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This spate of social welfare legislation laid the foundations for better conditions
to lessen the ravages of tuberculosis and indeed of other diseases too. In 1909 the
first London tuberculosis "Dispensary" was established in Paddington by a local
voluntary committee; rebuilt in 1940 it is one of the best equipped and most
attractive clinics in the country. The National Health Insurance Act passed in 1911
was the first important legal measure to make statutory provision for the treatment of
tuberculosis, albeit limited to the insured working population ; to provide for financial
payments to patients during sickness; and to lay the foundations of the Medical
Research Council. At this time more than 3,000 hospital beds were available in
London, provided by the poor law authorities, for the treatment of pulmonary and
"surgical" tuberculosis. In addition, the Metropolitan Asylums Board provided
hospital beds for the treatment of tuberculous children.
Compulsory notification of tuberculous sufferers had applied to inmates of poor
law institutions since 1908, and by Regulation in October, 1911 such notification was
extended to all cases of tuberculosis coming under the care of a medical practitioner
whether in a hospital or otherwise.
Concern at the prevalence of tuberculosis disclosed by notification and at the
variable provisions for treatment and control led to the appointment by the
Chancellor of the Exchequer in 1912 of a committee to report on general policy in
tuberculosis in its "preventive, curative and other aspects which should guide the
Government and local bodies in making or aiding provision for the treatment of
tuberculosis."
The improvement in mortality from pulmonary tuberculosis, already manifest
by 1900, led Sir Shirley Murphy, first Medical Officer of Health to the London County
Council, to report in 1905:—
"I know that if the sanitary areas of London are arranged, first in order
according to the amount of overcrowding, i.e., the proportion of their population
overcrowded; and second, according to their rate of mortality from phthisis,
you will find much parallelism between the two. That demonstrates pretty
clearly that the phthisis death rate of a district stands in close relation to the
proportion of its population which is overcrowded—and overcrowding is, after
all, only an expression for poverty."
In the clinical field shortly after this time, sanatorium treatment by graduated
exercise and rest was established and the Out-patient "Dispensary" became
accepted as the community centre for diagnosis and supervision. The Brompton
Hospital "for Consumption," the first of its kind in England, had been founded in
London in 1840. Rontgen discovered X-rays in 1893, and in the same year Nils
Finsen began treating lupus (tuberculosis of the skin) in Denmark with ultra-violet
light focused on to the lesion by a system of lenses fitted into special lamps.
The first clinic in England for the treatment of lupus by heliotherapy was
established at the London Hospital in 1900. It is still the largest known of its kind.
Some indication of the prevalence of skin tuberculosis at that time may be gauged
from the statement of E. W. Morris in his "History of the London Hospital " that
"within a month or two of the opening of the department, the lamps were booked
forward for two years and no more patients could be treated."
The merits of improved hygienic conditions in the prevention of tuberculosis
were becoming sufficiently recognised to draw the following remarks from Dr.
Theodore Williams at the Harveian Oration delivered before the Royal College of
Physicians of London in 1911—"What are the prospects of the crusade against
tuberculosis in this country, and how can we further them ? We must bear in mind
the blessed agencies of prevention which, when set in motion, go on pursuing their
beneficent course independently of fashion and caprice. Such are improved drainage,
more cubic space and less overcrowding, better food and more of it, more air and
sunlight, cleanliness of house and person and greater opportunities for play and