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Efficiency and expense
~,,
~9o7j
The Late Dr. Joseph Groves
535
the following particulars. Dr. J. Groves was interred at Newport Cemetery on Friday, the 24th of May. Every house and shop in Newport had blinds drawn and shutters up; the pavements were lined with crowds of poor persons, chiefly men, with bared heads. The church of St. Thomas, Newport, where the full choral service was held, was filled with members of the Bench, the Guardians, and Local Authorities with which Dr. Groves was associated. " I t was a wonderful sight to see the signs of simple affection to him . . . . . He was simply worshipped by the poor, attending many for years without fees." Dr. Groves was a bachelor of medicine and of arts in the University of London. He was a magistrate, and in marly other ways made his influence and character tell on the life of the island, including the encouragement of horticulture and sports. He was never married. He lived in a small cottage at Carisbrooke, filling it and several emptor houses near it, which belonged to him, with a collection of old china, paintings, ivories, antique silver, and furniture. His collection of antiques is said to be extremely valuable, and it is believed that he had intended to found a museum for the Isle of Wight. In the resolutions of local authorities which have so far come to hand, tribute is paid to "his remarkable independence, treating the squire exactly as he did the peasant "; and to his "useful and able public work, his marked independence, and his love aud kindness for the poor, which would be a lasting monume~ to his name."
EFFICIENCY
AND
EXPENSE.
V ~ R. O ' C O N N O R ' S paper and the discussion arising out of it reported in the last issue of PUBLIC HEALTH gave m u c h insight into the difficulties impeding efficient sanitary administration in large combined sanitary districts. One of the chief of these difficulties consists in the expense of journeying to and fro. The time involved in such iourneyings cannot with equal reason be stated to be a serious difficulty ; for even when train services are n o t available, the motorist is now able to cover great distances in a short time. The real and only difficulty, therefore, which prevents the medical officer of health from making systematic and frequent visits to the most distant parts of extensive s a n i t a r y areas is the expense of efficient locomotion. A painful instance of this is recorded in a recent report b y Dr. Deane Sweeting on the general sanitary circumstances and administration in p a r t of one of the eastern counties of England. The medical officer of the one u r b a n and three rural districts referred to receives a total salary of £272 per annum. He is appointed yearly to each of the above four districts separately. H e is allowed nothing for travelling expenses a n d is debarred from private practice. Dr. Sweeting has found it necessary to pass certain strictures on the work of the medical officer
536
Efficiency and Expense
ll~blte
Health
of health in question. Although his entries in his journals as to infectious diseases are fairly full, there is no record of " action taken " on matters referred to in previous reports, and seldom any on " directions of council on matters reported." The report goes on to state that "... had the candour to acknowledge to me t h a t he could not afford to go round his districts regularly in view of his meagre salary, since it cost him a considerable sum for horse hire every time he took a journey of inspection . . . . As it is . . . says t h a t he spends some £40, out of the total £272, on horse hire. The area of the two districts is over 100 square miles." This particular instance brings out very strikingly the evils of the present arrangements for paying medical officers of health. It obviously puts a premium on inefficiency to mulct an officer each time t h a t he has to make a distant visit. Dr. Sweeting in his list of recommendations says : " The medical officer of health should give more time to the regular and systematic inspection of both districts. The councils should consider the question of making an allowance towards the travelling expenses of this officer." I t is unfortunate t h a t the Local Government Board apparently cannot go further t h a n the expression of opinion embodied in the last quoted sentence. I t would greatly increase the efficiency of administration of combined sanitary districts if the Local Government Board had power to regulate the size of such combinations, to prevent their arbitrary separation, and to insist on reasonable travelling and other expenses being paid apart from salaries. Is it too much to hope t h a t this m a y be given, b y new legal enactments if necessary ?
EFFICIENT DEMOCRACY.* UNDER t h e above title a r e c e n t l y p u b l i s h e d book h a s been sent to us,
which from many social standpoints is an eloquent plea for the installation of efficient methods of check on the various branches of work for the betterment of the people. Mr. W. H. Allen, the author of this book, starts out with the dictum that to be efficient is more difficult than to be good, and that the average citizen honestly in favour of "good government " fails to appreciate that intelligence and efficiency are as f a r beyond the reach of mere goodness as is business efficiency beyond the reach of mere good intention. Hence the general necessity for "efficiency tests." Such tests cannot be
*E~.c~ent Democracy. By Wm. H. Allen, General Agent, New York Association for improving the Condition of the Poor ; Secretary, Committee on Physical Welfare of School Children. (New York: Dood, Mead & Co., 1907, 346 pp., 8in. by 5in.).
J~ne, ~9o7j
Annotations
537
applied without accurate knowledge, and knowledge of details of government cannot be made common property without statistics. Mr. Allen lays down the bold rule that an " h o n e s t man who is inefficient can do more to defeat the purpose for which he is employed than a dishonest man compelled by intelligent supervision to render efficient service." Hence efficiency tests are more important than, and must to a large extent be substituted for, goodness tests. The value and the justification of these dicta lies in their application, and the sixteen chapters of Mr. Allen's book bear out his premises. The contents of the first chapter, dealing with " T h e Goodness Fallacy," may be summarised in the words " No man is good, unless good for something. Goodness is subjective. Goodness for something is objective, and may be counted, weighed, tested." We do not, for instance, require hospital managers, because they are men of undoubted worth, or eminent in some particular, but on account of their business capacity. THE STATISTICAL KEY TO EFFICIENT GOODNESS.
TO avoid corruption in any branch of government, the statistical method intelligently applied ensures a prompt record of work accomplished, and of needs disclosed. Notwithstanding the ancient criticism as to the hierarchy of liars--plain liars, expert liars, and statistics--statistics are universally employed, and indeed indispensable. They are often dull, still oftener untrustworthy, and frequently overloaded with unnecessary detail, but efficiency in any department cannot be tested without them, and the remedy for their defects is to employ competent men as statisticians, and for business men to insist on such dissection of data by these statisticians as is required for administrative insight, to enable them to gauge efficiency. THI~ STATI~ AS DOCTOR.
N o better instance of the statistical test of efficiency could be given than the inauguration of public health measures. In England they owed their initiation in large measure to our national system of death returns; and their efficiency can similarly be measured by death and sickness returns. The weekly and quarterly comparisons contained in the reports of the ]Registrar-General are a constant sthnulus to the laggards in sanitary administration: and we are only at the beginning of the utility of this means of efficiency. The districts with a high infant mortality, and with a high death-rate from phthisis will, as time goes on, have the search-light of public attention directed to them, and will be compelled to alleviate, and as far as is practicable remove the evil conditions, making them conspicuous by high death-rates. HOSPITAL ~-FFICII~NCY.
~¢IR. ALLEN'S remarks as to hospital efficiency may be applied with advantage to the management of isolation hospitals. He points out the necessity of hospital authorities not only themseh, es knowing what each item of service costs, but also of showing the public that they know, and of enabling the public also to know. The attention now being drawn to efficient hospital administration, both in this country and in America, must ~to great good. " N o hospital is rich enough to afford an incompetent book-keeper. No hospital is too poor to afford proof that it is run on an economical basis consistent with efficiency in treatment." The following remarks are of special value, in view of the enormous waste of time of skilled officers in filling up schedules. " Men whose affairs are organised on the principle that a $100 clerk should never be permitted to do the work of a $30 messenger will go into a hospital and spend their time on routine inspection,
538
Annotations
[Public Health
making estimates, and counting details." An efficient business man converted into a hospital governor does not "analyze his own and his colleagues' experience ; accepts from a hospital treasurer a summary of the year's work that does not~show where the hospital stood at the beginning of the year, how far it has travelled, in what direction it is going, what needs it has met, and what needs it has failed to meet." The above deficiencies of hospital accounts obviously militate against public support, for " a n uninformed public is a fickle friend." In the preceding paragraphs only a few of the valuable suggestions contained in Mr. Allen's interesting book have been mentioned : but the whole book is instructive, and should lead to the more general introduction of business methods into the public life of communities. ACCOUNT KEEPING IN ISOLATION HOSPITALS.
AS an important branch of administrative efficiency, we draw attention to a valuable repor~ on the Isolation Hospitals of Derbyshire, recently issued by Dr. Barwise, in which the subject of account keeping in isolation hospitals is fully considered. By Section 17 of the Isolation Hospitals Act, it is enacted that the expenses incurred in respect of any isolation hospital shall be classified under the headings of structural, establishment, and patients' expenses. The schedule form drawn up by the Local Government Board, Dr. Barwise states, does not give sufficient details to enable full and accurate comparisons of the expenses of different hospitals to be made. One of the chief difficulties in allocating expenses occurs in regard to provisions for patients and staffs respectively. It is obviously v e r y difficult to keep separate accounts for the food of staff and patients, and Dr. Barwise suggests that in order to insure uniformity in accounts, the simplest plan would be to charge for the staff 7s. 6d. per head per week under this heading, and to transfer the balance of the costs of provisions to the patients' expenses account. The system appears to be preferable to charging for the patients and transferring the balance to the staff, because the amount of food consumed by the patients is more variable than that consumed by the staff. I t would be a most useful reform were a detailed schedule of expenses made out and all isolation hospitals instructed to adhere to this schedule. T H E C O N T R O L OF TUBERCULOSIS.
DR. H. ARMSTI~O~G in a recent exhaustive report to the City Council of Newcastle-upon-Tyne makes valuable suggestions on the control of tuberculosis. He criticises adversely the model milk clauses of various Corporations. No power is given to deal with any form of tuberculosis among cows, however extensive, other than disease of the udder; although, as shown by many bacteriologists, the. milk of cows without visible sign of tuberculosis of the udder may be infectious. Dr. Armstrong recommends that every Sanitary Authority should have power to apply the tuberculin test, and tO prevent the sale of the milk of any cow reacting to this test. Attention is also drawn in this report to the objectionable practice of sweeping the footways with ordinary brooms. He adds: " T h i s process is carried out by shop-keepers in all main thoroughfares at the time when they are crowded with foot passengers on their way to business; and the dust, especially in windy weather, is both disgusting and a serious source of disease. The invention of an apparatus after the style of the household carpet sweeper for taking the dust from footways without creating a nuisance, would be a public boon. Sanitary Authorities would insist on its adoption, and it would rapidly gain favour with shopkeepers." Dr.
~u.o, ~907]
Annotations
539
Armstrong's remarks in this report on the establishment of a National Sanitary Authority are given on this and following pages. WOM~-N'S WORK IN PUBLIC HEALTH.
IN a recent paper on the aim and scope of women's work in relation to public health, Dr. Meredith Richards draws attention to the importance in allotting women's work in public health administration, of paying due regard to the fundamental differences between the two sexes, not only in training, but also in their physical and mental capabilities. Evidently, as he points out, we are. not making the best of the human material unless we recognise these aptitudes, and assign to each the task which each can do most efficiently with the greatest ease to themselves and advantage to the community. This is not a question of superiority, or inferiority, but one of recognising differences. Women's minds, as was observed by Buckle many years ago, are not only more deductive than men's, but quicker of apprehension; and these qualities make them specially valuable for the educational side of public health work, as in the instruction of mothers, the care of children, and personal hygiene generally. Their work, Dr. Richards added, would undoubtedly be greatly increased when the compulsory medical inspection of school children was begun; for much of the preliminary work of medical inspection could be entrusted to a trained nurse.
A NATIONAL SANITARY AUTHORITY. BY H. A. ARMSTRONG, D.HYG., M.R.C.S., Medical Officer of Health of Newcastle-upon-Tyne.*
T
HE treatment of tuberculosis as a serious national menace is one of the highest imaginable, and one to the promotion Of which any
m a n m a y be glad to devote the best energies of his life. Such a work to succeed m u s t be carefully planned and energetically" executed. I t s scope extends far b e y o n d the selfish aims of p a r t y politics or the restricted sphere of an incorporeal Local Government B o a r d ; it requires for its conception, initiation and direction, a governing b o d y freed from narrow interests and local prejudices , and having in view only the good of the S t a t e ; a b o d y so constituted as to represent the hygienic interests of all classes of the c o m m u n i t y alike; a n d prepared to give to the public health service t h a t continuity of attention and b r e a d t h of t r e a t m e n t which the subject demands. An Authority', constituted of representatives of C o u n t y Councils, Metropolitan and Pro~inciat, a n d the large Sanitary Authorities, U r b a n a n d Rural, of the k i n g d o m would form a truly representative
and popular SUPREME NATIONAL HEALTH AUTHORITY
to consider and deal with all questions of purely public hygiene, including, inter alia Tuberculosis in m a n and animals ; From a special report to the Newcastle City Council.
~9o7j
The Late Dr. Joseph Groves
535
the following particulars. Dr. J. Groves was interred at Newport Cemetery on Friday, the 24th of May. Every house and shop in Newport had blinds drawn and shutters up; the pavements were lined with crowds of poor persons, chiefly men, with bared heads. The church of St. Thomas, Newport, where the full choral service was held, was filled with members of the Bench, the Guardians, and Local Authorities with which Dr. Groves was associated. " I t was a wonderful sight to see the signs of simple affection to him . . . . . He was simply worshipped by the poor, attending many for years without fees." Dr. Groves was a bachelor of medicine and of arts in the University of London. He was a magistrate, and in marly other ways made his influence and character tell on the life of the island, including the encouragement of horticulture and sports. He was never married. He lived in a small cottage at Carisbrooke, filling it and several emptor houses near it, which belonged to him, with a collection of old china, paintings, ivories, antique silver, and furniture. His collection of antiques is said to be extremely valuable, and it is believed that he had intended to found a museum for the Isle of Wight. In the resolutions of local authorities which have so far come to hand, tribute is paid to "his remarkable independence, treating the squire exactly as he did the peasant "; and to his "useful and able public work, his marked independence, and his love aud kindness for the poor, which would be a lasting monume~ to his name."
EFFICIENCY
AND
EXPENSE.
V ~ R. O ' C O N N O R ' S paper and the discussion arising out of it reported in the last issue of PUBLIC HEALTH gave m u c h insight into the difficulties impeding efficient sanitary administration in large combined sanitary districts. One of the chief of these difficulties consists in the expense of journeying to and fro. The time involved in such iourneyings cannot with equal reason be stated to be a serious difficulty ; for even when train services are n o t available, the motorist is now able to cover great distances in a short time. The real and only difficulty, therefore, which prevents the medical officer of health from making systematic and frequent visits to the most distant parts of extensive s a n i t a r y areas is the expense of efficient locomotion. A painful instance of this is recorded in a recent report b y Dr. Deane Sweeting on the general sanitary circumstances and administration in p a r t of one of the eastern counties of England. The medical officer of the one u r b a n and three rural districts referred to receives a total salary of £272 per annum. He is appointed yearly to each of the above four districts separately. H e is allowed nothing for travelling expenses a n d is debarred from private practice. Dr. Sweeting has found it necessary to pass certain strictures on the work of the medical officer
536
Efficiency and Expense
ll~blte
Health
of health in question. Although his entries in his journals as to infectious diseases are fairly full, there is no record of " action taken " on matters referred to in previous reports, and seldom any on " directions of council on matters reported." The report goes on to state that "... had the candour to acknowledge to me t h a t he could not afford to go round his districts regularly in view of his meagre salary, since it cost him a considerable sum for horse hire every time he took a journey of inspection . . . . As it is . . . says t h a t he spends some £40, out of the total £272, on horse hire. The area of the two districts is over 100 square miles." This particular instance brings out very strikingly the evils of the present arrangements for paying medical officers of health. It obviously puts a premium on inefficiency to mulct an officer each time t h a t he has to make a distant visit. Dr. Sweeting in his list of recommendations says : " The medical officer of health should give more time to the regular and systematic inspection of both districts. The councils should consider the question of making an allowance towards the travelling expenses of this officer." I t is unfortunate t h a t the Local Government Board apparently cannot go further t h a n the expression of opinion embodied in the last quoted sentence. I t would greatly increase the efficiency of administration of combined sanitary districts if the Local Government Board had power to regulate the size of such combinations, to prevent their arbitrary separation, and to insist on reasonable travelling and other expenses being paid apart from salaries. Is it too much to hope t h a t this m a y be given, b y new legal enactments if necessary ?
EFFICIENT DEMOCRACY.* UNDER t h e above title a r e c e n t l y p u b l i s h e d book h a s been sent to us,
which from many social standpoints is an eloquent plea for the installation of efficient methods of check on the various branches of work for the betterment of the people. Mr. W. H. Allen, the author of this book, starts out with the dictum that to be efficient is more difficult than to be good, and that the average citizen honestly in favour of "good government " fails to appreciate that intelligence and efficiency are as f a r beyond the reach of mere goodness as is business efficiency beyond the reach of mere good intention. Hence the general necessity for "efficiency tests." Such tests cannot be
*E~.c~ent Democracy. By Wm. H. Allen, General Agent, New York Association for improving the Condition of the Poor ; Secretary, Committee on Physical Welfare of School Children. (New York: Dood, Mead & Co., 1907, 346 pp., 8in. by 5in.).
J~ne, ~9o7j
Annotations
537
applied without accurate knowledge, and knowledge of details of government cannot be made common property without statistics. Mr. Allen lays down the bold rule that an " h o n e s t man who is inefficient can do more to defeat the purpose for which he is employed than a dishonest man compelled by intelligent supervision to render efficient service." Hence efficiency tests are more important than, and must to a large extent be substituted for, goodness tests. The value and the justification of these dicta lies in their application, and the sixteen chapters of Mr. Allen's book bear out his premises. The contents of the first chapter, dealing with " T h e Goodness Fallacy," may be summarised in the words " No man is good, unless good for something. Goodness is subjective. Goodness for something is objective, and may be counted, weighed, tested." We do not, for instance, require hospital managers, because they are men of undoubted worth, or eminent in some particular, but on account of their business capacity. THE STATISTICAL KEY TO EFFICIENT GOODNESS.
TO avoid corruption in any branch of government, the statistical method intelligently applied ensures a prompt record of work accomplished, and of needs disclosed. Notwithstanding the ancient criticism as to the hierarchy of liars--plain liars, expert liars, and statistics--statistics are universally employed, and indeed indispensable. They are often dull, still oftener untrustworthy, and frequently overloaded with unnecessary detail, but efficiency in any department cannot be tested without them, and the remedy for their defects is to employ competent men as statisticians, and for business men to insist on such dissection of data by these statisticians as is required for administrative insight, to enable them to gauge efficiency. THI~ STATI~ AS DOCTOR.
N o better instance of the statistical test of efficiency could be given than the inauguration of public health measures. In England they owed their initiation in large measure to our national system of death returns; and their efficiency can similarly be measured by death and sickness returns. The weekly and quarterly comparisons contained in the reports of the ]Registrar-General are a constant sthnulus to the laggards in sanitary administration: and we are only at the beginning of the utility of this means of efficiency. The districts with a high infant mortality, and with a high death-rate from phthisis will, as time goes on, have the search-light of public attention directed to them, and will be compelled to alleviate, and as far as is practicable remove the evil conditions, making them conspicuous by high death-rates. HOSPITAL ~-FFICII~NCY.
~¢IR. ALLEN'S remarks as to hospital efficiency may be applied with advantage to the management of isolation hospitals. He points out the necessity of hospital authorities not only themseh, es knowing what each item of service costs, but also of showing the public that they know, and of enabling the public also to know. The attention now being drawn to efficient hospital administration, both in this country and in America, must ~to great good. " N o hospital is rich enough to afford an incompetent book-keeper. No hospital is too poor to afford proof that it is run on an economical basis consistent with efficiency in treatment." The following remarks are of special value, in view of the enormous waste of time of skilled officers in filling up schedules. " Men whose affairs are organised on the principle that a $100 clerk should never be permitted to do the work of a $30 messenger will go into a hospital and spend their time on routine inspection,
538
Annotations
[Public Health
making estimates, and counting details." An efficient business man converted into a hospital governor does not "analyze his own and his colleagues' experience ; accepts from a hospital treasurer a summary of the year's work that does not~show where the hospital stood at the beginning of the year, how far it has travelled, in what direction it is going, what needs it has met, and what needs it has failed to meet." The above deficiencies of hospital accounts obviously militate against public support, for " a n uninformed public is a fickle friend." In the preceding paragraphs only a few of the valuable suggestions contained in Mr. Allen's interesting book have been mentioned : but the whole book is instructive, and should lead to the more general introduction of business methods into the public life of communities. ACCOUNT KEEPING IN ISOLATION HOSPITALS.
AS an important branch of administrative efficiency, we draw attention to a valuable repor~ on the Isolation Hospitals of Derbyshire, recently issued by Dr. Barwise, in which the subject of account keeping in isolation hospitals is fully considered. By Section 17 of the Isolation Hospitals Act, it is enacted that the expenses incurred in respect of any isolation hospital shall be classified under the headings of structural, establishment, and patients' expenses. The schedule form drawn up by the Local Government Board, Dr. Barwise states, does not give sufficient details to enable full and accurate comparisons of the expenses of different hospitals to be made. One of the chief difficulties in allocating expenses occurs in regard to provisions for patients and staffs respectively. It is obviously v e r y difficult to keep separate accounts for the food of staff and patients, and Dr. Barwise suggests that in order to insure uniformity in accounts, the simplest plan would be to charge for the staff 7s. 6d. per head per week under this heading, and to transfer the balance of the costs of provisions to the patients' expenses account. The system appears to be preferable to charging for the patients and transferring the balance to the staff, because the amount of food consumed by the patients is more variable than that consumed by the staff. I t would be a most useful reform were a detailed schedule of expenses made out and all isolation hospitals instructed to adhere to this schedule. T H E C O N T R O L OF TUBERCULOSIS.
DR. H. ARMSTI~O~G in a recent exhaustive report to the City Council of Newcastle-upon-Tyne makes valuable suggestions on the control of tuberculosis. He criticises adversely the model milk clauses of various Corporations. No power is given to deal with any form of tuberculosis among cows, however extensive, other than disease of the udder; although, as shown by many bacteriologists, the. milk of cows without visible sign of tuberculosis of the udder may be infectious. Dr. Armstrong recommends that every Sanitary Authority should have power to apply the tuberculin test, and tO prevent the sale of the milk of any cow reacting to this test. Attention is also drawn in this report to the objectionable practice of sweeping the footways with ordinary brooms. He adds: " T h i s process is carried out by shop-keepers in all main thoroughfares at the time when they are crowded with foot passengers on their way to business; and the dust, especially in windy weather, is both disgusting and a serious source of disease. The invention of an apparatus after the style of the household carpet sweeper for taking the dust from footways without creating a nuisance, would be a public boon. Sanitary Authorities would insist on its adoption, and it would rapidly gain favour with shopkeepers." Dr.
~u.o, ~907]
Annotations
539
Armstrong's remarks in this report on the establishment of a National Sanitary Authority are given on this and following pages. WOM~-N'S WORK IN PUBLIC HEALTH.
IN a recent paper on the aim and scope of women's work in relation to public health, Dr. Meredith Richards draws attention to the importance in allotting women's work in public health administration, of paying due regard to the fundamental differences between the two sexes, not only in training, but also in their physical and mental capabilities. Evidently, as he points out, we are. not making the best of the human material unless we recognise these aptitudes, and assign to each the task which each can do most efficiently with the greatest ease to themselves and advantage to the community. This is not a question of superiority, or inferiority, but one of recognising differences. Women's minds, as was observed by Buckle many years ago, are not only more deductive than men's, but quicker of apprehension; and these qualities make them specially valuable for the educational side of public health work, as in the instruction of mothers, the care of children, and personal hygiene generally. Their work, Dr. Richards added, would undoubtedly be greatly increased when the compulsory medical inspection of school children was begun; for much of the preliminary work of medical inspection could be entrusted to a trained nurse.
A NATIONAL SANITARY AUTHORITY. BY H. A. ARMSTRONG, D.HYG., M.R.C.S., Medical Officer of Health of Newcastle-upon-Tyne.*
T
HE treatment of tuberculosis as a serious national menace is one of the highest imaginable, and one to the promotion Of which any
m a n m a y be glad to devote the best energies of his life. Such a work to succeed m u s t be carefully planned and energetically" executed. I t s scope extends far b e y o n d the selfish aims of p a r t y politics or the restricted sphere of an incorporeal Local Government B o a r d ; it requires for its conception, initiation and direction, a governing b o d y freed from narrow interests and local prejudices , and having in view only the good of the S t a t e ; a b o d y so constituted as to represent the hygienic interests of all classes of the c o m m u n i t y alike; a n d prepared to give to the public health service t h a t continuity of attention and b r e a d t h of t r e a t m e n t which the subject demands. An Authority', constituted of representatives of C o u n t y Councils, Metropolitan and Pro~inciat, a n d the large Sanitary Authorities, U r b a n a n d Rural, of the k i n g d o m would form a truly representative
and popular SUPREME NATIONAL HEALTH AUTHORITY
to consider and deal with all questions of purely public hygiene, including, inter alia Tuberculosis in m a n and animals ; From a special report to the Newcastle City Council.