the first thing to be done is to 

 secure it, or kill it, if possible, immediately it leaves the 

 patient, especially, of course, in the sputum, as it comes 

 from the lungs. 



In the case of tuberculosis, isolation, in the ordinary 

 sense of the term, is out of the question, but although the 

 patient cannot be segregated from his fellows — and in 

 many cases it would be both unwise and cruel so to do — 

 he should be carefully trained to isolate himself, so far 

 as the tubercle bacillus is concerned, by taking every pre- 

 caution to prevent any undisinfected material from getting 

 beyond his immediate vicinity. More is necessary, how- 

 ever, than the mere killing of the bacillus as it leaves 

 the human body ; some attempt must be made so to 

 build up the strength of the patient that his tissues 

 may be capable of carrying on war with the bacillus 

 either on fairly level terms or on terms in favour of 

 the patient. This can only be done by ensuring good 

 hygienic conditions — plenty of fresh air, liglit, good 

 food, work enough with plenty of rest. Given these con- 

 ditions, and the tubercle bacillus has a bad time of it ; 

 remove the conditions, and the bad time falls to the 

 patient. It has been stated above that it is often un- 

 necessary to segregate consumptive patients ; it must be 

 remembered, however, that in the late stages of the 

 disease, when the patient is weak and when the various 

 discharges from the body, sputum and other excreta, may 

 contain enormous numbers of the infective bacilli, it may 

 be advisable, and even necessary, in the patient's own 

 interests as well as of those who daily come in contact 

 with him, to keep him in hospital, to make his last days, 

 or even weeks or months, as easy and as pleasant as 

 possible for him. Moreover, under these conditions the 

 destruction of the enormous number of tubercle bacilli 

 coming from the body is a comparatively easy matter. 



Those interested in the treatment of tuberculosis have 

 for long been convinced that good feeding and fresh air 

 are factors of prime importance in such treatment. Up to 

 a few years ago, however, the results obtained, though 

 very much better than any obtained under the old methods 

 of treatment, were in certain respects extremely disappoint- 

 ing. The patients were not properly classified for treat- 

 ment, and many died who apparently ought to have lived. 

 Those who went to Whitechapel to learn would find that 

 the treatment of consumptives under Dr. Paterson at 



