"A born writer, especially a born story-teller. Dr. Sutherland, who is distinguished in medicine, is an amateur in the sense that he only writes when he has nothing better to do. But when he does, it could hardly be done better." G.K. Chesterton.
Dr Halliday Sutherland said:—Mr. Chairman, Ladies, and Gentlemen,—As you, Sir, have stated, one of the most hopeful features of this age is the frank discussion of those maladies which affect the welfare of our people, and the pleasure and responsibility of addressing this Meeting are enhanced by knowing that it inaugurates an educational campaign against tuberculosis among our sailors and soldiers; that knowledge imparted to them through the medium of your Huts will be carried far and wide to distant homes; and that this work is of vital importance to the nation. You have won the confidence of the Navy and the Army. The work in your Huts, scattered along the frontiers of our Empire, means to weary sailors and soldiers rest and recreation, ay, and often a saving of men’s reason after the horrors of battle. Those who have worked in France believe that every man on his return will join the Red Triangle, if only out of gratitude for what it meant to him in war. By these Huts you have raised a monument more enduring than brass.
From some quarters there has recently come the query: What of the Y.M.C.A., with its vast organisation, after the war? Your answer is clear: We are going to take part in the reconstruction of our country. That means you are setting out on the conquest of Great Britain from the tyranny of poverty, disease and crime. In fields where other agencies may have failed, and in which the conjoint qualities of priest and physician arc required, men shall find in your Huts educational centres for the cultivation of body, mind and soul. And well they may. Troubled times are ahead of our country in the near future, and your organisation, above all parties and alongside all creeds, will he found then, as now, on the side of Justice and of Truth.
Wherein lies the strength of the Y.M.C.A.? It is, I think, largely due to your being a voluntary association; and as the success of this new campaign on which you are entering depends on voluntary individual effort, it is well to remember what this vast power has achieved in the past. During the middle ages the cry of suffering reached the quiet cloisters of the monastery, and was answered by old-world monks whose very memories are now dead and gone in this restless fevered age, but who left to England the divine heritage of her voluntary hospitals. Throughout all Christendom, the Church has eased that pain by a countless multitude of religious, philanthropic and social agencies. Science has contributed her share; and from those looms that are ever active, and those shuttles that are never still, the silver threads of knowledge have gone forth. In the calm of the laboratory, in the quiet light of the library, such men are working to-day. Behind all has been the energy of individual effort: and indeed without freedom, sympathy and sensitiveness, no national problem has ever yet been solved. We are agreed that any Peace with the uncrushed assassin outside the gates would be treason most foul to the spirits of our brave dead, but do we realise the duty of protecting our children from hidden enemies within this land?
During recent year, there has arisen a wide interest in the conquest of disease. Like Jews of old the people are clamouring for a sign, while from the housetops in Fleet Street is heard the voice of Mr. Israel Zangwill:—Where is the God who will give us a cure for cancer? Not so long ago that timorous question might have clung pitifully to the dying consumptive, and yet today modern medicine, having found the cause, sources and cure of this disease, as of many others is still urging its prevention, often in vain, to an unheeding generation. As long as apathy, arrogance, ignorance and indifference endure, so surely will tuberculosis claim its hourly victims—and there shall no sign be given. It were outside the order of human things to expect otherwise. When cholera was raging in London, Charles Kingsley, you will remember, refused to pray that it might cease. Men of Science, he said, have shown you how it may be prevented. The remedy is in your hands. Those words are true to-day of consumption. Nay, more: while at every point this dread disease is opposed, as will be shown, by the non-moral forces of nature, man and man alone has created the conditions under which it may arise, spread and destroy.
Consider the origin of the malady. For hundreds of years medicine groped in the dark to find a cause. In the fifteenth century a Spaniard surmised that the disease was infectious and legislation followed accordingly, so that during the next century there was a Royal Decree in Naples by which any house in which a consumptive had died was burnt down. But over the world there was darkness until in 1812 the light of Läennec dawned on the horizon of France. He it was who proclaimed all forms of consumption to be one and the same disease: and later on, in 1868 Villemin, another French physician, proved that tuberculosis was transmissible from one animal to another. It was not, however, until 1868 that Koch of Berlin, working on the basis created by the immortal Louis Pasteur of Paris, discovered the tubercle bacillus—a tiny rod-shaped organism, invisible to the naked eye. Twenty four thousand of these germs, if placed end to end, would measure an inch in length; and four hundred millions could lie on the surface of a postage stamp. Such is the tiny cause of a gigantic evil. In the United Kingdom every year fifty thousand people die of consumption or tuberculosis of the lung: twenty thousand more from other forms of the disease; a hundred and fifty thousand are disabled, while there are least five hundred thousand infected persons, of whom a tenth constitute the potential cases of the future. In the course of nature, as things are, one out of every eight will die of tuberculosis. Remember, also, that this disease strikes down men and women in their prime, after they have founded a home, but before their children are self-supporting. Prior to the war, consumption created one-eleventh of the total pauperism in England and Wales-being an annual charge on the State of one million sterling. He that despiseth little things shall perish little by little, said the Son of Sirach.
Is the illness inherited? It is not. No child is born tuberculous; nay more, every child who acquires the disease is infected after birth. There is not even, in my judgment, an inherited predisposition, although in the past medicine has made more of predisposition than theology of predestination. Perhaps both were unhappy doctrines. Yet it was but natural that a belief should have arisen in an inherited predisposition without which the malady could neither arise nor spread. For consumption appears more frequently in the children than in the husband of a tuberculous woman. Both children and husband are exposed to the same infection: but, so they reasoned, the children have an inherited predisposition which is absent in the husband, and this they are prone to develop the disease. This argument, at first glance clear and convincing, is nevertheless fallacious. In 1911, I examined 723 London children from families in which one or the other parent was tuberculous. Some of the parents were infectious, but others were in the earlier and non-infectious stages of the disease. Now among the children of non-infectious consumptives, there was not two per cent. more infection than amongst the children of healthy parents. Does no that dispel the sinister nightmare of an inherited predisposition, under which, during the past hundred years, men women and children have often resigned themselves to die just because one of their forbears had died of consumption? And does it not teach us too that by preventing infection the eradication of the disease may be yet achieved? Let us pass next to the sources of infection—those minute germs.
Tubercule bacilli in the milk of tuberculous cattle cause half the cases where this disease attacks the bones, glands and joints of children. Tuberculous milk kills 10,000 children every year and creates an amount of child sickness, suffering and sorrow so widespread as to be incomprehensible to a finite mind, and no more natural than if their food had been poisoned with arsenic. Yet in London to-day, one out of even eleven churns of milk arriving at our railway termini contains this death-dealing virus. Under these deplorable conditions it is well to know that tuberculous milk is harmless after being heated to 160 Fahrenheit for half an hour, that these forms of the disease in children, when diagnosed in time, are very amenable to tuberculin treatment, and that intervention is becoming less and less necessary.
To deal next with the danger, fortunately less, of infection from tuberculous meat, the Government authorities responsible appear to be indifferent to the magnitude of the evil. May I illustrate this? When I desired to know the number of seizures of tuberculous carcases exposed for sale in butchers shops throughout the country—still a very trivial offence for which small fines are sometimes inflicted hard-hearted magistrates—I wrote to the Board of Agriculture, who did not know, but referred me to the Local Government Board, who did not know, but referred me to the Home Office, who did not know. Nobody knows.
But there is the Milk and Dairies Act of 1914, which does not come into force until after the war. Even when it does, it will leave much undone because it deals with advanced disease in cattle, although long before the animal has become emaciated, or its udder diseased, tubercle bacilli are in the milk, but the necessary test is both difficult and expensive, and for the ordinary dairy farmer—to whom the discovery would mean financial loss—where ignorance is bliss, ’twere folly to be wise.
And yet it is possible by means of the tuberculin test, to distinguish between tuberculous and healthy cattle, and, by separating diseased from healthy to eliminate the disease from any herd in a few years. That is what they do in other countries: for example, in America, whose Federal Government Inspectors are stationed at British ports for the purpose of preventing our diseased animals from crossing the Atlantic. Moreover, in America half a million free doses of tuberculin are distributed to dairy farmers every year, while in the state of New York all milk is graded. Grade A for infants and invalids, is from cows that have passed the tuberculin test; and Grade B for adults, is from animals concluded to be healthy after physical examination. These grades are sold raw and pasteurised; and they must also conform to standards of cleanliness and of bacterial purity: Grade C for cooking, must be free of the grosser and more obvious impurities. These vital elements are ignored in our Milk anil Dairy Act. No free doses of tuberculin are sent out by our Board of Agriculture; and yet twenty years ago the Royal Commission on Tuberculosis recommended the official use of this test throughout the country. Is it not time and more than time, that these things were done?
Let us maintain, by all means, our Baby Week, but when we an instructing the poor for seven days about the care of infants for England’s sake, let us remember that 10,000 children are poisoned every year by milk from English cows, that for twenty years we have ignored the recommendation of a Royal Commission and that we have failed to do for our children what other countries have done for theirs.
But there remains one source of infection more deadly than milk, for consumption, the major form of the disease, is due to bacilli of the human type. Four billion bacilli may be discharged in a patient’s sputum every twenty-four hours; and if that sputum dries and is converted into dust the germs are widely distributed. Dust from a room in which a consumptive had died, was found to be infectious six weeks after the death, and thus infection may be carried in the air. Again, when a consumptive coughs, he may expel into the air small droplets of secretion containing tubercle bacilli. Although these droplets are rarely projected more than a few yards beyond the patient, nevertheless there exists an infected environment.
Fortunately, the virulence of tuberculous sputum is limited by certain simple factors-in particular, by exposure to sunlight. This germ, which can live for months in a dark room, is destroyed by three minutes’ exposure to the sun. Again, while the consumptive may at times be infectious, the educated consumptive, and by that I mean the patient who has been trained in simple precautions whereby he avoids infecting others—is a danger to none. This should be known, because, unfortunately, wherever our crusade goes, there is apt to grow up in the minds of an ignorant class a quite preposterous fear of infection, whereby injustice is done to individual sufferers. Indeed, there are many beautiful places in England, where owing to this unfounded fear of infection, selfish people have not allowed a sanatorium to be built within miles of their dwellings.
But why should you set out to prevent this infection and to cure the disease? There are some self-styled eugenists—whom you, Sir, from your pulpit have castigated as race breeders with the souls of cattle-breeders—who declaim that the prevention of disease is not in itself a good thing. They say the efficiency of the State is based upon what they call ‘the survival of the fittest.’ This war has smashed their rhetorical phrase. Who talks now about survival of the fittest, or thinks himself fit because he survives? I don’t know what they mean. I do know that in preventing disease you are not preserving the weak, but conserving the strong. And I do know that those evil conditions which will kill a weakly child within a few months of birth, and slay another when he reaches the teens, will destroy yet another when he comes to adult life.
Now while of all diseases tuberculosis claims the most victims, it is in many respects the most easily prevented. A long interval elapses between the date of infection and the time when the disease becomes advanced. For it is possible nor only to prevent infection, but also-and this more particularly in regard to the child-to arrest the illness in the bud by rendering the environment healthy. Yet what do we find? In the crowded areas of our industrial centres the mortality is highest, sometimes four times greater than it is amongst the general population. It is this this which brings us all into living touch with the social tuberculosis problem, illustrated tonight in the ‘The Story of John M’Niel’ on the cinema film, presented to this Association by the Royal Victoria Tuberculosis Trust.
A great deal of nonsense is talked about the poor. They are simple people. Many of them seem like children who have never grown up; and yet need I say that in the best civilisations, and amongst the most refined societies that the world has known, it has been freely and openly recognised that the virtue was most often to be found in their simple homes? In the Greek poet’s words: ‘Righteousness, under smoke-blackened rafters, shines inimpaired, honouring the humble lot.” On the other hand, they are ignorant and self-willed, and are apt also to fall into that dead apathy which is born, it is true, of bad air and entire ignorance of the essentials of health, and which, apart from any question of housing, is the chronic cause of the awful wreck of human life in our great cities. But what of the remedy? The panaceas are many. The spirit, some might think of Satire, answers: The State. Well, the State has done a great deal and can do a great deal; but everything depends, of course upon, first, what the State lays down, and next, who carries it out. There are, moreover, imminent dangers of excessive State interference in this as in any other field. As Charles Russell, who once spent his life regenerating the thieves of Manchester, once wrote to me, ‘the saddest thing about it all is, that when you are thinking and acting most for them, you are perhaps doing the very little thing to destroy what little independence of character is left.’ Let us avoid that danger, Ladies and Gentlemen, the poor deserve all of our sympathy, which in itself is but an extension of individuality, all our heart, but above everything, all our brain.
Regard their environment: when a population is overcrowded and underfed living in dark tenements, or in back-to-back houses, breathing foul or twice-breathed air in ill-ventilated rooms seldon lit by the sun, working long hours in gas-lit workshops for a sweated wage, striving without an end for strife, buying the cheapest food in the dearest market, and drugged by bad liquor, it it any marvel that they, the indigent product of city life, should fall the first and easiest victims to a disease which stands highest on the death-roll of every country in the civilised world?
It is amidst such appalling surroundings that you do find tuberculous homes and the ravages of infection—in one case a mother and her entire family of nine children all died of the disease within a period of ten years. A child is reared by a mother with advanced disease and no precautions are taken. She coughs, and the air in her immediate vicinity is laden with droplets of secretion containing tubercle bacilli. This air the child breathes. Millions of bacilli are deposited on the skin and clothing, and are carried to the mouth by the hands. Again the mother kisses the child and the germs are swallowed. She prepares the food and drink , handles it and coughs over it. Everything, including the table utensils, is infected, and the child swallows human infection at every meal. Such children are inoculated in every way. They are saturated with tubercle bacilli.
How then can we control and exterminate this disease? One thing is clear. We must search out the source of infection to its uttermost haunts. We must seek for the ignorant, undiagnosed, unknown and untreated consumptive who scatters infection throughout the ill-ventilated and over-crowded homes of the poor. It is useless to wait for the consumptive to come to us, for in most cases the patient does not seek medical advice until the disease is well advanced. Special measures are required.
For the disease cannot be eradicated either at general dispensaries or in the out-patient departments of hospitals where consumptives mingle with all kinds of other poor, receive a bottle of medicine and a little advice, and whence they return home, there to spread and to breed a preventable disease.
In that way the consumptive may be neglected. But it is not forgotten—where the carcase is there shall be the eagles be gathered together. In his newspaper he reads the advertisements for quack medicines and to Cagliostro and his breed he sends all the money he can spare. Yes! All. All that a man hath will he give for his life. Five years ago a Parliamentary committee was appointed to enquire into the extent of this evil, and—nothing has been done. On the field of battle those who rob the wounded are shot down like vermin; but here at home no punishment is meted out to the vultures who rob the suffering, the ignorant and the dying.
We are dealing with a protean malady, whose effects are apparent from the beginning of life to the end, and it would be senseless to treat every patient—from the child running about with the seeds of this disease to the bedridden dying consumptive—in the same way. For each class of patient it is necessary to make suitable and separate provision. But, since one stage of the illness may lead gradually into another, it is essential, in order to control the disease as a whole, that all measures against it should be co-ordinated into one harmonious plan.
In the full centre of this stricken field the Tuberculosis Dispensary takes its stand; and around it are the Open-air School, the Sanatorium, the Farm Colony, the Hospital for Advanced Cases, and the Public Health Authority, all of which are interdependent. From the Dispensary, patients are distributed to these other institutions, whose special functions and whose relation to each other and to the Dispensary will be described later on. To the Dispensary, patients come for diagnosis and treatment; and their homes are visited by dispensary doctors and nurses, whose triple aim is to raise, to stop the spread of infection, and to cure the disease.
First to raise the resistance of the people, pure air is essential. It is not so much a question of changing the environment of the patient to the mountain, the sea, or the desert. Amid large cities, despite many sources of constant pollution, the atmosphere in parks and open spaces, especially at night, differs but little in the proportion of its primary gases from air from the air of the country. This is because the impure air is diluted and swept away by wind, washed by rain, oxidised by sunlight, and replenished in day-time with oxygen from the leaves of plants. On stagnant day and during fog, when the winds are chained, the atmosphere of cities grows impure, and even in open spaces oxygen may fall from 20.94 to 20.8, while carbonic acid roses from .03 to .06, in a hundred volumes of air. Under the same conditions in mean streets, in narrow alleys, and in deep courts walled round by large tenements, a great amount of impurity has been found in the sunless, confined smoky, dusty, and petrol-laden air which fills the dwellings of unhappy thousands. In a slum, more than anywhere, the poisoned atmosphere of the ill-ventilated sitting-room and bedroom should be released, and the patient exposed to the free atmosphere, whether of the city or the country. When resistance to infection is raised, then the incidence and mortality of the disease diminish. Over sixty per cent. of those of the healthy population who meet with sudden accidental death, show on post-mortem examination scars of early infection of the lung, but in them the disease had failed to develop because resistance was stronger than infection.
Next, how is the spread of infection prevented? If a patient sleeps alone, expectorates into a flask containing five per cent carbolic acid, which destroys the germ in thirty seconds, uses separate table utensils, sterilised afterwards in boiling water, does not kiss his family, has no share in the preparation of food, and keeps the house free of dirt and dust, then the risk of infection is reduced to a minimum. But how impracticable in a two-roomed house!
Dispensaries have brought this knowledge, together with fresh air and sunlight, into the homes of the poorest; and have made their dwellings more healthy. It is asserted that if housing of the people were improved, the pthisis death rate would fall as rapidly is it did in the first era of sanitary reform, 1850 to 1880; and that therefore no money need be spent on measures to control infection or to cure the disease. Better housing, of course will raise resistance to tuberculosis, or to any other disease, but remember that consumption is an infectious malady whose virus, in massive or in long continued doses, will overcome the strongest resistance; and that an ignorant consumptive may infect others, whether he live in a well built house or in a hovel. Consumptives, infected and neglected, die in the palace. It is when a direct attack on the disease has failed, because imperfectly carried out, that those responsible maintain that dispensaries are of little value, and that we must wait for better houses. By their works ye shall know them, and those who tell us that clinical refinement in the early diagnosis of the malady is of no avail until we get better houses, are blind to more than half the truth.
In the poorest houses that exist, the dispensary doctor holds a March Past—a skilled examination—of those living in contact with the patient, and this has revealed one fact of great import. In nearly every household, rich or poor, in which there is a consumptive patient there are other cases of infection waiting to be recognised; and when the disease has occurred in one member of a family all the others should be carefully examined by an expert. It is possible to diagnose consumption long before the patient begins to cough; at the stage when be only feels easily tired or a little run down; and moreover when diagnosed in time, as you will recollect, there are few diseases which are more amenable to treatment.
‘In its beginning the malady is easy to cure but difficult to detect, but, in the course of time, when neither detected nor treated it becomes easy to detect but difficult to cure.’ These words were written in 1513, by Machiavelli, and is it not pitiful, in the twentieth century, after 400 years, that their truth should still be ignore? No measures against tuberculosis are of much avail if diagnosis be delayed until anyone can read consumption in the patient’s face, or until tubercle bacilli have been found in the expectoration, for by that time he has infected others and is himself perhaps beyond cure. Patients, too, often hide the truth from themselves, and while they are talking vaguely of a stomach cough, of a little phlegm from the throat, or of a weak chest, or of a touch of consumption, the disease is slowly advancing and their recovery is becoming more difficult. Only this morning a girl of seventeen, with advanced disease, was brought to me by her mother. Both wished to believe, and that I should believe, she had only been ill for a week. And yet the patient for the past three years had suffered from ‘colds which flew to the chest,’ and a year ago had coughed up a pint of blood. Surely that was a grave danger signal? But no, they explained it away as due to ‘a night at the theatre,’ as if any emotion in ths world could rupture a healthy lung. Men and women hide their faces in the sands of make-believe, postpone the inevitable hour when they must face truth, and thank Heaven if not too late. Time and again Life shows us tragedies which recall the cold truth in that line from Æschylus:
‘When a man is bent on ruin, God will help him on his way.’
There are whole families that are infected, for whom, apart from the Dispensary there is no provision either prevention or cure. There are children having the seeds of the disease, working adults in the early and middle stages and the advanced cases. For all these special provision is required. Working adults with early disease, about fifty per cent. of all cases, may be cured and are being cured by general and specific treatment at the Dispensary, without interfering with their occupation. Again, the Dispensary is a clearing house from which other patient; are suitably distributed to to its auxiliaries; and thereby the dispensary doctor undertakes a direct and thorough-going attack on the disease.
There are patients with advanced disease who, if the home surroundings be suitable, may be treated to the end from the dispensary; but if unable to have good nursing al home, or if there be risk of wholesale infection, it is better that they should be removed to special hospitals. These hospitals should be near the patient’s home, for it is inhuman to remove the dying far from friends. When such a patient leaves his home and enters a hospital he is doing not only a service to himself, but also to his fellows, and it is our duty to make special provision for him. And yet, apart from a few homes for the dying, shared by cancer patients, there is no such provision in any town in England, and the unfortunate sufferer in the last stages of consumption has no other salvation than the Poor Law. Nothing can defend that.
The consumptive, dying of a preventible disease contracted through no fault of his own, deserves better than to be placed under the Poor Law. He should have at least the chance of special treatment at the hand of the expert; and at present this is nor generally available in Poor Law Infirmaries. True, ten years ago a Royal Commission recommended certain long overdue reforms in our Poor Law system; but, needless to say, nothing has been done. Again, there is a natural prejudice against coming under the Poor Law. I attended one dying consumptive in Marylebone who actually smashed a window in order that his last days might be spent in prison. Rightly or wrongly, he preferred the comforts of a jail to those of the Poor Law.
It has been proposed by some that consumption could he abolished if every infectious patient were isolated by law and segregated for life. Apart from the inhumanity, this foolish proposal would fail; and for this reason that consumption, unlike the infectious fevers, is a disease not of months but of years, and in most cases the patient is intermittently infectious throughout a lifetime. The mischief of infection is done by the patient long before he is in the advanced stages. Compulsory segregation, indeed, has already been attempted in the city of New York without influencing the death-rate. The patients creep away to garrets and die without medical attendance rather than face compulsory removal to an institution from whence none return.
How different things might be! I can see in relation to each dispensary a small special hospital, of 20 beds if you like, where none would abandon hope, where some would recover sufficiently to become suitable for sanatorium treatment, where the whole resources of medical science would be available for those poor neglected people, ay, and where by patient observation and research we might yet discover something that would extend the frontiers of life. Found even one such hospital under your auspices, and others will follow. What an opportunity lies here for the man of wealth to whose heart and brain this appeal is made!
On the death of a patient, or on his temporary removal, or from time to time, it is necessary to disinfect the home. That, of course, is carried out by the Medical Officer of Health, to whom the dispensary notifies all patients and any structural defects in their homes. Again, the dispensary, through its case-committee, is in close touch with the Charity Organisation Society, the War Pensions Committee, and other agencies to whom cases requiring financial assistance are referred.
Furthermore the dispensary discovers infected children, and for them open-air schools are provided. These children do not thrive, never attain the weight for their age, in the ordinary schools where the conditions of ventilation require thorough revision, but in open-air schools, under the proper supervision of a dispensary, they soon recover, and when their earlier years are spent under healthy conditions they out-grow the disease and are less likely to become its victims when they enter the critical periods of life. Such schools are of the first importance to preventive medicine. And now you will find sixty children every day, winter or summer, at our open air school in the bandstand at Regent’s Park, the first of its kind in London; while the children themselves will tell you that open-air schools ought to be established throughout the length and breadth of the kingdom.
Then there are other patients who require treatment under happier conditions than are possible at home. These cases are selected by the dispensary and are sent to a sanatorium, where in good surroundings they lead the open-air life. There too they engage in work graduated under medical supervision according to their strength. This work, of curative and economic value, is essential to treatment for bodily activity increases the circulation of blood through the lungs; and in consumptives this results in small amounts of toxic products from tubercle bacilli being absorbed into the blood stream, so that immune substances are formed which eventually overcome the infection. Graduated work also ensures that weight is gained in muscle not in fat, and that patients on leaving the sanatorium have strength to earn their living. These things should be known, lest any think that their labour is being exploited for the benefit of the sanatorium.
Now sanatoria alone will not cure the disease; because, having cured the patient, you would send him back to the same evil conditions under which it arose; but where a sanatorium is linked up with a dispensary the patient returns to a home still under medical supervision. Again, sanatoria are for early cases who may be cured and to send unsuitable or advanced cases is a gigantic waste of public money. Much prejudice has arisen from this practice, and when doctors or laymen tell you of patients who went to sanatoria and died, you may take it that in most cases either the diagnosis or the treatment was delayed too late. Lastly, there should be only one factor which determines how long the patient stays at the sanatorium-so long as there is chance of curing him. Meanwhile the available number of beds is so small and the list of patients waiting so large that each patient can only receive a bare average of twelve weeks’ treatment, which is utterly inadequate: Dr. Acland, who here in London has devoted his life to this malady is impressed with the inadequacy: but as far as I can make out, that is the position in which the County of London Insurance Committee unfortunately finds itself to-day, and in which, still more unfortunately, it has found itself for the past four years.
The value of open-air in the maintenance of normal health, in the prevention of many diseases, for example of spotted fever, as well as in the cure of tuberculosis, is not yet appreciated either by doctors of by laymen. For thousands of years the treatment of consumption was based on erroneous principles. There were searchings after truth; and yet, while many thought that bad air might have something to do with the malady, it occurred to none that fresh air was essential to its cure. The open-air treatment, it is believed, was born In the Highlands of Scotland amidst–
‘Hills of sheep, and the homes of the silent vanished races,
And winds, austere and pure.’
In the 17th century, the unknown pioneer wrote a letter from a physician in the Highlands to his friends in London on the the healing properties of open-air. The message was ignored. In Scotland, however, I was not forgotten, nor in the early years of the 18rh century in the parish of Erskine the Rev. Dr. Stewart, who held both the high and ancient offices of priest and physician, was carrying out the open-air treatment on which differed on no essential point from those in vogue to-day. It was not, however, until 1847 that Dr. George Bodington, the English pioneer founded near London the first sanatorium in the world. His views were met by a storm of ridicule and sarcasm from the medical powers, his patients were forced to leave, and bis sanatorium closed down. It was later re-opened as a madhouse. George Bodington died, a broken man, in 1882; but his mind was the mind of a seer, for on his death-bed he wrote to his son— ‘I often think that when I am dead and buried, the profession may be more disposed to do me some justice than whilst I lived.’ Thus Bodington passed beyond the reach of professional jealousy. At Belfast, Henry McCormack had many a window thrown open, amid the mountains of Silesia Brchmer built a sanatorium, and among the lakes and pines of the Adirondacks Edward Trudeau saved the lives of thousands.
At the end of a century when we look back, who is it whose fame arises out of the eternal silence where most is forgotten, and who are they whose ghosts, men, women and children love to recall to the full centre of the stage, and I there to crown with those leaves that do not thrive on mortal soil? They are men like Laennec, Louis Pasteur, George Bodington and Edward Trudeau-men of single purpose, the servants of Truth.
In the sanitorium, now universal, it became apparent that for certain cases, in order to finish the cure and to send the man back, not only clinically cured, but in such a condition that he may once more take his place as a wage-earner, it is essential to bave a farm colony. These colonies are for the purpose not only of more prolonged treatment, but also of teaching the patient a new more healthy occupation. The Y.M.C.A. have such a colony to their credit at Kinson. It is intended to supplement the sanatorium and the dispensary, but not to replace them. Unfortunately, it is necessary to add that, because some people, who seem to decline to understand that the success of all these institutions depends upon their being co-ordinated into one harmonious scheme for the purpose of meeting the disease at every point, have recently been talking and writing about farm colonies as if they were to replace all else. It is hardly necessary to point out the folly of sending patients who are unfit for work lo a colony, or of putting infectious patients to any occupation concerned with the production of food. A few years ago some held that all we wanted was sanatoriums: and now, having proved themselves wrong, they proceed to say the same thing about farm colonies. Having watched these heresies for twelve years, may I prophesy that soon they will he proclaiming open-air schools to be the one and only solution.
At the Red Triangle Farm Colony at Kinson, in Dorset, conducted in association with the Ministry of Pensions, discharged soldiers, whose disablement is due to tuberculosis but in whom the disease is arrested, are receiving an all-round training in agriculture. This training is free of charge to the men. who are, indeed, remunerated for the work they do on a simple co-operative system. The aim of the Y.M.C.A. is to run this farm, not in order to make a profit, but rather to give every man a thorough experience of farming, so that on leaving he may earn good wages for himself. A reasonable return Is received for the produce of the farm. Money could scarcely be better expended; because it will enable these patients very soon to earn their own living by an open-air life on the land.
All the institutions mentioned to-night must make the wide co-ordinated scheme, recommended by the Department Committee on Tuberculosis. The buildings portrayed in the film are in Edinburgh, in which city Sir Robert Philip created, in 1887, the first tuberculosis dispensary in the world. Thence the movement has spread to many lands, and now in London there are eleven tuberculosis dispensaries founded from the Central Fund for the Promotion of the Dispensary System. Behind every element in this scheme there is the most powerful factor in the practice of medicine— the vix medicatrix naturæ—the healing force of nature, the recuperative power of mind and body. In ancient days by virtue of the recognition of that element in the sunlit cloisters of the great open temples of Æsculapius, suffering humanity found health and peace; and in the fuller realisation of that vast energy lies the hope of modern medicine. To-night I appeal to the Y.M.C.A. to help to realise that dream. Let there be no illusions as to the giants in the path of those who set out on this crusade. You will meet with apathy and indifference; you will encounter the baseless fear of an inherited destiny which paralyses all effort on the part of many patients; and above all you will have to win that support in high places which will afford the services of experts for all sections of the community. Ay, and you will soon realise that there is one wide influence which may baffle our progress and undermine the basis of all advance. The real tragedy of life is not a disease but the perverse human Will omnipresent.
I have detained you at some length; but for the purpose not only of stating an argument but showing you on what it is based, and if you of the Y.M.C.A. take up this policy it will be because you are convinced of its merits and believe in your soul and conscience that it is right.
Ladies and gentlemen, it is all part of an old story which we should have learned far back in the history of this Earth—that co-operative effort is based on individual conviction, and that the destiny and prosperity of a nation kindle on the hearths of her people. The scheme here outlined is one not of force or constraint, but of education and persuasion. At every stage the individual patient is encouraged to cooperate. His mind is brought to bear, and his own will is rallied to assist in the eradication of this mortal foe. Recollect, while in this Kingdom every year 50,000 die of a preventible disease, we are still in the Valley of the Shadow of Death. But together, we are going forward ‘on to the bounds of the Waste, on to the City of God.’ And to what end? That when our generation has passed, when peoples customs, comedies, tragedies and tears are sinking deeper and deeper into the eternal sea, a race that is yet unborn may for a time remember that in this century one sorrow was lifted from the lives of men.