View report page

53
APPENDIX VII.
Insurance Committee for the County of London.
TREATMENT OF TUBERCULOSIS.
A Memorandum presented to the Committee by their Medical Adviser,
Noel D. Bardswell, M.V.O., M.D., F.R.C.P., F.R S. (Ed ).
The social aspect of the problem of the consumptive in relation to a comprehensive scheme.
After a lapse of some twelve years, during which my work lay almost entirely among patients
belonging to the more prosperous sections of the community, I have again come into close touch with
the problem of the consumptive poor. Comparing my experience of to-day with that of the past twelve
years, I am impressed with the wide gulf that separates the prospects of the consumptive among the
industrial classes and those of his neighbour in a higher social stratum; I note also that many of the
difficulties which beset my earlier efforts among the workers in Sheffield still remain, and that, as then,
they lie at the root of what is termed the failure of sanatorium treatment. Since my Sheffield days,
however, there has been one change of great moment, namely, the passing of the Insurance Acts. It is
not too much to say that this legislation has revolutionised the outlook of those suffering from tuberculosis ;
while incidentally, it has been the means of revealing the tuberculosis problem as we now see it.
It is an axiom in medicine that to discover the cause of any ill is to take the first big step towards
finding the remedy. In general terms, the factors which render sanatorium treatment a somewhat
qualified success are well appreciated ; it may not be inopportune, however, to refer to some of them more
specifically, and to this end I propose briefly to draw upon my personal experience as Medical Adviser to
the London Insurance Committee. It is superfluous for me to say much about sanatorium treatment;
I would but emphasise that we have no specific remedy for tuberculosis, and that when faced with a case
of tuberculosis of the lungs all that we can do is to restore and, subsequently, to maintain for a long
period that natural immunity to the disease which is possessed by all of us in a varying degree, and thus
enable the affected person to achieve his own cure. For the frank case of open tuberculosis, however
favourable, permanent recovery cannot be looked for in less than a year ; throughout this period the essentials
of treatment must be available, particularly sufficient food, a reasonable amount of fresh air,
and freedom from excessive fatigue. Viewed from this standpoint residence for some twelve to sixteen
weeks in a sanatorium must be looked upon less as a cure than as a means of education, although it may
give the patient a good start on the road to recovery. Whether the desired goal will be reached or not
depends upon how far the standard of the sanatorium can be maintained when he returns home. That
it will be lowered is inevitable ; the question is, will the fall be such that the effective treatment of tuberculosis
becomes impossible. Reduced to its essential, home treatment is a matter of money ; its
efficiency is determined, beyond all things by the weekly sum at the command of the patient. In fact,
from first to last in his career, the fortunes of the consumptive worker are dominated by his social circumstances,
expecially by his income. Moreover, the incidence of tuberculosis is closely associated
with this question of wage. Dr. Benjamin Moore has recently pointed out that the majority of occupations
experiencing a very heavy incidence of tuberculosis are characterised by the stigma of intermittent
and badly paid labour ; conditions which result in a low nutrition. Thus is it that the treatment
of tuberculosis is as much a problem for the social reformer as for the physician, though neither the one
nor the other can hope to solve it single handed.
The Problem
Financial difficulties of patients.
In the first place, let us examine the conditions in which most wage earners with families dependent
upon them find themselves when faced with the fact that they have contracted consumption. A few
characteristic instances will suffice—
Before
admission tc
sanatorium
H.W., aged 30, a painter; usual wage 40s. to 45s. a week. A sudden onset of symptoms of
pulmonary tuberculosis necessitated an immediate cessation from work, and in due course, application
for benefit was followed by an offer of admission to a sanatorium. The patient's acknowledgment of
this recommendation was accompanied by a request for immediate assistance for his family, otherwise
he would be unable to take advantage of it. On enquiry I ascertained that his circumstances
were as follows—He had a wife and one child of nine years ; his sole source of income was his sickness
benefit of 10s. a week, of which 6s. was absorbed by his rent. Thus there remained a balance of but 4s.
a week for the maintenance of his family. The patient's wife was shortly expecting her confinement, so
was not able to go out to work and thus to augment the family's resources.
H. T., aged 33, compositor ; a case of early pulmonary tuberculosis. Offered a bed in a sanatorium
ne refused it on the grounds of domestic difficulties. This man's circumstances were as follows—His
family numbered seven ; himself, his wife, and five children all under 14 years of age. His usual income
of 50s. a week had dropped to 10s. a week, namely, the amount of his sickness benefit. He paid 5s. 6d.