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As an incentive to treatment, Government allowances were introduced for
tuberculous persons in need, who gave up work in order to undertake institutional
treatment as recoverable cases of pulmonary tuberculosis.
Considerable bomb damage was done to hospital buildings, and this, combined
with serious post-war nursing and domestic staff shortages, has seriously restricted
hospital treatment provision. Between 1945 and 1950 the waiting period was often
nine months or more for a patient recommended by his physician for sanatorium
treatment compared with 2 to 3 weeks before the war. This led to an increasing
interest in the home treatment of the tuberculous involving special arrangements
by the Council for the nursing of patients undergoing new drug or lung collapse
treatment in bed at home.
In conjunction with Mr. B. Benjamin, I wrote in the British Medical Journal
in 1942:—
"The experience of London has been less favourable than in the country
as a whole. A probable effect of evacuation has been to increase the proportion
of tuberculous persons in the population remaining. Part of the increases in
the numbers of notifications of, and deaths from, tuberculosis can be attributed
to reduced resistance to the disease and increased numbers of new cases among
London patients in mental hospitals. The statistics of non-pulmonary tuberculosis
throw light on the type of infection and on the efficacy of pasteurisation
of milk. Most of the milk consumed in the Metropolis is pasteurised and therefore
the fact that abdominal infections have not increased in proportion to
infections at other sites is of special significance. The disproportionate rise in
non-abdominal infections indicates that the principal infecting source is human.
The increase in the incidence of tuberculosis is greater in respect of children
than in respect of adults, and new cases of pulmonary tuberculosis increased
more in adults than new cases of non-pulmonary disease.
As compared with 1938, there was in 1941 an increase of 43 per cent. in the
rate of occurrence of new cases of pulmonary and of 15 per cent. in new cases
of non-pulmonary tuberculosis. The pulmonary tuberculosis death-rates increased
over the same period by 72 per cent. and the non-pulmonary rate by
67 per cent. These increases are much greater than for England and Wales as
a whole."
The increased mortality rates associated with both wars were transient and after
each war the steady fall which had begun in 1860 continued.
The 1946 National Health Service Act and after
The provisions of this Act came into force in July, 1948, and had the following
effects on tuberculosis control:—
All clinics, hospitals, sanatoria and mass radiography units came under
the control of the Ministry of Health; those previously owned by the Council
were handed over to the newly formed Regional Hospital Boards, who admitted
into the hospitals, without charge, patients from a much larger area than London.
A free General Practitioner service was made available to everybody. Diagnosis
and treatment became a Hospital Board responsibility, the Council's interests
being now confined to prevention; home nursing; boarding of child contacts;
providing domestic "home helps"; industrial rehabilitation; diversional
therapy; providing hostels for homeless infective cases; providing a free
ambulance service; arranging health education of the public; providing
better housing accommodation, extra nutriment, clothing, and other personal
needs.
The Council arranged to share with the Hospital Boards and Boards of Governors
of certain London Teaching Hospitals the services of the senior physician at each