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16
ANNUAL REPORT OF THE TUBERCULOSIS DISPENSARY.
1917. By Andrew J. Shinnie, M.D., D.P.H., Tuberculosis
Medical Officer.
I have the honour to submit niv second annual :eport on the work
performed at or in connection with the dispensary at 1, Pimlico Road.
This report represents the first complete year of the Council's tuberculosis
scheme—last year's report dealt only with the period from the commencement
of the scheme on April 1st to December 31st, 1916. In
accordance with the injunction to economise paper I propose to state
the few observations I have to make with the utmost brevity and to add
a few statistical facts.
Sir Arthur Newshclme in a recent paper discussed the question of tuberculosis
as a war and after-war problem. His views on the subject of
tuberculosis carry so great authority that I think it would be well to
consider some of the points which he raised. He pointed out that the
death rate from tuberculosis showed a steady decline to the year 1915,
but that in 1916 there had been a considerable increase, particularly in
regard to women. He seemed to think that this increased death-rate
was mainly attributable to an increase in acute infections such as influenza,
pneumonia and bronchitis, which tend to lower individual
resistance and thus allow latent tuberculosis to blossom forth. My
experience of the dispensary leads me to concur in this view. Many
cases are now coming to light showing active tuberculosis where the
disease had remained dormant for a considerable number of years. He
also laid stress on the fact that tuberculous subjects attracted by the
high wages now obtainable had taken up work in factories, &c., and were
thus liable to infect their fellow workers. The return of the tuberculous
soldier to his home was also a factor to be reckoned with in accounting
for the increase in tuberculosis by local infection. A certain degree of
shortage in fats and some of the customary articles of diet of the people
has accounted in some instances for the outbreak of active tuberculosis
in quiescent cases. He regarded "Housing" as the most important
condition in measures taken to deal with tuberculosis and divided this
question into two sections: (1) Housing of the healthy; (2) Housing of the
sick. Under the latter head he quoted Koch's axiom " Tuberculosis is
a bedroom infection." He hoped that further initiative would be
shown by sanitary authorities in providing hospital accommodation for
the infectious tuberculous cases, and pointed out that in London there