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dispensary—now called a "chest clinic" and to provide an appropriate number
of tuberculosis visitors and an almoner (who also acted as secretary to her local
tuberculosis care committee) and clerk at each chest clinic. A diversional therapy
instructor was also provided at almost all the clinics.
The Council also provided "recuperative holidays" for those patients who
needed a holiday after illness but without medical or nursing requirements.
Considerable misgiving was felt about this dichotomy of the tuberculosis control
services and the closest, most patient liaison with Hospital Boards was required to
promote smooth and efficient working.
In 1947 streptomycin and in 1948 para-amino salicylic acid became widely
available as the new active therapeutic agents in tuberculosis. Their great value in
the treatment of miliary and meningeal disease and to reduce patients' infectivity
soon became recognised. Pneumoperitoneum was added to measures of collapse
therapy while bold surgery to excise affected lung lobes or to collapse a chest wall by
thoracoplasty became commonplace. Injections of large doses of Vitamin D proved
a quicker and better treatment for skin lupus than the older local treatments.
In 1950 a scheme was completed for the preventive inoculation with B.C.G.
vaccine of the healthy contacts of known tuberculous persons.
Prospects
Tuberculosis in closely aggregated, long standing, urban industrial communities
has become a chronic disabling infectious disease of widespread incidence and heavy
though decreasing mortality.
The new antibiotic and chemotherapeutic agents show prospects of reducing
the infectivity of a proportion of advanced cases and of curing early or localised
ones, while B.C.G. and other vaccines offer possibilities of increased immunity for
the young susceptible members of the population.
The post-war emphasis on "social medicine" has introduced clinicians to a
renewed interest in the domestic, financial, psychological and industrial background
of the tuberculous patient. Mass radiography and tuberculin surveys are new and
useful weapons in epidemiological control.
Bovine type tuberculosis has faded steadily in the last half century both in
incidence and severity. Massive scrofulous glands of neck or abdomen, large patches
of lupus, wards full of spinal cases fixed to frames, or of children with "hip disease,"
common at the beginning of the century, are rare conditions now.
The newer pathology envisages the "primary lesion" as a small lung focus in
childhood with gross intrathoracic glandular enlargement, usually healing and leaving
a partial immunity by allergy which can subsequently break down to produce active
phthisis under abnormal nutritional, psychological, traumatic or other injurious
tissue influences.
The hazards of exposure to infection once a primary lesion has appeared and
healed are, by one current school of thought, no longer considered to have serious
implication.
In tuberculosis, as in other diseases, treatment of the individual makes greater
appeal, on the short-term view, than does the application of preventive measures.
It may be necessary to emphasise the paramount importance of never losing sight
of the fact that tuberculosis is an infectious and preventable disease.
It may well be that the second half of the century calls for a review of the
"set-up" of tuberculosis control and a careful consideration of what further steps
can be taken in an attempt to eradicate this great national scourge. This stocktaking
may assist in focusing attention on what has been done and what still remains
to be done.