A. Basic Facts as to Tuberculosis.
Explanations of the Decreasing Death-rate from Tuberculosis.
Diminished Virulence of the Tubercle Bacillus.
Increased Human Resistance by Natural Selection.
Immunization by Small Doses of the Contagium.
Diminished Tuberculosis with Increased Aggregation of Population.
Hospital Treatment of Consumptives.
Koch’s Views as to Hospital Segregation.
Improved Housing in Reduction of Tuberculosis.
B. Measures of Control.
Notification of Cases.
Causes of Failure in Notification.
Public Health Action following Notification.
Examination of Contacts.
Scope of Tuberculosis Schemes.
Tuberculosis Dispensaries.
Should be Part of General Dispensaries.
The Home Visitation of Patients.
Sanatorium Benefit.
Residential Institutions.
General Observations on Treatment in Sanatoria.
Hospital Treatment.
Industrial Colonies.
Special Dwellings and Help in Support.
Summary.
LECTURE X
Child Welfare Work in England [240-267]
The Earlier Work of Medical Officers of Health.
The Notification of Births.
Chief Causes and Course of Infant Mortality.
The Influence of School Medical Inspection.
The Influence of Statistical Studies.
The Midwives Acts.
Health Visiting.
Voluntary Work.
Child Welfare Centers.
Training and Provision of Midwives.
Ante-natal Work.
Dental Assistance.
Creches.
Observation Beds at Child Welfare Centers.
Grant’s to Local Authorities.
Course of Mortality in Childbearing.
CHAPTER I
Public Health Progress in England During the Last Fifty Years[1]
After thirty-five years in active public health work in England—during eleven of those years having been the principal officer of its central public health department on its medical side—I may be assumed to possess some qualification for the task of reviewing the past half century’s progress in public health in England.
Parallelism of Events in New and Old England
I find it, however, beyond my power to compass in a short address a resumé of my subject which shall be complete, or completely in perspective, or which shall not omit features on which, had time permitted, one would have wished to comment; and I must ask you to remember that only a portion—and that chiefly non-administrative[2]—of the history of this wonderful half century can be embraced within the present address. The survey should, I think, take a panoramic view of the story as it has developed, should note the changes as they have occurred, the obstacles which impeded reforms as well as the reforms secured; and should also, at least incidentally, state—in the light of unfailing historical guidance, as well as of increasing knowledge—the pressing desiderata for more efficient and more rapid future progress. I cannot hope to accomplish this task except to a fragmentary extent, but I am happy to remember that sanitary history in Old and in New England has proceeded largely on parallel lines. The curves of annual death-rates from all causes, from typhoid fever, from tuberculosis, and of the mortality of infants show the closeness of the parallelism of the public health history of England and Massachusetts.
The work of the last fifty years was built on preceding pioneer work of men in Old and in New England; and for a complete understanding of this work, a momentary glance is required at the men of this earlier generation and their work.
In the old country we speak with reverence of the names of Southwood Smith, Kay, Chadwick, Farr and Simon; and you remember with gratitude the names of Lemuel Shattuck, of Bowditch, of Walcott, S. W. Abbott, and Theobald Smith; and it is gratifying to remember that the epoch-making report of the Massachusetts Sanitary Commission of 1850—to which were attached the ever memorable names of Shattuck, N. P. Banks, and Jehiel Abbott—among its many statesmanlike and far-seeing proposals, recommended a sanitary survey of the State, and referred to the recent English sanitary surveys, with which British sanitation may be said to have begun.