A. Means of ascertaining the existence of the disease—
- 1. Bacteriological diagnosis.
- 2. Notification of cases, voluntary or compulsory.
B. Direct preventive measures—
- 1. Law against expectoration in places of public resort.
- 2. Disinfection and cleanliness.
- 3. Isolation.
- 4. General sanitary improvement.
C. Education of the public and of patients as to the importance of the preceding measures.
The gratuitous examination of suspected sputum is now being undertaken in certain towns. The earlier the infectious condition of expectoration is detected, the sooner can the necessary precautions be taken.
The notification to the medical officer of health of all cases of consumption I have repeatedly advocated. This is already carried out for the chief acute infectious diseases, and although the difficulties of acting on the information received in regard to a chronic disease like consumption are considerable, they can be overcome with tact and discretion. Voluntary notification is already practised in Brighton, Manchester, and a few other towns. Notification gives increased and more exact opportunities of preventing phthisis by—1. Enabling disinfection and cleansing of affected rooms to be effected; 2. Enabling instructions to be given to the patient and his relatives as to the exact precautions required; and by 3. Facilitating the removal of the insanitary conditions of home and work which may have caused the case or favoured its untoward progress.
The following scheme of measures of disinfection was prepared by Drs. Niven and Newman and myself for the National Association for the Prevention of Consumption, and is issued by them in pamphlet form:—
In preventing a consumptive person from spreading the disease, two sets of preventive measures are required:—1st, The removal or destruction of the infective matter already disseminated by the patient’s discharges, especially by his phlegm; and, 2nd, the prevention of future dissemination. For the latter purpose the main object is not to permit any discharge to become dry before being destroyed. Before the consumptive person has learned the personal precautions which must be taken, and up to the time when he has been trained to carry them out carefully, he has probably distributed a considerable amount of infective matter. This is especially liable to accumulate in a dangerous form at home, where the space is small, and light and ventilation are defective. Infective particles will be found in greater abundance on and near the floors, on ledges, and in room-hangings. But the personal clothing and bedclothes will also have become infected. Hence it is necessary to disinfect the floor, walls, and ceiling of the rooms occupied by the patient, as well as the furniture, carpet, bedclothes, &c.
When this has been done, if the personal precautions advised are carried out by the consumptive, further disinfection should not be needed.