View report page

174
tuberculosis react very differently. The former has little resistance
and tends to succumb rapidly—the latter responds much more readily
to treatment, often when there is quite extensive disease.
The need for special supervision of susceptible people.
A recent investigation in Jarrow has shown that the high tuberculosis
death-rate there is to a large extent made up of Irish
immigrants. It is evident that in London these racial differences will
be very obvious. Large numbers of these susceptible people whose
Standard of living, never very high, has suffered recently because of the
industrial depression, have flocked to London to seek work. No
effort should be spared to keep them under close medical supervision,
and to improve their dietary and housing conditions. It is essential
to give those of them who develop tuberculosis prolonged institutional
treatment, even when they have made considerable progress. The
dangers of allowing these low-resistant patients to return too soon to
an unsatisfactory environment are very great. Indeed, in assessing
a tuberculous subject a sort of fourth dimension—the patient's
nationality—should be taken into account.
The "Contacts" of these people must be carefully watched
at the Tuberculosis Dispensary. It should not be difficult to evolve a
scheme whereby an X-ray examination of the chest could be made in
the case of all young people—particularly the racially susceptible ones
—who come to London to find work. The cost would be repaid by the
detection of early cases who would not require such a long period of
institutional treatment as those (who form the present majority) who
have advanced disease when first brought to the notice of the Dispensary
Medical Officer.
Housing.
Satisfactory conditions of housing are of especial importance
for both the tuberculous patient and his family. When he returns
from Sanatorium to live in a damp, ill-ventilated, overcrowded house,
he soon breaks down in health again. Life in an insanitary, overcrowded
dwelling is also a cause of the transmission of the disease to
other members of the family. For these reasons every effort is made
to re-house tuberculous families who live in unsuitable homes, and