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91
22nd October, 1929.
To the Worshipful The Sanitary Committee.
Gentlemen,
NATIONAL ASSOCIATION FOR THE PREVENTION OF TUBERCULOSIS :
(1) Conference on Hygiene and Welfare of Merchant Seamen, Geneva, 7—9th October, 1929.
(2) Fifteenth Annual Conference, Newcastle-upon-Tyne, 10th-12th October, 1929.
On Monday and Tuesday, 7th and 8th October, your Medical Officer duly attended at the Second
Conference on the Health and Welfare of Merchant Seamen held at Geneva, under the International
Committee of the Red Cross.
The proceedings, mainly conducted in the French tongue, were made the more useful by a distribution
of the papers read, in the English. Your Medical Officer contributed a statement on the
facilities for medical treatment open to the seaman of whatever nationality who is found to be suffering
from tuberculosis, or is stranded from the same disability in a British Port : these facilities being
those afforded to the public in general, plus special sailors' dispensaries in large ports and preferential
treatment for the homeless seaman in the matter of sanatorium benefit if the case is suitable for this.
The deputations were entertained by the Town of Geneva and by the International Red Cross.
By forced marches from Geneva to Newcastle (24 hours exactly) your Medical Officer was able to
attend at the opening and all sittings of the Fifteenth Annual Conference of the National Association
for the Prevention of Tuberculosis, on October the 10th and 11th.
The subjects discussed showed the meeting of the irresistible and the immoveable in the
almost universality of infection by the bacillus at an early age, and the escape unhurt of the vast
majority of the people under some protective factor.
The analogy with acute infective processes, e.g., in smallpox, has led to the emphatically announced
campaign against spitting and for the careful disposal of infective saliva. Nobody was against
this, but many suggested that there is some deeper and possibly more important factor than the
mere infection : the vagaries of resistance to tuberculosis infection need close examination : the
devoted wife may nurse a case of tuberculosis for years, exposed to repeated infection, only to go
down herself as a case when cessation of her care and duties and, incidentally, of infection leaves a void
in her life. " Worry " was suggested as the important factor in such cases.
An attempt to elucidate tuberculosis was foreshadowed in a paper dealing with the Tyneside
townships, which showed that there were different tuberculosis rates in these crowded communities,
with different social conditions obtaining, and suggested a complete survey of these townships in order
that some correlation may be established. This survey will probably be effected, the present state
of our knowledge being unsatisfactory for the conduct of a comprehensive campaign on the soundest
economic lines. Obviously the most potent factors inducing and protracting the disease should be
the first attacked, when known. Mere overcrowding does not of necessity produce the large incidence.
Sir Robert Philip held that tuberculosis is infective and it is universal, therefore measures must
be applicable equally to every member of the community. Infection is for the most part contracted
in childhood, nearly every child is tuberculised before puberty. The individual, once infected, is
probably to some extent immune to fresh infection, but effects of the original infection may emerge
at any time in life. The supreme effect of physiological (sanatorium) methods in raising individual
resistance must be applied in the preventive sphere. Watch should be scientifically kept for the
advent of the infection in the child, the date of its discovery registered, and the accredited sanatorium
methods of de-tuberculisation practised, though not in a sanatorium, in a way which anticipates
preventively the further budding of disease.
With work on these lines in dispensary and family practice, Sir Robert Philip thinks one may
justly expect that the need for curative institutions and places of segregation will correspondingly
disappear. Broadly speaking, Sir Robert Philip means that every child must have adequate sunshine,
fresh air, food, rest, exercise, and the other hygienic factors in a well-regulated life.
From 1901-27 pulmonary tuberculosis mortality in Newcastle-on-Tyne has decreased 45 per cent.
The broad survey of the field afforded by the Congress was of more than customary utility to
the gathering of a true perspective in the subject.
Colonel Blackham and your Medical Officer constituted the delegation of the City of London.
I have the honour to be, Gentlemen,
Your obedient Servant,
(Signed) W. M. WILLOUGHBY,
Medical Officer of Health.