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London County Council
TREATMENT OF TUBERCULOSIS.
Conference with representatives of the London Sanitary Authorities.
Memorandum by the Chairman of the Public Health Committee. 28 /2/3 /
The Chairman of the Committee has considered it desirable to set oat his personal views in this
Memorandum, rather than to embody them in an address from the Chair.
During the past year, I have had under continual consideration the necessity for a scheme for
the treatment of tuberculosis within the county of London. Now that my year of office as Chairman
of the Public Health Committee is on the point of expiring, it appears to me desirable that I should
place on record such general views as I hold with regard to the methods of dealing with tuberculosis.
It is desirable to emphasise that, in so doing, I commit no one to the adoption of my views, but in the
absence of any other suggestions, what I now propose may possibly form a basis for discussion with a
view to evolving a scheme for London.
I may as well candidly confess that it appears to me that, however desirable it may be both from
the public health and humane point of view to deal thoroughly with the whole population afflicted with
tuberculosis, it is impracticable to do so except within certain defined limits. I would rather that money
should be spent in preserving the rising generation than in attempting to cure the present, for cure
is only attainable in certain selected cases. Treatment for adults must be undertaken to some extent,
although the limit I suggest should be fixed mainly on preventative grounds.
It is accepted that some persons are much more resistant to infection from bovine or human
sources than others, and that the same persons are unequally resistant at different times. Hence,
hygienic measures tending to improve general health must always bear an important part in the prevention
of tuberculosis.
However high the importance of such measures be placed, the prevention of infection from milk,
or from human cases of open tuberculosis must always form an essential part of a campaign against
tuberculosis. This can only be changed, if in the future it should be proved that small doses of infection
in earlv life protect against tuberculosis in later life, and if it should become possible to vaccinate
everyone with measured doses of a vaccinating material. It is doubtful what proportion of adults
suffering from tuberculosis have been infected with the cause of their present illness in childhood, and
what proportion within a few years of their illness. There is no doubt that some measure of infection—
from which recovery has occurred, or which has not caused appreciable illness,—is very common in the
first ten years of life. This, as before, is derived from bovine or human sources.
Whether this latent infection of childhood, resuscitated under the influence of such conditions
as insanitary circumstances, alcoholism, debilitating illness (e.g., influenza), or overwork, is the main
source of adult tuberculosis or whether adult tuberculosis is caused mainly by the more recent infection
which must very commonly be received, may be regarded as an open point.
Whichever view be adopted, the practical action required is the same.
Action is needed—
(a) to increase the powers of resistance.
(b) to diminish the dosage of infection received.
For both children and adults, the removal of the conditions favouring infection, including careful
attention to convalescents from diseases other than tuberculosis, is very important. For both children
and adults, apart from milk infection, a main item in the campaign must also be to prevent infection
from cases of "open" human tuberculosis. This occurs chiefly from adult consumptives.
Any provisions made should include, apart from domiciliary treatment and the dispensaries now
in process of organisation:
(a) hospital beds for advanced cases of open tuberculosis, from whom is received the most
dangerous massive infection (vide later Rest Homes) ;
(b) beds for "short-term" treatment of cases of open tuberculosis, where such patients
can be taught practically to adopt hygienic habits, and where other patients can be kept under
observation; or special treatment commenced;
(c) beds for early cases of pulmonary tuberculosis, who may thus be prevented from
becoming a source of infection, and who may themselves become cured.
It will be clear, therefore, that from the point of view of children's welfare, it is essential that
adults with "open" tuberculosis should be properly treated. The existence of the two schools of
thought as to the occurrence of infection in early or adult life, does not appear to me to be much more
than an academic point. It is common ground that ample arrangements must be made for the adequate
treatment of tuberculous children under the best conditions.
The situation which has arisen out of the National Insurance Act, offering moneys towards the
treatment of insured persons suffering from this disease and its subsequent developments, is fully set
forth in the report of the Public Health Committee, dated 30th January, 1913. That report was
adopted by the Council, and a scheme is now to be formulated by the Public Health Committee. It is
suggested in that report that the scheme should be divided into parts, any or all of which can be put
500—22 2,13—14373 C./1335