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THE BRITISH CONGRESS ON

TUBERCULOSIS.

His MAJESTY THE KING received at Marlborough Houseon Thursday afternoon, July 25th, the foreign delegates tothe Congress. His Majesty shook hands with each delegatein turn and then made the following speech :—

" GENTLEMEN,-Let me express to you the great pleasureand satisfaction it has given me to ask you to come here to-day, and I only regret that you should have arrived duringsuch a severe thunderstorm.

It has been a source of great concern to me that owing tocircumstances over which I had no control I was preventedfrom presiding at the opening of your important Congressand attending its meetings, but I can assure you that thoughnot present I take the deepest interest in its proceedings andthat I follow, through the medium of the daily press, withmuch interest the papers which are read and the discussionson the subject.There is no more terrible disease than that known as

consumption, and I only hope and trust that you may be themeans of minimising its evil effects and thereby receive thegratitude of the whole world.There is still one other terrible disease which has up to

now baflied the scientific and medical men of the world, andthat is cancer.God grant that before long you may be able to find a cure

for it or check its course. I think that to him who makes’the discovery a statue should be erected in all the capitals ofthe world.. In taking leave of you I trust that your stay in London,and in England, has been an enjoyable one, and that youwill one and all carry away pleasant recollections of yourvisit to my country."

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THE FOURTH GENERAL MEETING.The fourth general meeting of the Congress was held in

the Queen’s Hall on July 25th, at 3 P.M., to hear an addressfrom Professor J. McFADYEAN, M.B., M.R.C.V.S., on

Tubercle Bacilli in Cow’s Milk as a possible Source ofTuberculous Disease in Man. This will be found in full on

p. 268. Much interest was taken in the delivery of this

paper, as it was an open secret that it would be a direct ’,answer to the views of Professor Koch.The chair was taken at the meeting by Lord SPENCER who,

before he called upon Professor McFadyean to deliver theaddress, pointed out that though he himself was a laymanand did not imagine he could give an opinion regarding thescientific view of the matter, still for the pronouncements ofscientific men to be of use they must have the support ofpublic opinion. In his judgment he still considered thatthe public should be protected from the sale of milk fromdiseased sources. The agriculturists had a great deal ofrisk in this matter and though he had great sympathy withthe,views expressed by Mr. Chaplin he felt confident that theagricultural world would give its support to the regulationsrequired to prevent infection from tuberculosis.

Sir JAMES CRICHTON BROWNE informed the meeting thatthe official delegate of the State of Wisconsin (Dr. Brown)had received an answer from his Government to a telegramwhich he had despatched giving Professor Koch’s statementsand the answer was that they would begin experimentsto-morrow." He considered that further consideration wasnecessary before accepting Professor Koch’s views and thatthe Government should undertake an investigation.The next two speakers were Professor NOCARD and

- Professor D. J. HAMILTON (Aberdeen), who declared thatbovine tuberculosis was a source of danger to the humanrace.

Dr. M. P. RAVENEL (Philadelphia) instanced several cases. where bovine tuberculosis had occurred in man fromaccidental infection.

Professor E. M. CROOKSHANK said that in consequence ofthe publication of Professor Koch’s opinion the measures that

.had been devised for the safety of the public might beparalysed. At that Congress a great variety of interestswere represented and they would all agree that free and

. open discussion was the only way to secure the truth. Hisown opinion was that Professor Koch was quite wrong inconsequence of a too precipitate generalisation from the facts

before him. He protested against Professor Koch’s viewthat no measures should be undertaken for the prevention ofinfection of man from bovine tuberculosis.The proceedings closed with a vote of thanks to Professor

McFadyean.THE FINAL GENERAL MEETING.

Under the presidency of Lord DERBY the fifth (and final)general meeting of the Congress was held at Queen’s Hallon July 26th.Lord DERBY said they had reached the last stage of their

official proceedings at the Congress and it became their dutyto submit certain resolutions which had been arrived at inthe sections. He thought the Congress had achieved a

success which would render it one to be remembered amongthe history of similar congresses in the world.

Mr. MALCOLM MORRIS proposed :That tuberculous sputum is the main agent for the conveyanceof

the virus of tuberculosis from man to man and that indiscriminatespitting should therefore be suppressed.He said it was not a particularly pleasant subject, but’it wasthe key to the whole question, and they must come boldly tothe point and carry the motion.

Mr. HAROLD SWITHINBANK seconded the resolution andsaid that it was time that they prevented the indiscriminatedistribution of tuberculous poison in sputum in the streets.The motion was put and carried.Professor G. SIMS WOODHEAD proposed :—

That it is the opinion of this Congress that all public hospitals’landdispensaries should present every out-patient suffering from phthisiswith a leaflet containing instructions with regard to the prevention ofconsumption and should supply and insist on the proper use of aipocketspittoon.

Sir WILLIAM BROADBENT, in seconding, said thatd ameasure of that kind was of the first necessity to preventthe out-patients’ departments becoming centres of infection.The motion was carried.Dr. J. NIVEN (Manchester) proposed :—

That the voluntary notification of cases of phthisis attended withtuberculous expectoration and the increased preventive action whichit has rendered practicable has been attended by a promising measureof success and that the extension of notification should be encouragedin all districts in which efficient sanitary administration renders itpossible to adopt the consequential measures.

He said that in dealing with such a large subject as thenotification of phthisis he could not do wrong in saying thatthe way in that practical measure had been shown to them bytheir American cousins in New York where they had carriedon in ever-increasing efficiency a large measure of notificationof phthisis.

’ Professor T. CLIFFORD ALLBUTT (Cambridge), in secondingthe motion, which was duly carried, said that it was possibleby the means proposed to enable working men to attend totheir work while under treatment.

Sir JOHN BURDON SANDERSON (Oxford) proposed:-That the provision of sanatoria is an indispensable part of the

measures necessary for the diminution of tuberculosis.

He urged that sanatoria were of great value to all classes ofthe community, but especially for the poor workman whoseearnings were only sufficient to cover his expenses, but whowas too poor to make proper provision against the greatcalamity of sickness.

Sir RICHARD DouGLAS POWELL, in seconding the motion,which was carried, said it was quite unnecessary for him toadd any words to the eloquent remarks of the proposer.

Sir HERBERT MAXWELL proposed:-That in the opinion of this Congress and in the light of the work that

has been presented at its sittings medical officers of health shouldcontinue to use all the powers at their disposal and relax no effort toprevent the spread of tuberculosis by milk and meat.

He said that those who had heard the magnificent oration ofProfessor Koch on the one hand, and of Professor McFadyeanon the other hand, would perceive that, like other questions,it had two sides.

’

Lord SPENCER seconded the motion, which was carried,and said that he would like to urge on all those who have toact in that matter the advisability of judicious methods ofadministration with a certain amount of elasticity and agreat deal of good sense in their regulations.

Dr. G. A. HERON moved, and Mr. F. J. LLOYD seconded,the following :-That in view of the doubts thrown on the identity of human and

bovine tuberculosis it is expedient that the Government be approachedand requested to institute an immediate inquiry into this question,which is of vital importance to the public health and of great con-sequence to the agricultural industry.

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Dr. R. FARQUHARSON, M.P., said that though they could u

not ignore such an authority as Professor Koch he thought they had done well to keep to the status quo ante. The motion was then put to the meeting and carried n

unanimously. ’1Sir JAMES CRICHTON BROWNE moved that- a

The educational work of the great national societies for the pre- c

vention of tuberculosis is deserving of every encouragement and support. It is through their agency that a rational public opinion may rbe formed, the duties of public health officers made easier of perform-ance and such local and State legislation as may ho requisite called into existence. IHe said that the work of the Congress could be summed up r

in the one word ’’ enlightenment." (

Dr. ALFRED HILLIER seconded the motion which was put ‘and carried.

Sir WILLIAM BROADBENT moved the following :- 1

That this Congress is of opinion that a permanent national committeeshould be appointed (a) to collect evidence and report on the measures ]that have been adopted for the prevention of tuberculosis in different countries; (b) to publish a popular statement of these measures ;(c) to keep and publish periodically a record of scientific research inrelation to tuberculosis; and (d) to consider and recommend measuresof prevention. This Congress is further of opinion that such a

committee should consist of representatives to be elected by the greatnational societies formed for the suppression of tuberculosis and alsorepresentatives nominated by various Governments. It is further ofopinion that all international committees and great national societieswhose object is the prevention of tuberculosis should be invited tocooperate.He said that the Congress was doing magnificent work inexciting public interest and spreading information.

Professor BROUARDEL, in seconding the motion, said that Ithe work which they had done would help in the struggleagainst tuberculosis.The motion was carried.Professor CROOKSHANK proposed :-That, in the opinion of this Congress, overcrowding, defective ven-

tilation, damp, and general unsanitary conditions in the houses of theworking-classes diminish the chance of curing consumption and aid inpredisposing’to and spreading the disease. i He said that they must not confine their attention to thetubercle bacillus alone but must consider the other factorsin the production of tuberculosis.

Dr. C. THEODORE WILLIAMS seconded the motion and

explained how the depressing conditions under which theylived caused the milliner, the tailor, the printer, and others Ito become liable to the attacks of the disease. !

The motion was carried.Professor BROUARDEL submitted the following motion

which was seconded by Professor CALMETTE and dulycarried :-That while reeognising the great importance of sanatoria in com-

bating tuberculosis in every country the attention of Governmentsshould be directed towards informing charitable and philanthropicindividuals and societies of the necessity for anti-tuberculous dispen-saries as the best means of checking tuberculous disease amongst theindustrial and indigent classes.

The last motion was proposed by Professor ROBIN andseconded by Sir WILLIAM BROADBENT and carried :-That the following question be submitted to the consideration of the

next Congress :-The :constitutional :conditions of the individual whichpredispose to tuberculosis and the means whereby they can bemodified.

The CHAIRMAN, after replying to a question from Mr.BowEN-JoNES (Shrewsbury), who spoke from the back of thehall and to whom he explained that the resolutions of theVeterinary Section were not submitted because they wereunsuitable for discussion at that particular meeting, con-

gratulated the members of the Congress on the successfultermination of their labours.

THE SECTIONS.SECTION I.

STATE AND MUNICIPAL.

THURSDAY, JULY 25TH.

DIVISION IV., THE INTERNATIONAL ASPECTSOF TUBERCULOSIS.

A general discussion upon this subject was opened byDr. ALFRED HILLIER (London). Having dealt with the’conditions essential to the establishment of tubercu-losis in man Dr. Hillier proceeded to discuss the measureswhich had been taken by science to check the intro-duction of the bacillus. Could they doubt that pro- tection from the indiscriminate distribution of sputum would result in tuberculosis becoming more completely

under control than small-pox 7 He then considered whatwas being done in the civilised States of Europe andAmerica to check the disease and then in general termsmentioned what they were called upon most urgently to do.The movement for the provision of sanatoria in Germany wasahead of that in all other countries, and this was for allclasses. The United States had certainly led the way inpractical downright measures of prevention. To Francemust be accorded the honour of having done more for theeducation of public opinion than probably any other country.It was worth noting that Norway had recently passed a lawmaking notification of tuberculosis throughout the kingdomcompulsory. Denmark also had taken its full share in thestruggle against the disease. He suggested the formation ofa committee* in which all civilised countries should berepresented and its work should be to formulate the

principles on which all were agreed and to define the broadline of action which should be taken. Legislation couldnever terminate by itself many of the abuses associatedwith the spread of tuberculosis, but if fortified by publicopinion it could and would do so.

Dr. F. MONTIZAMBERT (Canada), Director-General ofPublic Health, Ottawa, Canada, Delegate of the CanadianGovernment, read some

Notes on Tuberculosis in the Dominion of Canada.He said : Tuberculosis in the Dominion of Canada, as else-where, has heretofore levied a heavy tax upon the well-beingand the lives of the people. Some 8000 deaths per annumin Canada are attributed to this disease. Some of theseare, of course, amongst native-born Canadians; others areamongst those who have brought the seeds of the disease withthem from other countries. Here, as elsewhere, the know-ledge of the true nature of the disease and of the’ methodsof its spread has advanced pari passu with the advances ofmedical science. With this extension of knowledge in themedical profession have come also wiser counsels to patients and their friends and to the public. This was until recentlyonly the action of boards of health, of medical societies, ofindividuals, and of comparatively small local associations.This year, however, Lord Minto, the Governor-General ofCanada, has organised a national movement for the pre-vention and cure of this disease-the Canadian Association

for the Prevention of Tuberculosis. Of this association his

Excellency is the honorary president. The first meetings

were held in Ottawa in February last and the work ofthis general national movement was begun-the work ofendeavouring to rouse to a sense of their danger the massof the people, whilst at the same time a knowledge of the- possibility of prevention and cure is brought home to theirminds and they are thus both encouraged and urged to

Itake the practical measures necessary to attain the greate object in view-the limitation, if not, indeed, the extinction,

of this preventable disease. Already some of the munici-apalitles are moving in the matter. If there be anything in

climatic influences in the prevention and cure of tuberculosisCanada offers a wide field for choice. She stretches fromocean to ocean and her vast inland tablelands and mountain

e ranges offer all the elements of dryness, altitude, and clear-ness of atmosphere, with absence of strong penetrating

. winds, that may be desired. And this with a variety ofe grandeur of scenery and full opportunities for outdoore sports, hunting, fishing, &c., for those who seek them ; and’e for all the pleasant summer weather and the dry and1- invigorating cold in winter render life and rest out of doors

a possibility and a benefit at all seasons of the year by nightas well as by day.

Professor ROBINSON (America) referred to the measureswhich had been taken in the State of Maine to combatdisease and which were attended with some success. The firstessential was a systematic education of the people in referenceto the evils caused by phthisis. This great work of educationhad begun 11 years ago and the result was really remarkable.In seven years there had been a lessening of the mortalityrate due to phthisis of more than one-fourth. Sanatoriawere being built by voluntary contributions.

, Dr. VAN RYN (Belgium), General Secretary of the Belgiumby National League against Tuberculosis, having passed inhe review the Present Position of the Crusade against Human

Tuberculosis in various countries,:es Dr. HOLZER RÖRDAM (Denmark), Chief Physician of thero- First Class of the Denmark Naval Marine, described thero-

im Measures taken against Tuberculosis in Denmark.sly Compared, he said, with many other countries in Europe,